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Taylor Pearson KE. Pediatric Clinical Staff Perspectives on Secure Messaging. J Nurs Care Qual 2024; 39:317-323. [PMID: 39172531 DOI: 10.1097/ncq.0000000000000775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
BACKGROUND Secure messaging (SM) is a communication feature within a patient portal that allows patients and clinical staff to exchange health-related information securely and confidentially. PURPOSE This study aimed to explore how pediatric clinical staff use SM, identify challenges in its implementation, and suggest quality improvements. METHODS A descriptive quantitative study was administered using an online survey in a large health care system. The Task, User, Representation, and Function framework guided the research. RESULTS The survey participants were moderately satisfied with the SM. Opportunities to design this system to be more efficient and maximize patient safety were identified. CONCLUSION Improving training and workflow can aid in incorporating SM into clinician's daily routines, focusing on enhancing user satisfaction. Future developments aimed at increasing usage and standardizing message content are crucial for encouraging adoption and ensuring patient safety.
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Dang P, Chavez A, Pham C, Tipton M, Woodard LD, Adepoju OE. Proxy use of patient portals on behalf of children: Federally Qualified Health Centers as a case study. Digit Health 2024; 10:20552076231224073. [PMID: 38205036 PMCID: PMC10777763 DOI: 10.1177/20552076231224073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Objective This study examined the proxy use of patient portals for children in a large Federally Qualified Health Centers (FQHC) network in Texas. Methods We used de-identified individual-level data of patients, 0-18 years, who had 1+ visits between December 2018 and November 2020. Logistic regression was used to examine patient-, clinic-, and geographic-level factors associated with portal usage by an assumed proxy (i.e. parent or guardian). Results The proxy portal usage rate increased from 28% in the pre-pandemic months (November 2018-February 2020) to 34% in the pandemic months (March-Nov 2020). Compared to patients 0-5 years, patients aged 6 to 18 years had lower odds of portal usage (6-10 OR: 0.77, p < 0.001; 11-14 OR: 0.62, p < 0.001; 15-18 OR: 0.51, p < 0.001). Minoritized groups had significantly lower odds of portal usage when compared to their non-Hispanic White counterparts (non-Hispanic Black OR: 0.78, p < 0.001; Hispanic OR 0.63, p < 0.001; Asian OR: 0.69, p < 0.001). Having one chronic condition was associated with portal usage (OR: 1.57, p < 0.001); however, there were no significant differences in portal usage between those with none or multiple chronic conditions. Portal usage also varied by service lines, with obstetrics and gynecology (OR: 1.84, p < 0.001) and behavioral health (OR 1.82, p < 0.001) having the highest odds of usage when compared to pediatrics. Having a telemedicine visit was the strongest predictor of portal usage (OR: 2.30, p < 0.001), while residence in zip codes with poor broadband internet access was associated with lower odds of portal usage (OR: 0.97, p < 0.001). Conclusion While others have reported portal usage rates as high as 64% in pediatric settings, our analysis suggests proxy portal usage rates of 30% in pediatric FQHC settings, with race/ethnicity, age group, and chronic disease status being significant drivers of portal non-usage. These findings highlight the need for appropriate and responsive health information technology approaches for vulnerable populations receiving care in low-resource settings.
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Affiliation(s)
- Patrick Dang
- Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, USA
| | - Arlette Chavez
- Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, USA
| | - Cecilia Pham
- Tilman J Fertitta Family College of Medicine, University of Houston, Houston, USA
| | - Mary Tipton
- Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, USA
| | - LeChauncy D Woodard
- Tilman J Fertitta Family College of Medicine, University of Houston, Houston, USA
| | - Omolola E Adepoju
- Humana Integrated Health Systems Sciences Institute, University of Houston, Houston, USA
- Tilman J Fertitta Family College of Medicine, University of Houston, Houston, USA
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Korngiebel DM, West KM. Patient Recommendations for the Content and Design of Electronic Returns of Genetic Test Results: Interview Study Among Patients Who Accessed Their Genetic Test Results via the Internet. JMIRX MED 2022; 3:e29706. [PMID: 37725563 PMCID: PMC10414314 DOI: 10.2196/29706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/26/2021] [Accepted: 01/29/2022] [Indexed: 09/21/2023]
Abstract
BACKGROUND Genetic test results will be increasingly made available electronically as more patient-facing tools are developed; however, little research has been done that collects data on patient preferences for content and design before creating results templates. OBJECTIVE This study identifies patient preferences for the electronic return of genetic test results, including what considerations should be prioritized for content and design. METHODS Following user-centered design methods, 59 interviews were conducted by using semistructured protocols. The interviews explored the content and design issues of patient portals that facilitated the return of test results to patients. We interviewed patients who received electronic results for specific types of genetics tests (pharmacogenetic tests, hereditary blood disorder tests, and tests for the risk of heritable cancers) or electronically received any type of genetic or nongenetic test results. RESULTS In general, many of participants felt that there always needed to be some clinician involvement in electronic result returns and that electronic coversheets with simple summaries would be helpful for facilitating this. Coversheet summaries could accompany, but not replace, the more detailed report. Participants had specific suggestions for such results summaries, such as only reporting the information that was the most important for patients to understand, including next steps, and doing so by using clear language that is free of medical jargon. Electronic result returns should also include explicit encouragement for patients to contact health care providers about questions. Finally, many participants preferred to manage their care by using their smartphones, particularly in instances when they needed to access health information on the go. CONCLUSIONS Participants recommended that a patient-friendly front section should accompany the more detailed report and made suggestions for organization, content, and wording. Many used their smartphones regularly to access test results; therefore, health systems and patient portal software vendors should accommodate smartphone app design and web portal design concomitantly when developing platforms for returning results.
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Ossai CR, McDonnell J, Behairy M, Schelzig C, Larkin L, Jones J, Liu W, Das A. Association of Parental Use of Patient Portals with Breastfeeding Rates in Infants. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2021. [DOI: 10.1080/15398285.2021.1943635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Chionye R. Ossai
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children’s, Cleveland, Ohio, USA
| | - John McDonnell
- Department of Allergy and Immunology, Cleveland Clinic Children’s, Cleveland, Ohio, USA
| | - Mohga Behairy
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children’s, Cleveland, Ohio, USA
| | - Colleen Schelzig
- Department of Pediatric Hospital Medicine, Cleveland Clinic Children’s, Cleveland, Ohio, USA
| | - Lauren Larkin
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Jessica Jones
- Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Wei Liu
- Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Anirudha Das
- Department of Neonatology, Cleveland Clinic Children’s, Cleveland, Ohio, USA
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Chad L, Szego MJ. Please give me a copy of my child's raw genomic data. NPJ Genom Med 2021; 6:15. [PMID: 33597540 PMCID: PMC7889911 DOI: 10.1038/s41525-021-00175-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 12/24/2020] [Indexed: 11/23/2022] Open
Abstract
In this work, we explore whether raw genetic data generated during sequencing ought to be returned to a pediatric patient and/or their parents/guardians. We identify the principles used by various professional societies in their guidelines on the return of secondary findings and apply them to this new context. We conclude that since each situation is unique, decisions should be made on a case-by-case basis according to the best interests of the child.
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Affiliation(s)
- Lauren Chad
- Clinical and Metabolic Genetics, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Bioethics, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Michael J Szego
- Centre for Clinical Ethics, Unity Health Toronto, Toronto, ON, Canada. .,The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, ON, Canada. .,Dalla Lana School of Public Health, Departments of Family and Community Medicine and Molecular Genetics, University of Toronto, Toronto, ON, Canada.
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Patient and physician perspectives on training to improve communication through secure messaging: Clarifying the rules of engagement. Health Care Manage Rev 2020; 47:3-11. [PMID: 32379081 DOI: 10.1097/hmr.0000000000000279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the study was to incorporate the perspectives of both patients and providers into the development of training to improve the exchange of secure messages through a patient portal as well as to identify management strategies that support patient engagement. METHODOLOGY Three patient focus groups (17 patients) and interviews with 21 ambulatory physicians across 17 outpatient clinics at a large Midwestern academic medical center using Epic MyChart were performed. Rigorous thematic analysis was guided by the Systems Engineering Initiative for Patient Safety 2.0 framework adapted to patient portal implementation. RESULTS Patients and physicians identified strategies at the patient, portal, physician, and health system levels that could help each group navigate the portal to communicate via secure messages more efficiently. Patient-focused training strategies included multimodal materials addressing how to navigate portal features and direction on when, what, and how to message. Changes to the format of the messaging feature and pop-ups with communication tips were also frequently mentioned. Physician and clinic-level strategies focused on how the clinic and health system management could enhance physician training on the patient-facing portal features and on how to manage patient care within the portal. Physicians also requested that the health system administration standardize physician and care team work processes related to secure messages within the portal and communicate clear management expectations of physician portal management. CONCLUSION As communication via secure messaging has become more common, our study identified patient, physician, portal and health system-level management and training strategies to enhance patient portal use. PRACTICE IMPLICATIONS Health system administrators and outpatient clinic management could implement these strategies to clarify the rules of engagement in the collaborative work of incorporating a patient portal into the primary care workflow and facilitating provider and patient use.
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Shimoga SV, Lu YZ. Role of provider encouragement on patient engagement via online portals. J Am Med Inform Assoc 2019; 26:968-976. [PMID: 30925585 DOI: 10.1093/jamia/ocz026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/12/2019] [Accepted: 02/16/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The study sought to examine whether provider encouragement is associated with improvements in engaging patients with their healthcare processes using online portals. MATERIALS AND METHODS Using the Health Information National Trends Survey 2017 (N = 2, 670), we conducted an exploratory factor analysis with varimax orthogonal rotation and derived 3 outcome variables on patient engagement: (1) information access score, (2) care convenience score, and (3) patient engagement score. Multivariable linear regression on each outcome variable was conducted with provider encouragement as the main predictor, controlling for patient demographics. RESULTS Women (60%), white participants (69%), and those with a college degree (49%) were more likely to report receiving provider encouragement. Those who were encouraged to use patient portals scored higher on all 3 outcome measures compared with those who were not encouraged (B = 0 .80 vs B = 0.11 for information access, B = 1.13 vs B = 0.13 for care convenience, and B = 0.44 vs B = 0.05 for patient engagement; all P < .001). For every additional 100 patients receiving encouragement, 65 more information access tasks, 94 more care convenience tasks, and 40 more patient engagement tasks would be performed. DISCUSSION Provider encouragement was most influential concerning care convenience tasks and least influential on complex decision-making tasks. This may be due to portal design and the content available to patients, which merit consideration in future studies. CONCLUSIONS Provider encouragement is associated with more patient engagement, as indicated by significantly higher utilization of patient portals for accessing information, participating in routine care processes, and making complex healthcare decisions.
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Affiliation(s)
- Sandhya V Shimoga
- Department of Health Care Administration, California State University, Long Beach, Long Beach, California, USA
| | - Yang Z Lu
- Department of Health Care Administration, California State University, Long Beach, Long Beach, California, USA
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Tsai R, Bell EJ, Woo H, Baldwin K, Pfeffer MA. How Patients Use a Patient Portal: An Institutional Case Study of Demographics and Usage Patterns. Appl Clin Inform 2019; 10:96-102. [PMID: 30727003 PMCID: PMC6365289 DOI: 10.1055/s-0038-1677528] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Given the widespread electronic health record adoption, there is increasing interest to leverage patient portals to improve care. OBJECTIVE To determine characteristics of patient portal users and the activities they accessed in the patient portal. METHODS We performed a retrospective analysis of patient portal usage at University of California, Los Angeles, Health from July 2014 to May 2015. A total dataset of 505,503 patients was compiled with 396,303 patients who did not register for the patient portal and 109,200 patients who registered for a patient portal account. We compared patients who did not register for the online portal to the top 75th percentile of users based on number of logins, which was done to exclude those who only logged in to register. Finally, to avoid doing statistical analysis on too large of a sample and overpower the analysis, we performed statistical tests on a random sample of 300 patients in each of the two groups. RESULTS Patient portal users tended to be older (49.45 vs. 46.22 years in the entire sample, p = 0.008 in the random sample) and more likely female (62.59 vs. 54.91% in the entire sample, p = 0.035 in the random sample). Nonusers had more monthly emergency room (ER) visits on average (0.047 vs. 0.014, p < 0.001). The most frequently accessed activity on the portal was viewing laboratory results (79.7% of users looked at laboratory results). CONCLUSION There are differences between patient portal users and nonusers, and further understanding of these differences can serve as foundation for further investigation and possible interventions to drive patient engagement and health outcomes.
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Affiliation(s)
- Raymond Tsai
- Department of Health Information Technology, University of California, Los Angeles, California, United States
| | - Elijah J Bell
- Department of Health Information Technology, University of California, Los Angeles, California, United States.,Department of Emergency Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Hawkin Woo
- Department of Health Information Technology, University of California, Los Angeles, California, United States.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
| | - Kevin Baldwin
- Department of Health Information Technology, University of California, Los Angeles, California, United States
| | - Michael A Pfeffer
- Department of Health Information Technology, University of California, Los Angeles, California, United States.,Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, United States
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Ancker JS, Sharko M, Hong M, Mitchell H, Wilcox L. Should parents see their teen's medical record? Asking about the effect on adolescent-doctor communication changes attitudes. J Am Med Inform Assoc 2018; 25:1593-1599. [PMID: 30247699 DOI: 10.1093/jamia/ocy120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/20/2018] [Indexed: 11/12/2022] Open
Abstract
Objective Parents routinely access young children's medical records, but medical societies strongly recommend confidential care during adolescence, and most medical centers restrict parental records access during the teen years. We sought to assess public opinion about adolescent medical privacy. Materials and Methods The Cornell National Social Survey (CNSS) is an annual nationwide public opinion survey. We added questions about a) whether parents should be able to see their 16-year-old child's medical record, and b) whether teens would avoid discussing sensitive issues (sex, alcohol) with doctors if parents could see the record. Hypothesizing that highlighting the rationale for adolescent privacy would change opinions, we conducted an experiment by randomizing question order. Results Most respondents (83.0%) believed that an adolescent would be less likely to discuss sensitive issues with doctors with parental medical record access; responses did not differ by question order (P = .29). Most also believed that parents should have access to teens' records, but support for parental access fell from 77% to 69% among those asked the teen withholding question first (P = .01). Conclusions Although medical societies recommend confidential care for adolescents, public opinion is largely in favor of parental access. A brief "nudge," asking whether parental access might harm adolescent-doctor communication, increased acceptance of adolescent confidentiality, and could be part of a strategy to prepare parents for electronic patient portal policies that medical centers impose at the beginning of adolescence.
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Affiliation(s)
- Jessica S Ancker
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Marianne Sharko
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Matthew Hong
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Hannah Mitchell
- Department of Healthcare Policy & Research, Weill Cornell Medical College, New York, New York, USA
| | - Lauren Wilcox
- School of Interactive Computing, Georgia Institute of Technology, Atlanta, Georgia, USA
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Van den Bulck SA, Hermens R, Slegers K, Vandenberghe B, Goderis G, Vankrunkelsven P. Designing a Patient Portal for Patient-Centered Care: Cross-Sectional Survey. J Med Internet Res 2018; 20:e269. [PMID: 30287416 PMCID: PMC6231862 DOI: 10.2196/jmir.9497] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Revised: 05/09/2018] [Accepted: 06/29/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In recent literature, patient portals are considered as important tools for the delivery of patient-centered care. To date, it is not clear how patients would conceptualize a patient portal and which health information needs they have when doing so. OBJECTIVE This study aimed (1) to investigate health information needs, expectations, and attitudes toward a patient portal and (2) to assess whether determinants, such as patient characteristics, health literacy, and empowerment status, can predict two different variables, namely the importance people attribute to obtaining health information when using a patient portal and the expectations concerning personal health care when using a patient portal. METHODS We conducted a cross-sectional survey of the Flemish population on what patients prefer to know about their digital health data and their expectations and attitudes toward using a patient portal to access their electronic health record. People were invited to participate in the survey through newsletters, social media, and magazines. We used a questionnaire including demographics, health characteristics, health literacy, patient empowerment, and patient portal characteristics. RESULTS We received 433 completed surveys. The health information needs included features such as being notified when one's health changes (371/396, 93.7%), being notified when physical parameters increase to dangerous levels (370/395, 93.7%), observing connections between one's symptoms or diseases or biological parameters (339/398, 85.2%), viewing the evolution of one's health in function of time (333/394, 84.5%), and viewing information about the expected effect of treatment (349/395, 88.4%). Almost 90% (369/412) of respondents were interested in using a patient portal. Determinants of patients' attachment for obtaining health information on a patient portal were (1) age between 45 and 54 years (P=.05); (2) neutral (P=.03) or interested attitude (P=.008) toward shared decision making; and (3) commitment to question physicians' decisions (P=.03, R2=0.122). Determinants of patients' expectations on improved health care by accessing a patient portal were (1) lower education level (P=.04); (2) neutral (P=.03) or interested attitude (P=.008) toward shared decision making; and (3) problems in understanding health information (P=.04; R2=0.106). CONCLUSIONS The interest in using a patient portal is considerable in Flanders. People would like to receive alerts or some form of communication from a patient portal in case they need to act to manage their health. Determinants such as education, attached importance to shared decision making, difficulties in finding relevant health information, and the attached importance in questioning the decisions of physicians need to be considered in the design of a patient portal.
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Affiliation(s)
- Steve Alfons Van den Bulck
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Rosella Hermens
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Scientific Institute for Quality in Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Radboud University Nijmegen, Nijmegen, Netherlands
| | - Karin Slegers
- Meaningful Interactions Lab, Imec, KU Leuven, Leuven, Belgium
| | | | - Geert Goderis
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Patrik Vankrunkelsven
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Ratliff-Schaub K, Valleru J. Increasing Patient Portal Activation in a Pediatric Subspecialty Clinic. Pediatr Qual Saf 2018; 2:e049. [PMID: 30229185 PMCID: PMC6132890 DOI: 10.1097/pq9.0000000000000049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/02/2017] [Indexed: 11/25/2022] Open
Abstract
Background: Online patient portals are not widely used, despite their advantages for efficient communication, especially for patients with chronic conditions. A hospital-based group practice of Developmental-Behavioral Pediatricians initiated this quality improvement (QI) project with a goal to increase the percentage of patients with an active MyChart (Epic Systems Corporation’s patient portal) account and ultimately improve efficiency of communication between families and clinical staff. Methods: Using QI methodology, we identified staff commitment, workflow issues, and family awareness as gaps and implemented progressive Plan, Do, Study, Act cycles aimed at developing standard processes for activating families on MyChart. We tracked our project measures with statistical process control methodology and sustained our progress with improving awareness and regular feedback. Results: Patient portal activations increased from 1.8% to 30% in a 6-month time period. Highly successful interventions included development and implementation of a standard process for activation, staff education to ensure comfort and commitment, having families opt out instead of opt in, and completed activation of accounts before families leaving clinic. Conclusions: Patient portal activation can be significantly increased through systematic application of QI methodology to address staff training and workflow in a busy subspecialty clinic. Engagement of operations staff and completion of the activation process while the family is still in clinic seemed to be effective in getting families activated in MyChart. It is possible to improve patient portal activation with minimal impact to workflow.
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Kolff CA, Scott VP, Stockwell MS. The use of technology to promote vaccination: A social ecological model based framework. Hum Vaccin Immunother 2018; 14:1636-1646. [PMID: 29781750 PMCID: PMC6067841 DOI: 10.1080/21645515.2018.1477458] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Vaccinations are an important and effective cornerstone of preventive medical care. Growing technologic capabilities and use by both patients and providers present critical opportunities to leverage these tools to improve vaccination rates and public health. We propose the Social Ecological Model as a useful theoretical framework to identify areas in which technology has been or may be leveraged to target undervaccination across the individual, interpersonal, organizational, community, and society levels and the ways in which these levels interact.
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Affiliation(s)
- Chelsea A Kolff
- a Department of Pediatrics , Columbia University , New York , NY , USA.,b Department of Population and Family Health , Mailman School of Public Health, Columbia University , New York , NY , USA
| | - Vanessa P Scott
- a Department of Pediatrics , Columbia University , New York , NY , USA.,c NewYork-Presbyterian Hospital , New York , NY , USA
| | - Melissa S Stockwell
- a Department of Pediatrics , Columbia University , New York , NY , USA.,b Department of Population and Family Health , Mailman School of Public Health, Columbia University , New York , NY , USA.,c NewYork-Presbyterian Hospital , New York , NY , USA
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Clinician-Stakeholders' Perspectives on Using Patient Portals to Return Lynch Syndrome Screening Results. J Genet Couns 2017; 27:349-357. [PMID: 29159545 DOI: 10.1007/s10897-017-0179-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 11/14/2017] [Indexed: 12/12/2022]
Abstract
Test results for genetic conditions, such as Lynch Syndrome (LS), have traditionally been returned by genetic counselors or other providers who can explain results implications and provide psychosocial support. Returning genetic results through an Electronic Health Record's patient portal may increase the efficiency of returning results and could activate patient follow-up; however, stakeholder input is necessary to determine acceptability and appropriate implementation for LS. Twenty interviews were conducted with clinicians from six specialties involved in LS screening that represent a range of settings. Data were analyzed using directed content analysis and thematic analysis across content categories. Participants felt that patient portals could supplement personal calls, but the potential sensitive nature of LS screening results indicated the need for caution. Others felt that LS results could be returned through portals if there were clear explanations of the result, reputable additional information available within the portal, urging follow up confirmatory testing, and a referral to a genetics specialist. Patient portals were seen as helpful for prompting patient follow-up and providing resources to notify at-risk family members. There is potential for patient portals to return LS screening and other genetic results, however we raise several issues to resolve before implementation is warranted.
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Sieck CJ, Hefner JL, Schnierle J, Florian H, Agarwal A, Rundell K, McAlearney AS. The Rules of Engagement: Perspectives on Secure Messaging From Experienced Ambulatory Patient Portal Users. JMIR Med Inform 2017; 5:e13. [PMID: 28676467 PMCID: PMC5516097 DOI: 10.2196/medinform.7516] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 03/28/2017] [Accepted: 04/14/2017] [Indexed: 11/23/2022] Open
Abstract
Background Patient portals have shown promise in engaging individuals in self-management of chronic conditions by allowing patients to input and track health information and exchange secure electronic messages with their providers. Past studies have identified patient barriers to portal use including usability issues, low health literacy, and concerns about loss of personal contact as well as provider concerns such as increased time spent responding to messages. However, to date, studies of both patient and provider perspectives on portal use have focused on the pre-implementation or initial implementation phases and do not consider how these issues may change as patients and providers gain greater experience with portals. Objective Our study examined the following research question: Within primary care offices with high rates of patient-portal use, what do experienced physician and patient users of the ambulatory portal perceive as the benefits and challenges of portal use in general and secure messaging in particular? Methods This qualitative study involved 42 interviews with experienced physician and patient users of an ambulatory patient portal, Epic’s MyChart. Participants were recruited from the Department of Family Medicine at a large Academic Medical Center (AMC) and included providers and their patients, who had been diagnosed with at least one chronic condition. A total of 29 patients and 13 primary care physicians participated in the interviews. All interviews were conducted by telephone and followed a semistructured interview guide. Interviews were transcribed verbatim to permit rigorous qualitative analysis. Both inductive and deductive methods were used to code and analyze the data iteratively, paying particular attention to themes involving secure messaging. Results Experienced portal users discussed several emergent themes related to a need for greater clarity on when and how to use the secure messaging feature. Patient concerns included worry about imposing on their physician’s time, the lack of provider compensation for responding to secure messages, and uncertainty about when to use secure messaging to communicate with their providers. Similarly, providers articulated a lack of clarity as to the appropriate way to communicate via MyChart and suggested that additional training for both patients and providers might be important. Patient training could include orienting patients to the “rules of engagement” at portal sign-up, either in the office or through an online tutorial. Conclusions As secure messaging through patient portals is increasingly being used as a method of physician-patient communication, both patients and providers are looking for guidance on how to appropriately engage with each other using this tool. Patients worry about whether their use is appropriate, and providers are concerned about the content of messages, which allow them to effectively manage patient questions. Our findings suggest that additional training may help address the concerns of both patients and providers, by providing “rules of engagement” for communication via patient portals.
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Affiliation(s)
- Cynthia J Sieck
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jennifer L Hefner
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Jeanette Schnierle
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Hannah Florian
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Aradhna Agarwal
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Kristen Rundell
- The Ohio State University College of Medicine, Columbus, OH, United States
| | - Ann Scheck McAlearney
- The Ohio State University College of Medicine, Columbus, OH, United States.,The Ohio State University College of Public Health, Division of Health Services Management and Policy, Columbus, OH, United States
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15
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The impacts of email reminder/recall on adolescent influenza vaccination. Vaccine 2017; 35:3089-3095. [PMID: 28455173 DOI: 10.1016/j.vaccine.2017.04.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/27/2017] [Accepted: 04/12/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND We sought to: (1) explore the feasibility of using email for seasonal influenza vaccination reminders to parents of adolescents and (2) assess influenza vaccination rates among adolescents whose parents were randomized to either receive or not receive email reminders. METHODS Email addresses were obtained for parents of patients 10-18years from 4 practices in Michigan. Addresses were randomized to either receive email reminders, or not. Reminder messages were sent during October 2012-March 2013 (Season 1) and October 2013-March 2014 (Season 2). Vaccination status was determined 60days following the last email reminder for each season using the statewide Michigan Care Improvement Registry (MCIR); per protocol bivariate and multivariate logistic regression analyses were conducted to evaluate reminder notification. RESULTS After email cleaning, testing, and matching with MCIR, approximately half of email addresses (2348 of 5312 in Season 1; 3457 of 6549 in Season 2) were randomized. Bivariate analyses found that influenza vaccination within 60days after notification date was similar among those notified (34%) versus not notified (29%) in both Season 1 (p=0.06) and Season 2 (39% vs. 37%, p=0.20). However, multivariate models adjusted for season, site, and receipt of notification in two seasons found a higher likelihood of influenza vaccination among children that received notification (aOR=1.28, 95% CI=1.09, 1.51); in addition, differences in influenza vaccination were also observed between practice sites (range: p=0.15 to p<0.001). CONCLUSIONS We found that practice-based email influenza vaccine reminders to parents of adolescents are feasible, but not without complications. Our study demonstrates that email reminders from practices can yield increases in influenza vaccination rates among adolescents. Practices should consider email as an option for influenza reminders and establish business practices for collecting and maintaining patient email addresses. This study is registered at www.ClinicalTrials.gov id #NCT01732315.
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16
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Williamson RS, Cherven BO, Gilleland Marchak J, Edwards P, Palgon M, Escoffery C, Meacham LR, Mertens AC. Meaningful Use of an Electronic Personal Health Record (ePHR) among Pediatric Cancer Survivors. Appl Clin Inform 2017; 8:250-264. [PMID: 28293684 PMCID: PMC5373768 DOI: 10.4338/aci-2016-11-ra-0189] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 01/08/2017] [Indexed: 01/22/2023] Open
Abstract
Background and Objectivs: Survivors of pediatric and adolescent cancer are at an increased risk of chronic and debilitating health conditions and require life-long specialized care. Stand-alone electronic personal health records (ePHRs) may aid their self-management. This analysis characterizes young adult survivors and parents who meaningfully use an ePHR, Cancer SurvivorLinkTM, designed for survivors of pediatric and adolescent cancer. METHODS This was a retrospective observational study of patients seen at a pediatric survivor clinic for annual survivor care. Young adult survivors and/or parent proxies for survivors <18 years old who completed ePHR registration prior to their appointment or within 90 days were classified as registrants. Registrants who uploaded or downloaded a document and/or shared their record were classified as meaningful users. RESULTS Overall, 23.7% (148/624) of survivors/parents registered and 38% of registrants used SurvivorLink meaningfully. Young adult registrants who transferred to adult care during the study period were more likely to be meaningful users (aOR: 2.6 (95% CI: 1.1, 6.1)) and used the ePHR twice as frequently as those who continued to receive care in our institution's pediatric survivor clinic. Among survivors who continued to receive care at our institution, being a registrant was associated with having an annual follow-up visit (aOR: 2.6 (95% CI: 1.2, 5.8)). CONCLUSIONS While ePHRs may not be utilized by all survivors, SurvivorLink is a resource for a subset and may serve as an important bridge for patients who transfer their care. Using SurvivorLink was also associated with receiving recommended annual survivor care.
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Affiliation(s)
- Rebecca S Williamson
- Rebecca Williamson, MPH, 2015 Upper Gate Drive, 4th Floor, Atlanta, GA 30322, Phone: 404.785.9929 Fax: 404.785.9248,
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