Disparities in Pediatric Patient Portal Activation and Feature Use

Abstract Objective Disparities in adult patient portal adoption are well-documented; however, less is known about disparities in portal adoption in pediatrics. This study examines the prevalence and factors associated with patient portal activation and the use of specific portal features in general pediatrics. Materials and methods We analyzed electronic health record data from 2012 to 2020 in a large academic medical center that offers both parent and adolescent portals. We summarized portal activation and use of select portal features (messaging, records access and management, appointment management, visit/admissions summaries, and interactive feature use). We used logistic regression to model factors associated with patient portal activation among all patients along with feature use and frequent feature use among ever users (ie, ≥1 portal use). Results Among 52 713 unique patients, 39% had activated the patient portal, including 36% of patients aged 0–11, 41% of patients aged 12–17, and 62% of patients aged 18–21 years. Among activated accounts, ever use of specific features ranged from 28% for visit/admission summaries to 92% for records access and management. Adjusted analyses showed patients with activated accounts were more likely to be adolescents or young adults, white, female, privately insured, and less socioeconomically vulnerable. Individual feature use among ever users generally followed the same pattern. Conclusions Our findings demonstrate that important disparities persist in portal adoption in pediatric populations, highlighting the need for strategies to promote equitable access to patient portals.

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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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The Use of an Electronic Health Record Patient Portal to Access Diagnostic Test Results by Emergency Patients at an Academic Medical Center: Retrospective Study (Preprint)

10.2196/preprints.13791 ◽

2019 ◽

Cited By ~ 2

Author(s):

Brody Foster ◽

Matthew David Krasowski

Keyword(s):

Diagnostic Test ◽

Laboratory Tests ◽

Medical Center ◽

Academic Medical Center ◽

Patient Portal ◽

Test Results ◽

Patient Portals ◽

Radiology Reports ◽

Academic Medical ◽

Laboratory Results

BACKGROUND Electronic health record (EHR) patient portals provide a means by which patients can access their health information, including diagnostic test results. Little is known about portal usage by emergency department (ED) patients. OBJECTIVE The study aimed to assess patient portal utilization by ED patients at an academic medical center using account activation rates along with the rates of access of diagnostic test results (laboratory results and radiology reports), analyzing the impact of age, gender, and self-reported patient race. METHODS This institutional review board–approved retrospective study was performed at a 60,000-visits-per-year university-based ED. We utilized EHR data reporting tools to examine EHR portal activation and utilization for all patients who had at least one ED encounter with one or more diagnostic tests performed between October 1, 2016, and October 1, 2017. The total dataset for laboratory testing included 208,635 laboratory tests on 25,361 unique patients, of which 9482 (37.39%) had active portal accounts. The total dataset for radiologic imaging included 23,504 radiology studies on 14,455 unique patients, of which 5439 (37.63%) had an active portal account. RESULTS Overall, 8.90% (18,573/208,635) of laboratory tests and 8.97% (2019/22,504) of radiology reports ordered in the ED were viewed in the patient portal. The highest rates of viewing of laboratory and radiology results were seen for those who were female, were aged 0 to 11 years (parent or guardian viewing by proxy) and 18 to 60 years, and self-reported their race as Caucasian or Asian. The lowest rates were for those who were teenagers, aged older than 81 years, African American/black, and Hispanic/Latino. Infectious disease, urinalysis, and pregnancy testing constituted the highest number of laboratory tests viewed. Magnetic resonance imaging reports were viewed at higher rates than computed tomography or x-ray studies (P<.001). Approximately half of all the diagnostic test results accessed by patients were reviewed within 72 hours of availability in the patient portal (laboratory results: 9904/18,573, 53.32% and radiology reports: 971/2019, 48.1%). On the other extreme, 19.9% (3701/18,573) of laboratory results and 31.6% (639/2019) of radiology reports were viewed more than 2 weeks after availability in the portal. CONCLUSIONS The data highlight the relatively low use of a patient portal by ED patients and existing disparities between patient groups. There can be wide lag time (months) between result/report availability and access by patients. Opportunities for improvement exist for both activation and more robust utilization of patient portals by ED patients.

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Long-term Patterns of Patient Portal Use for Pediatric Patients at an Academic Medical Center

Applied Clinical Informatics ◽

10.4338/aci-2017-01-ra-0005 ◽

2017 ◽

Vol 08 (03) ◽

pp. 779-793 ◽

Cited By ~ 10

Author(s):

Robert Cronin ◽

Sharon Davis ◽

Ellen Yan ◽

Gretchen Jackson ◽

Bryan Steitz

Keyword(s):

Pediatric Patients ◽

Medical Center ◽

Academic Medical Center ◽

Medical Specialty ◽

Patient Portal ◽

Patient Portals ◽

Secure Messaging ◽

Patients Âgés ◽

Academic Medical

SummaryBackground: Patient portal adoption has increased over the last two decades. Most research about patient portals has focused on adult populations in the primary care and medical specialty settings.Objective: We describe initial and long-term portal use by pediatric patients and their caregivers in a broadly deployed patient portal at an academic medical center.Methods: We analyzed portal usage for pediatric patients and their caregivers from 2008 to 2014. We recorded usage events with time stamps; user role defined as self, surrogate (i.e., parent or guardian), or delegate; and functions accessed. Usage events were grouped into sessions to calculate descriptive statistics by patient age, user role, and active use over time.Results: From 2008 to 2014, the number of portal accounts increased from 633 to 17,128. 15.9% of pediatric patients had their own account; 93.6%, a surrogate account; and 2.2% a delegate account. During the study period, 15,711 unique users initiated 493,753 sessions and accessed 1,491,237 functions. Most commonly used functions were secure messaging (accessed in 309,204 sessions; 62.6%); test results (174,239; 35.3%) and appointments (104,830; 21.2%). Function usage was greatest for patients ages 0-2 years (136,245 functions accessed; 23.1%) and 15-17 years (109,241;18.5%). Surrogate users conducted 83.2% of logins for adolescent patients. Portal accounts were actively used for < 1 year for 9,551 patients (55.8%), 1-2 years for 2,826 patients (16.5%), 2–3 years for 1,968 patients (11.5%) and over 3 years for 2,783 patients (16.3%).Conclusion: Pediatric patients and caregivers have avidly used messaging, test result, and appointment functions. The majority of access was done by surrogates. Adolescent portal usage increased with age. Most accounts for pediatric patients were only used actively for a few years, with peak usage for patients in early childhood and late adolescence.Citation: Steitz BD, Cronin RM, Davis SE, Yan Z, Jackson GP. Long-term Patterns of Patient Portal Use for Pediatric Patients at an Academic Medical Center. Appl Clin Inform 2017; 8: 779–793 https://doi.org/10.4338/ACI-2017-01-RA-0005

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Rapid development of telehealth capabilities within pediatric patient portal infrastructure for COVID-19 care: barriers, solutions, results

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocaa065 ◽

2020 ◽

Vol 27 (7) ◽

pp. 1116-1120 ◽

Cited By ~ 16

Author(s):

Pious D Patel ◽

Jared Cobb ◽

Deidre Wright ◽

Robert W Turer ◽

Tiffany Jordan ◽

...

Keyword(s):

Pediatric Patients ◽

Medical Center ◽

Rapid Development ◽

Academic Medical Center ◽

Security Policies ◽

Patient Portal ◽

Privacy And Security ◽

Academic Medical ◽

Adolescent Autonomy ◽

National Emergency

Abstract The COVID-19 national emergency has led to surging care demand and the need for unprecedented telehealth expansion. Rapid telehealth expansion can be especially complex for pediatric patients. From the experience of a large academic medical center, this report describes a pathway for efficiently increasing capacity of remote pediatric enrollment for telehealth while fulfilling privacy, security, and convenience concerns. The design and implementation of the process took 2 days. Five process requirements were identified: efficient enrollment, remote ability to establish parentage, minimal additional work for application processing, compliance with guidelines for adolescent autonomy, and compliance with institutional privacy and security policies. Weekly enrollment subsequently increased 10-fold for children (age 0–12 years) and 1.2-fold for adolescents (age 13–17 years). Weekly telehealth visits increased 200-fold for children and 90-fold for adolescents. The obstacles and solutions presented in this report can provide guidance to health systems for similar challenges during the COVID-19 response and future disasters.

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The Use of an Electronic Health Record Patient Portal to Access Diagnostic Test Results by Emergency Patients at an Academic Medical Center: Retrospective Study

Journal of Medical Internet Research ◽

10.2196/13791 ◽

2019 ◽

Vol 21 (6) ◽

pp. e13791 ◽

Cited By ~ 3

Author(s):

Brody Foster ◽

Matthew David Krasowski

Keyword(s):

Retrospective Study ◽

Electronic Health Record ◽

Diagnostic Test ◽

Medical Center ◽

Academic Medical Center ◽

Health Record ◽

Patient Portal ◽

Test Results ◽

Emergency Patients ◽

Academic Medical

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Data on the activation and utilization of an electronic health record patient portal in an adult inpatient population at an academic medical center

Data in Brief ◽

10.1016/j.dib.2021.106806 ◽

2021 ◽

Vol 35 ◽

pp. 106806

Author(s):

Corey T. Allard ◽

Matthew D. Krasowski

Keyword(s):

Electronic Health Record ◽

Medical Center ◽

Academic Medical Center ◽

Health Record ◽

Patient Portal ◽

Academic Medical ◽

Adult Inpatient ◽

Inpatient Population ◽

Electronic Health

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Factors associated with posttraumatic growth among healthcare workers at an academic‐medical center: A correlational study

Perspectives In Psychiatric Care ◽

10.1111/ppc.12817 ◽

2021 ◽

Author(s):

Chizimuzo T. C. Okoli ◽

Sarret Seng

Keyword(s):

Posttraumatic Growth ◽

Healthcare Workers ◽

Medical Center ◽

Academic Medical Center ◽

Correlational Study ◽

Factors Associated ◽

Academic Medical

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A Novel Digital Platform Approach to Enhance Enterprise-Wide Patient Portal Adoption (Preprint)

10.2196/preprints.11816 ◽

2018 ◽

Author(s):

Yauheni Solad ◽

Shrawan Patel ◽

Allen Hsiao ◽

Ashish Atreja

Keyword(s):

Medical Information ◽

Medical Center ◽

Academic Medical Center ◽

Patient Portal ◽

New Haven ◽

Patient Portals ◽

Digital Platform ◽

Care Plans ◽

Number Of Patients ◽

Haven Hospital

BACKGROUND Patient portals provide a simplified route for health providers to share medical information with individual patients, and are incentivized under Meaningful Use. Currently there are numerous friction factors in the onboarding process of patient portals that limits patients signing up for them. As a result, health systems are spending significant resources to drive the adoption of patient portals, with limited success. OBJECTIVE To evaluate the effectiveness of a innovative rules-driven digital patient engagement strategy for patients to sign up for online patient portal at an academic medical center. METHODS Rx.Universe is a digital platform integrated into provider EMR systems that enables physicians to directly “prescribe” mobile health applications and/or digital care bundles to patients. Rx.Universe Bulk Prescription feature was used to prescribe—via SMS—a direct link to the MyChart login page with the patient’s unique code and personal information embedded within the link. This removed several key barriers to adoption: patients needing to copy and paste access codes, fill in their personal data and complete this process within 30 days—after which their unique access code expires. The Rx.Universe engagement dashboard displayed the total number of patients who received prescribed messages, the number of unsuccessful prescriptions, prescriptions opened in the first 24 hours, and total prescriptions opened. RESULTS We digitally prescribed MyChart Activation to 23,485 patients under the care of Yale-New Haven Hospital over a period of 2 days. Of these prescriptions, 21,997 (93.66%) were successfully delivered and 1488 (6.33%) failed to be delivered because of incorrect cell phone numbers in EHR. Of the prescriptions successfully prescribed, 2170 (9.86%) were clicked within 24 hours of being prescribed with a total of 2378 (10.81%) clicked within a week. CONCLUSIONS Digital Medicine Platforms offer new channel for onboarding and following up patients through customized digital care plans. The power of this approach in removing barriers for patients is highlighted by the fact that Yale-New Haven Hospital met their yearly MyChart adoption target through this campaign within a week. Furthermore, the data could be assessed and acted upon in real-time as opposed to the usual weeks. This technology can be extended to close the care gaps for hospitals and Accountable Care Organizations (ACO) in a scalable manner for a subpopulation, with manual processes reserved for patients unable to be reached in an automated fashion.

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