scholarly journals The Next Frontier in Communication and the ECLIPPSE Study: Bridging the Linguistic Divide in Secure Messaging

2017 ◽  
Vol 2017 ◽  
pp. 1-9 ◽  
Author(s):  
Dean Schillinger ◽  
Danielle McNamara ◽  
Scott Crossley ◽  
Courtney Lyles ◽  
Howard H. Moffet ◽  
...  
Keyword(s):  
Health Systems ◽  
Computational Linguistics ◽  
Online Communication ◽  
Safety Net ◽  
Literacy Skills ◽  
Patient Portals ◽  
Healthcare Organizations ◽  
Linguistic Complexity ◽  
Secure Messaging ◽  
Linguistic Divide

Health systems are heavily promoting patient portals. However, limited health literacy (HL) can restrict online communication via secure messaging (SM) because patients’ literacy skills must be sufficient to convey and comprehend content while clinicians must encourage and elicit communication from patients and match patients’ literacy level. This paper describes the Employing Computational Linguistics to Improve Patient-Provider Secure Email (ECLIPPSE) study, an interdisciplinary effort bringing together scientists in communication, computational linguistics, and health services to employ computational linguistic methods to (1) create a novel Linguistic Complexity Profile (LCP) to characterize communications of patients and clinicians and demonstrate its validity and (2) examine whether providers accommodate communication needs of patients with limited HL by tailoring their SM responses. We will study >5 million SMs generated by >150,000 ethnically diverse type 2 diabetes patients and >9000 clinicians from two settings: an integrated delivery system and a public (safety net) system. Finally, we will then create an LCP-based automated aid that delivers real-time feedback to clinicians to reduce the linguistic complexity of their SMs. This research will support health systems’ journeys to become health literate healthcare organizations and reduce HL-related disparities in diabetes care.

scholarly journals Growth of Secure Messaging Through a Patient Portal as a Form of Outpatient Interaction across Clinical Specialties

2015 ◽  
Vol 06 (02) ◽  
pp. 288-304 ◽  
Author(s):  
S.E. Davis ◽  
J.A. Shenson ◽  
Q. Chen ◽  
S.T. Rosenbloom ◽  
G.P. Jackson ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Medical Center ◽  
Patient Portal ◽  
Care Providers ◽  
Patient Portals ◽  
Healthcare Organizations ◽  
Secure Messaging ◽  
Medical Specialties ◽  
Face To Face ◽  
Clinic Visits

SummaryObjective: Patient portals are online applications that allow patients to interact with healthcare organizations. Portal adoption is increasing, and secure messaging between patients and health-care providers is an emerging form of outpatient interaction. Research about portals and messaging has focused on medical specialties. We characterized adoption of secure messaging and the contribution of messaging to outpatient interactions across diverse clinical specialties after broad portal deployment.Methods: This retrospective cohort study at Vanderbilt University Medical Center examined use of patient-initiated secure messages and clinic visits in the three years following full deployment of a patient portal across adult and pediatric specialties. We measured the proportion of outpatient interactions (i.e., messages plus clinic visits) conducted through secure messaging by specialty over time. Generalized estimating equations measured the likelihood of message-based versus clinic outpatient interaction across clinical specialties.Results: Over the study period, 2,422,114 clinic visits occurred, and 82,159 unique portal users initiated 948,428 messages to 1,924 recipients. Medicine participated in the most message exchanges (742,454 messages; 78.3% of all messages sent), followed by surgery (84,001; 8.9%) and obstetrics/gynecology (53,424; 5.6%). The proportion of outpatient interaction through messaging increased from 12.9% in 2008 to 33.0% in 2009 and 39.8% in 2010 (p<0.001). Medicine had the highest proportion of outpatient interaction conducted through messaging in 2008 (23.3% of out-patient interactions in medicine). By 2010, this proportion was highest for obstetrics/gynecology (83.4%), dermatology (71.6%), and medicine (56.7%). Growth in likelihood of message-based interaction was greater for anesthesiology, dermatology, obstetrics/gynecology, pediatrics, and psychiatry than for medicine (p<0.001).Conclusions: This study demonstrates rapid adoption of secure messaging across diverse clinical specialties, with messaging interactions exceeding face-to-face clinic visits for some specialties. As patient portal and secure messaging adoption increase beyond medicine and primary care, research is needed to understand the implications for provider workload and patient care.Citation: Cronin RM, Davis SE, Shenson JA, Chen Q, Rosenbloom ST, Jackson GP. Growth of secure messaging through a patient portal as a form of outpatient interaction across clinical specialties. Appl Clin Inf 2015; 6: 288–304http://dx.doi.org/10.4338/ACI-2014-12-RA-0117

scholarly journals An Untapped Potential in Primary Care: Semi-Structured Interviews with Clinicians on How Patient Portals Will Work for Caregivers in the Safety Net (Preprint)

2020 ◽  
Author(s):  
Alejandra Casillas ◽  
Anupama Gunshekar Cemballi ◽  
Anshu Abhat ◽  
Miya Lemberg ◽  
Jennifer D Portz ◽  
...  
Keyword(s):  
Health Systems ◽  
Digital Literacy ◽  
Limited English Proficiency ◽  
English Proficiency ◽  
Safety Net ◽  
Security And Privacy ◽  
Structured Interviews ◽  
Patient Portals ◽  
Privacy And Security ◽  
Safety Net Providers

BACKGROUND Patients within safety-net settings are less likely to access health information on patient portals, despite expressed interest. Family and friends are important resources to assist these patients (ie, Medicaid recipients, older patients, patients with limited English proficiency) in navigating health systems, and provider support of the use of patient portals among these groups may also facilitate caregivers’ use of their patients’ portal. OBJECTIVE Because safety net providers work closely with caregivers to care for their patients, we used qualitative methods to explore safety net providers’ perspectives on portal use among caregivers for their patients, especially as there is limited literature about caregivers’ use of portals in the safety net. METHODS We conducted 45- to 60-min semistructured telephone interviews with providers from three large California safety-net health systems. The interviews focused on providers’ experiences with caregivers, caregiver roles, and how the portal could be leveraged as a tool to support caregivers in their responsibilities. A total of three coders analyzed the interview transcripts using both deductive and inductive approaches and established a consensus regarding major themes. RESULTS Of the 16 participants interviewed, 4 specialized in geriatrics, and all held a leadership or administrative role. We described themes highlighting providers’ recognition of potential benefits associated with caregiver portal use and specific challenges to caregiver engagement. CONCLUSIONS Providers recognized the potential for portals to improve information delivery and communication by helping caregivers assist socially and medically complex patients in the safety net. Providers in safety net sites also discussed a clear need for better ways to keep in touch with patients and connect with caregivers, yet security and privacy are perhaps of higher importance in these settings and may pose challenges to portal adoption. They noted that caregivers of patients in the safety net likely face similar communication barriers as patients, especially with respect to digital literacy, health literacy, and English proficiency. Further research is needed to assess and support caregivers’ interest and ability to access portals across barriers in health and digital literacy, and English proficiency. Portal platforms and health systems must also address specific strategies to uphold patient preferences while maintaining privacy and security.

scholarly journals Meaningful use in the safety net: a rapid ethnography of patient portal implementation at five community health centers in California

2017 ◽  
Vol 24 (5) ◽  
pp. 903-912 ◽  
Author(s):  
Sara L Ackerman ◽  
Urmimala Sarkar ◽  
Lina Tieu ◽  
Margaret A Handley ◽  
Dean Schillinger ◽  
...  
Keyword(s):  
Health Care ◽  
Health Systems ◽  
Low Income ◽  
Community Health Centers ◽  
Health Care Systems ◽  
Meaningful Use ◽  
Safety Net ◽  
Patient Portal ◽  
Patient Portals ◽  
Staff Support

Abstract Objective:US health care institutions are implementing secure websites (patient portals) to achieve federal Meaningful Use (MU) certification. We sought to understand efforts to implement portals in “safety net” health care systems that provide services for low-income populations. Materials and Methods:Our rapid ethnography involved visits at 4 California safety net health systems and in-depth interviews at a fifth. Visits included interviews with clinicians and executives (n = 12), informal focus groups with front-line staff (n = 35), observations of patient portal sign-up procedures and clinic work, review of marketing materials and portal use data, and a brief survey (n = 45). Results:Our findings demonstrate that the health systems devoted considerable effort to enlisting staff support for portal adoption and integrating portal-related work into clinic routines. Although all health systems had achieved, or were close to achieving, MU benchmarks, patients faced numerous barriers to portal use and our participants were uncertain how to achieve and sustain “meaningful use” as defined by and for their patients. Discussion:Health systems’ efforts to achieve MU certification united clinic staff under a shared ethos of improved quality of care. However, MU’s assumptions about patients’ demand for electronic access to health information and ability to make use of it directed clinics’ attention to enrollment and message routing rather than to the relevance and usability of a tool that is minimally adaptable to the safety net context. Conclusion:We found a mismatch between MU-based metrics of patient engagement and the priorities and needs of safety net patient populations.

scholarly journals An Untapped Potential in Primary Care: Semi-Structured Interviews with Clinicians on How Patient Portals Will Work for Caregivers in the Safety Net

10.2196/18466 ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. e18466 ◽  
Author(s):  
Alejandra Casillas ◽  
Anupama Gunshekar Cemballi ◽  
Anshu Abhat ◽  
Miya Lemberg ◽  
Jennifer D Portz ◽  
...  
Keyword(s):  
Health Systems ◽  
Digital Literacy ◽  
Limited English Proficiency ◽  
English Proficiency ◽  
Safety Net ◽  
Security And Privacy ◽  
Structured Interviews ◽  
Patient Portals ◽  
Privacy And Security ◽  
Safety Net Providers

Background Patients within safety-net settings are less likely to access health information on patient portals, despite expressed interest. Family and friends are important resources to assist these patients (ie, Medicaid recipients, older patients, patients with limited English proficiency) in navigating health systems, and provider support of the use of patient portals among these groups may also facilitate caregivers’ use of their patients’ portal. Objective Because safety net providers work closely with caregivers to care for their patients, we used qualitative methods to explore safety net providers’ perspectives on portal use among caregivers for their patients, especially as there is limited literature about caregivers’ use of portals in the safety net. Methods We conducted 45- to 60-min semistructured telephone interviews with providers from three large California safety-net health systems. The interviews focused on providers’ experiences with caregivers, caregiver roles, and how the portal could be leveraged as a tool to support caregivers in their responsibilities. A total of three coders analyzed the interview transcripts using both deductive and inductive approaches and established a consensus regarding major themes. Results Of the 16 participants interviewed, 4 specialized in geriatrics, and all held a leadership or administrative role. We described themes highlighting providers’ recognition of potential benefits associated with caregiver portal use and specific challenges to caregiver engagement. Conclusions Providers recognized the potential for portals to improve information delivery and communication by helping caregivers assist socially and medically complex patients in the safety net. Providers in safety net sites also discussed a clear need for better ways to keep in touch with patients and connect with caregivers, yet security and privacy are perhaps of higher importance in these settings and may pose challenges to portal adoption. They noted that caregivers of patients in the safety net likely face similar communication barriers as patients, especially with respect to digital literacy, health literacy, and English proficiency. Further research is needed to assess and support caregivers’ interest and ability to access portals across barriers in health and digital literacy, and English proficiency. Portal platforms and health systems must also address specific strategies to uphold patient preferences while maintaining privacy and security.

scholarly journals Accurate Measurement In California’s Safety-Net Health Systems Has Gaps And Barriers

2018 ◽  
Vol 37 (11) ◽  
pp. 1760-1769
Author(s):  
Elaine C. Khoong ◽  
Roy Cherian ◽  
Natalie A. Rivadeneira ◽  
Gato Gourley ◽  
Jinoos Yazdany ◽  
...  
Keyword(s):  
Health Systems ◽  
Safety Net

Behavioral Health Patient Engagement in Video-based Visits through a Patient Portal at an Urban Safety-Net Hospital During COVID-19: Direct Patient Outreach and Case-Control Study (Preprint)

2021 ◽  
Author(s):  
Han Yue ◽  
Victoria Mail ◽  
Maura DiSalvo ◽  
Christina Borba ◽  
Joanna Piechniczek-Buczek ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Behavioral Health ◽  
Patient Engagement ◽  
Safety Net ◽  
Patient Portal ◽  
Patient Portals ◽  
Safety Net Hospital ◽  
Urban Safety

BACKGROUND Patient portals are a safe and secure way for patients to connect with providers for video-based telepsychiatry and help to overcome the financial and logistical barriers associated with face-to-face mental health care. Due to the coronavirus disease 2019 (COVID-19) pandemic, telepsychiatry has become increasingly important to obtaining mental health care. However, financial, and technological barriers, termed the “digital divide,” prevent some patients from accessing the technology needed to utilize telepsychiatry services. OBJECTIVE As part of an outreach project during COVID-19 to improve patient engagement with video-based visits through the hospital’s patient portal among adult behavioral health patients at an urban safety net hospital, we aimed to assess patient preference for patient portal-based video visits or telephone-only visits, and to identify the demographic variables associated with their preference. METHODS Patients in an outpatient psychiatry clinic were contacted by phone and preference for telepsychiatry by phone or video through a patient portal, as well as device preference for video-based visits, were documented. Patient demographic characteristics were collected from the electronic medical record. RESULTS One hundred and twenty-eight patients were reached by phone. Seventy-nine patients (61.7%) chose video-based visits and 69.6% of these patients preferred to access the patient portal through a smartphone. Older patients were significantly less likely to agree to video-based visits. CONCLUSIONS Among behavioral health patients at a safety-net hospital, there was a relatively low engagement with video-based visits through the hospital’s patient portal, particularly among older adults.

Novel use of existing technology: A preliminary study of patient portal use for telerehabilitation

2020 ◽  
pp. 1357633X2095017
Author(s):  
Susan S Conroy ◽  
Stacey Harcum ◽  
Linda Keldsen ◽  
Christopher T Bever
Keyword(s):  
Care Delivery ◽  
Health Service Delivery ◽  
Patient Portal ◽  
Significant Other ◽  
Patient Portals ◽  
Secure Messaging ◽  
Exercise Time ◽  
Stroke Population ◽  
Therapist Communication ◽  
Randomised Controlled

Patient portals (PPs) foster engagement and self-management of chronic disease and are emerging as extensions of the care continuum. Utilisation from a health service delivery perspective is growing; however, it is a relatively new model of care in the field of rehabilitation. This pilot, within a larger randomised controlled stroke rehabilitation trial, explored the feasibility and acceptance of secure messaging using an established nationwide PP system for e-visits. Fifteen participants with stroke-related arm disability were randomised to 6 weeks of home arm telerehabilitation. All were over the age of 60 and 73% lived with a spouse or significant other. Mean intervention time was 6.8 weeks, and participants sent 2.3 ± 1.4 messages per week to complete 15.1 h of reported therapy (prescribed therapy = 18 h). Portal use improved therapist efficiency and resulted in a 1:6 therapist to patient exercise time ratio compared with the conventional 1:1 ratio for in-person therapy. Low initial electronic health literacy, self-efficacy or cognitive scores did not prohibit utilisation, and satisfaction with secure messaging for patient–therapist communication was 3.5 ± 1.2 out of 5. Overall, PP-supported e-visits were a feasible and acceptable telerehabilitation care delivery method for this chronic stroke population. ClinicalTrials.gov Identifier NCT02665052. Registered 27 January 2016. https://clinicaltrials.gov/ct2/show/NCT02665052

Communicating Corporate Social Responsibility in Healthcare Through Digital and Traditional Tools

2020 ◽  
pp. 184-208
Author(s):  
Gianpaolo Tomaselli ◽  
Lalit Garg ◽  
Vipul Gupta ◽  
Peter A. Xuereb ◽  
Sandra C. Buttigieg ◽  
...  
Keyword(s):  
Corporate Social Responsibility ◽  
Social Responsibility ◽  
Health Systems ◽  
Quantitative Research ◽  
Research Approach ◽  
Healthcare Organizations ◽  
Interactive Technologies ◽  
Social Responsibilities ◽  
Continuous Technology ◽  
Corporate Social

Health systems are currently facing a series of challenges dealing with continuous technology advances and social demands, which require changes at managerial and policy level that fully incorporate social responsibilities within healthcare organizations' strategy. Thus, communicating corporate social responsibility (CSR) takes an important role in today's health contexts worldwide. This work aims to investigate CSR communication in healthcare through the use of both traditional and interactive technologies by adopting a mixed qualitative-quantitative research approach. To this extent, a comparative research was conducted in two different countries with different health systems and contexts, namely Malta and India. Findings show that healthcare organisations of both countries are increasing their awareness towards their social responsibilities and the different ways of communicating their CSR activities. A mixed strategy—including both digital (interactive technologies) and traditional tools—was identified as the most effective way of communicating CSR in a healthcare context.

scholarly journals Characterizing Patient-Clinician Communication in Secure Medical Messages: Retrospective Study (Preprint)

2021 ◽  
Author(s):  
Ming Huang ◽  
Jungwei Fan ◽  
Julie Prigge ◽  
Nilay D Shah ◽  
Brian A Costello ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioner ◽  
Mayo Clinic ◽  
Communication Complexity ◽  
Physician Assistant ◽  
Wide Spectrum ◽  
Patient Portal ◽  
Patient Portals ◽  
Secure Messaging ◽  
Clinician Communication

BACKGROUND Patient-clinician secure messaging is an important function in patient portals and enables patients and clinicians to communicate on a wide spectrum of issues in a timely manner. With its growing adoption and patient engagement, it is time to comprehensively study the secure messages and user behaviors in order to improve patient-centered care. OBJECTIVE The aim of this paper was to analyze the secure messages sent by patients and clinicians in a large multispecialty health system at Mayo Clinic, Rochester. METHODS We performed message-based, sender-based, and thread-based analyses of more than 5 million secure messages between 2010 and 2017. We summarized the message volumes, patient and clinician population sizes, message counts per patient or clinician, as well as the trends of message volumes and user counts over the years. In addition, we calculated the time distribution of clinician-sent messages to understand their workloads at different times of a day. We also analyzed the time delay in clinician responses to patient messages to assess their communication efficiency and the back-and-forth rounds to estimate the communication complexity. RESULTS During 2010-2017, the patient portal at Mayo Clinic, Rochester experienced a significant growth in terms of the count of patient users and the total number of secure messages sent by patients and clinicians. Three clinician categories, namely “physician—primary care,” “registered nurse—specialty,” and “physician—specialty,” bore the majority of message volume increase. The patient portal also demonstrated growing trends in message counts per patient and clinician. The “nurse practitioner or physician assistant—primary care” and “physician—primary care” categories had the heaviest per-clinician workload each year. Most messages by the clinicians were sent from 7 AM to 5 PM during a day. Yet, between 5 PM and 7 PM, the physicians sent 7.0% (95,785/1,377,006) of their daily messages, and the nurse practitioner or physician assistant sent 5.4% (22,121/408,526) of their daily messages. The clinicians replied to 72.2% (1,272,069/1,761,739) patient messages within 1 day and 90.6% (1,595,702/1,761,739) within 3 days. In 95.1% (1,499,316/1,576,205) of the message threads, the patients communicated with their clinicians back and forth for no more than 4 rounds. CONCLUSIONS Our study found steady increases in patient adoption of the secure messaging system and the average workload per clinician over 8 years. However, most clinicians responded timely to meet the patients’ needs. Our study also revealed differential patient-clinician communication patterns across different practice roles and care settings. These findings suggest opportunities for care teams to optimize messaging tasks and to balance the workload for optimal efficiency.

scholarly journals What Is COVID-19 Teaching Us About Community Health Systems? A Reflection From a Rapid Community-Led Mutual Aid Response in Cape Town, South Africa

2020 ◽  
Author(s):  
Manya van Ryneveld ◽  
Eleanor Whyle ◽  
Leanne Brady
Keyword(s):  
Community Health ◽  
Health Systems ◽  
Cape Town ◽  
Safety Net ◽  
Community Action ◽  
Community Response ◽  
The State ◽  
System Response ◽  
Mutual Aid ◽  
Community Health Systems

The coronavirus disease 2019 (COVID-19) pandemic has exposed the wide gaps in South Africa’s formal social safety net, with the country’s high levels of inequality, unemployment and poor public infrastructure combining to produce devastating consequences for a vast majority in the country living through lockdown. In Cape Town, a movement of self-organising, neighbourhood-level community action networks (CANs) has contributed significantly to the community-based response to COVID-19 and the ensuing epidemiological and social challenges it has wrought. This article describes and explains the organising principles that inform this community response, with the view to reflect on the possibilities and limits of such movements as they interface with the state and its top-down ways of working, often producing contradictions and complexities. This presents an opportunity for recognising and understanding the power of informal networks and collective action in community health systems in times of unprecedented crisis, and brings into focus the importance of finding ways to engage with the state and its formal health system response that do not jeopardise this potential.

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