The Promise and Peril of the Patient Portal

Abstract Background While there have been published reports detailing technical challenges of incorporating genetic test results into the electronic health record (EHR) with proposed solutions, less has been published about unanticipated sociotechnological or practical communication challenges involved in this process. Objectives This study was aimed to describe unanticipated issues that arose returning genetic research results through the EHR as part of the National Human Genome Research Institute (NHGRI)-funded electronic Medical Records and Genomics (eMERGE) 3 consortium, and provide lessons learned for future implementations Methods We sequenced 3,000 participants on a 109-gene panel and returned genetic results initially in person and/or by letter, with a later release directly into the EHR and patient portal. Results When results were returned through the EHR, multiple participants expressed confusion and contacted the health system, resulting in our institution temporarily freezing our return of research results. Discussion We determined the likely causes of this issue to be (1) the delay between enrollment and results return, (2) inability to personalize mass e-mail messages announcing new research test results in the EHR, (3) limited space for description of test results in the EHR, and (4) the requirement to list an ordering physician for research results in the EHR. For future return of results, we propose sending preparatory e-mails to participants, including screenshots of how they can expect to see their results presented in the EHR portal. Conclusion We hope our lessons learned can provide helpful guidance to other sites implementing research genetic results into the EHR and can encourage EHR developers to incorporate greater flexibility in the future.

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The formation of patient trust and its transference to online health services: the case of a Dutch online patient portal for rehabilitation care

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-021-01552-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Lex van Velsen ◽

Ina Flierman ◽

Monique Tabak

Keyword(s):

Health Services ◽

Structural Equation ◽

Assessment Tool ◽

Measurement Model ◽

Care Team ◽

Care Organization ◽

Patient Portal ◽

Patient Trust ◽

Related Factors ◽

Ehealth Service

Abstract Background Trust is widely recognized as a crucial factor in successful physician–patient communication and patient engagement in treatment. However, with the rise of eHealth technologies, such as online patient portals, the role of trust and the factors that influence it need to be reconsidered. In this study, we aim to identify the factors that contribute to trust in an eHealth service and we aim to identify the consequences of trust in an eHealth service in terms of use. Methods The Patient Trust Assessment Tool was provided to new outpatients of a rehabilitation center in the Netherlands, that were expected to use the center’s online patient portal. Via this tool, we assessed five trust-related factors. This data was supplemented by questions about demographics (age, gender, rehabilitation treatment) and data about use (number of sessions, total time spent in sessions), derived from data logs. Data was analyzed via Partial Least Squares Structural Equation Modelling. Results In total, 93 patients participated in the study. Out of these participants, 61 used the portal at least once. The measurement model was considered good. Trust in the organization was found to affect trust in the care team (β = .63), trust in the care team affected trust in the treatment (β = .60). Both, trust in the care team and trust in the treatment influenced trust in the technology (β = .42 and .30, respectively). Trust in the technology affected the holistic concept trust in the service (β = .78). This holistic trust in the service finally, did not affect use. Conclusions This study shows that the formation of this trust is not unidimensional, but consists of different, separate factors (trust in the care organization, trust in the care team and trust in the treatment). Trust transfer does take place from offline to online health services. However, trust in the service does not directly affect the use of the eHealth technology.

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Patient Portal Use Near the End-of-Life

Journal of General Internal Medicine ◽

10.1007/s11606-020-06333-9 ◽

2021 ◽

Author(s):

Jennifer Dickman Portz ◽

J. D. Powers ◽

M. Baldwin ◽

David B. Bekelman ◽

Alejandra Casillas ◽

...

Keyword(s):

End Of Life ◽

Patient Portal

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Patients’ moral attitudes toward electronic health records: Survey study with vignettes and statements

Health Informatics Journal ◽

10.1177/1460458220980039 ◽

2021 ◽

Vol 27 (1) ◽

pp. 146045822098003

Author(s):

Tania Moerenhout ◽

Ignaas Devisch ◽

Laetitia Cooreman ◽

Jodie Bernaerdt ◽

An De Sutter ◽

...

Keyword(s):

Electronic Health Records ◽

De Novo ◽

Information Access ◽

Survey Study ◽

Sensitive Information ◽

Patient Portal ◽

Care Providers ◽

Health Records ◽

Electronic Health ◽

Moral Attitudes

Patient access to electronic health records gives rise to ethical questions related to the patient-doctor-computer relationship. Our study aims to examine patients’ moral attitudes toward a shared EHR, with a focus on autonomy, information access, and responsibility. A de novo self-administered questionnaire containing three vignettes and 15 statements was distributed among patients in four different settings. A total of 1688 valid questionnaires were collected. Patients’ mean age was 51 years, 61% was female, 50% had a higher degree (college or university), and almost 50% suffered from a chronic illness. Respondents were hesitant to hide sensitive information electronically from their care providers. They also strongly believed hiding information could negatively affect the quality of care provided. Participants preferred to be informed about negative test results in a face-to-face conversation, or would have every patient decide individually how they want to receive results. Patients generally had little experience using patient portal systems and expressed a need for more information on EHRs in this survey. They tended to be hesitant to take up control over their medical data in the EHR and deemed patients share a responsibility for the accuracy of information in their record.

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Association between Patient Portal use and Office Visits

Journal of Medical Systems ◽

10.1007/s10916-021-01749-0 ◽

2021 ◽

Vol 45 (7) ◽

Author(s):

Reginald A. Silver ◽

Chandrasekar Subramaniam ◽

Antonis Stylianou

Keyword(s):

Patient Portal ◽

Office Visits

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Policies and procedures governing patient portal use at an Academic Medical Center

JAMIA Open ◽

10.1093/jamiaopen/ooz039 ◽

2019 ◽

Vol 2 (4) ◽

pp. 479-488

Author(s):

Bryan D Steitz ◽

Joseph Isaac S Wong ◽

Jared G Cobb ◽

Brian Carlson ◽

Gaye Smith ◽

...

Keyword(s):

Government Regulation ◽

Medical Center ◽

Academic Medical Center ◽

Successful Implementation ◽

Patient Portal ◽

Patient Portals ◽

Identity Verification ◽

Policies And Procedures ◽

Academic Medical ◽

And Function

Abstract Background and Objective Patient portal use has increased over the last two decades in response to consumer demand and government regulation. Despite growing adoption, few guidelines exist to direct successful implementation and governance. We describe the policies and procedures that have governed over a decade of continuous My Health at Vanderbilt (MHAV) patient portal use. Methods We examined MHAV usage data between May 2007 and November 2017. We classified patient portal activity into eight functional categories: Appointment, Billing, Document Access, Genetics, Health Result, Immunization, Medication, and Messaging. We describe our operating policies and measure portal uptake, patient account activity, and function use over time. Results By the end of the study period, there were 375 517 registered accounts. Policies made MHAV available to competent adults and adolescents 13 and over. Patients signed up for a limited access account online, which could be upgraded to a full-access account after identity verification. Patients could assign proxy accounts to family and caregivers, which permitted nonpatient access to select MHAV functions. Laboratory and radiology results were accessible via MHAV. Results were classified into three groups based on sensitivity, which govern the length of delay before results appeared in MHAV. Discussion and Conclusion Patient portals offer significant opportunity to engage patients in their healthcare. However, there remains a need to understand how policies can promote uptake and use. We anticipate that other institutions can apply concepts from our policies to support meaningful patient portal engagement.

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Who are we missing with EHR-based smoking cessation treatments? A descriptive study of patients who smoke and do not regularly visit primary care clinics

The Journal of Smoking Cessation ◽

10.1017/jsc.2020.21 ◽

2020 ◽

Vol 15 (4) ◽

pp. 175-180

Author(s):

Margaret Nolan ◽

Deejay Zwaga ◽

Danielle McCarthy ◽

Christian Kastman ◽

Timothy Baker ◽

...

Keyword(s):

Primary Care ◽

Care Provider ◽

Primary Care Provider ◽

The United States ◽

Primary Care Visit ◽

Patient Portal ◽

The Past ◽

Healthcare Settings ◽

Care Visit ◽

Tobacco Treatment

AbstractIntroductionMost tobacco treatment efforts target healthcare settings, because about 75% of smokers in the United States visit a primary care provider annually. Yet, 25% of patients may be missed by such targeting.AimsTo describe patients who smoke but infrequently visit primary care – their characteristics, rates of successful telephone contact, and acceptance of tobacco treatment.MethodsTobacco Cessation Outreach Specialists ‘cold-called’ those without a primary care visit in the past year, offering tobacco dependence treatment. Age, sex, insurance status, race, ethnicity, electronic health record (EHR) patient-portal status and outreach outcomes were reported.ResultsOf 3,407 patients identified as smokers in a health system registry, 565 (16.6%) had not seen any primary care provider in the past year. Among 271 of those called, 143 (53%) were successfully reached and 33 (23%) set a quit date. Those without visits tended to be younger, male, some-day versus every-day smokers (42 vs. 44 years, P = 0.004; 48% vs. 40% female, P = 0.0002, and 21% vs. 27% some-day, P = 0.003), and less active on the EHR patient portal (33% vs. 40%, P = 0.001).ConclusionsA substantial proportion of patients who smoke are missed by traditional tobacco treatment interventions that require a primary care visit, yet many are receptive to quit smoking treatment offers.

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Using a Patient Portal to Expand Warfarin Self-Management

The Journal for Nurse Practitioners ◽

10.1016/j.nurpra.2020.09.017 ◽

2020 ◽

Author(s):

Amanda Cabral ◽

Kathleen R. Bonaventura ◽

Kerry A. Milner

Keyword(s):

Self Management ◽

Patient Portal

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Patient Portal, Patient-Generated Images, and Medical Decision-Making in a Pediatric Ambulatory Setting

Applied Clinical Informatics ◽

10.1055/s-0040-1718754 ◽

2020 ◽

Vol 11 (05) ◽

pp. 764-768

Author(s):

Karolin Ginting ◽

Adrienne Stolfi ◽

Jordan Wright ◽

Abiodun Omoloja

Keyword(s):

Decision Making ◽

Health Care Providers ◽

Medical Decision Making ◽

Pediatric Population ◽

Private Insurance ◽

Medical Decision ◽

Ambulatory Setting ◽

Patient Portal ◽

Care Providers ◽

Patient Portals

Abstract Background Electronic health record (EHR) patient portals are a secure electronic method of communicating with health care providers. In addition to sending secure messages, images, and videos generated by families can be sent to providers securely. With the widespread use of smart phones, there has been an increase in patient-generated images (PGI) sent to providers via patient portals. There are few studies that have evaluated the role of PGI in medical decision-making. Objectives The study aimed to characterize PGI sent to providers via a patient portal, determine how often PGI-affected medical decision-making, and determine the rate of social PGI sent via patient portal. Methods A retrospective chart review of PGI uploaded to a children's hospital's ambulatory patient portal from January 2011 to December 2017 was conducted. Data collected included patient demographics, number and type of images sent, person sending images (patient or parent/guardian), and whether an image-affected medical decision-making. Images were classified as medical related (e.g., blood glucose readings and skin rashes), nonmedical or administrative related (e.g., medical clearance or insurance forms), and social (e.g., self-portraits and camp pictures). Results One hundred forty-three individuals used the portal a total of 358 times, sending 507 images over the study period. Mean (standard deviation) patient age was 9.5 (5.9) years, 50% were females, 89% were White, and 64% had private insurance. About 9% of images were sent directly by patients and the rest by parents/guardians. A total of 387 (76%) images were sent for medical related reasons, 20% for nonmedical, and 4% were deemed social images. Of the 387 medical related images, 314 (81%) affected medical decision-making. Conclusion PGI-affected medical decision-making in most cases. Additional studies are needed to characterize use of PGI in the pediatric population.

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