scholarly journals Metrics for Outpatient Portal Use Based on Log File Analysis: Algorithm Development

10.2196/16849 ◽  
2020 ◽  
Vol 22 (6) ◽  
pp. e16849
Author(s):  
Gennaro Di Tosto ◽  
Ann Scheck McAlearney ◽  
Naleef Fareed ◽  
Timothy R Huerta
Keyword(s):  
Medical Information ◽  
Medical Center ◽  
Academic Medical Center ◽  
Time Frame ◽  
Median Number ◽  
Patient Portal ◽  
Record System ◽  
User Interactions ◽  
Methodological Choices ◽  
Log File

Background Web-based outpatient portals help patients engage in the management of their health by allowing them to access their medical information, schedule appointments, track their medications, and communicate with their physicians and care team members. Initial studies have shown that portal adoption positively affects health outcomes; however, early studies typically relied on survey data. Using data from health portal applications, we conducted systematic assessments of patients’ use of an outpatient portal to examine how patients engage with the tool. Objective This study aimed to document the functionality of an outpatient portal in the context of outpatient care by mining portal usage data and to provide insights into how patients use this tool. Methods Using audit log files from the outpatient portal associated with the electronic health record system implemented at a large multihospital academic medical center, we investigated the behavioral traces of a study population of 2607 patients who used the portal between July 2015 and February 2019. Patient portal use was defined as having an active account and having accessed any portal function more than once during the study time frame. Results Through our analysis of audit log file data of the number and type of user interactions, we developed a taxonomy of functions and actions and computed analytic metrics, including frequency and comprehensiveness of use. We additionally documented the computational steps required to diagnose artifactual data and arrive at valid usage metrics. Of the 2607 patients in our sample, 2511 were active users of the patients portal where the median number of sessions was 94 (IQR 207). Function use was comprehensive at the patient level, while each session was instead limited to the use of one specific function. Only 17.45% (78,787/451,762) of the sessions were linked to activities involving more than one portal function. Conclusions In discussing the full methodological choices made in our analysis, we hope to promote the replicability of our study at other institutions and contribute to the establishment of best practices that can facilitate the adoption of behavioral metrics that enable the measurement of patient engagement based on the outpatient portal use.

scholarly journals Metrics for Outpatient Portal Use Based on Log File Analysis: Algorithm Development (Preprint)

2019 ◽  
Author(s):  
Gennaro Di Tosto ◽  
Ann Scheck McAlearney ◽  
Naleef Fareed ◽  
Timothy R Huerta
Keyword(s):  
Medical Information ◽  
Medical Center ◽  
Academic Medical Center ◽  
Time Frame ◽  
Median Number ◽  
Patient Portal ◽  
Record System ◽  
User Interactions ◽  
Methodological Choices ◽  
Log File

BACKGROUND Web-based outpatient portals help patients engage in the management of their health by allowing them to access their medical information, schedule appointments, track their medications, and communicate with their physicians and care team members. Initial studies have shown that portal adoption positively affects health outcomes; however, early studies typically relied on survey data. Using data from health portal applications, we conducted systematic assessments of patients’ use of an outpatient portal to examine how patients engage with the tool. OBJECTIVE This study aimed to document the functionality of an outpatient portal in the context of outpatient care by mining portal usage data and to provide insights into how patients use this tool. METHODS Using audit log files from the outpatient portal associated with the electronic health record system implemented at a large multihospital academic medical center, we investigated the behavioral traces of a study population of 2607 patients who used the portal between July 2015 and February 2019. Patient portal use was defined as having an active account and having accessed any portal function more than once during the study time frame. RESULTS Through our analysis of audit log file data of the number and type of user interactions, we developed a taxonomy of functions and actions and computed analytic metrics, including frequency and comprehensiveness of use. We additionally documented the computational steps required to diagnose artifactual data and arrive at valid usage metrics. Of the 2607 patients in our sample, 2511 were active users of the patients portal where the median number of sessions was 94 (IQR 207). Function use was comprehensive at the patient level, while each session was instead limited to the use of one specific function. Only 17.45% (78,787/451,762) of the sessions were linked to activities involving more than one portal function. CONCLUSIONS In discussing the full methodological choices made in our analysis, we hope to promote the replicability of our study at other institutions and contribute to the establishment of best practices that can facilitate the adoption of behavioral metrics that enable the measurement of patient engagement based on the outpatient portal use.

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

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.

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

JAMIA Open ◽  
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.

Abstract P257: Getting to the Golden Hour: Correlating “Door-To” Times with 60-Minute Administration of tPA in an Academic Medical Center

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Ann M Leonhardt ◽  
Curtis G Benesch ◽  
Kate C Young
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Rank Correlation ◽  
Correlation Coefficients ◽  
Time Frame ◽  
Arrival Times ◽  
Golden Hour ◽  
Stroke Team ◽  
Time Standards ◽  
Scheduling Protocols

Introduction: The efficacy of intravenous tPA for the treatment of acute stroke diminishes over time. The AHA/ASA and NINDS recommend a goal door to needle time of 60 minutes or less. Objective: Identify potential barriers to tPA administration within 60 minutes of arrival. Methods: Retrospective review of tPA adsinistration using “Get With the Guidelines” (GWTG) and institutional records from January 1, 2009 through December 31, 2010 (n=100). Spearman rank correlation coefficients were calculated for the NINDS recommended time standards, age and NIH Stroke Scale (NIHSS) score. We used a receiver-operator curve (ROC) to identify the door to CT time predictive of tPA administration ≤ 60 minutes. Results: Median door to physician, door to CT, and door to stroke team times were within the recommended goals. Door to CT (ρ=0.53, p<0.0001), and door to stroke team (ρ=0.33, p<0.01) times were positively correlated with door to tPA times. Last known well to arrival (ρ= -0.28, p<0.01) and NIHSS (ρ= -0.32, p<0.01) were negatively correlated with door to tPA times; patients with higher NIHSS and longer last-known-well to arrival times received tPA in a shorter time frame. Age and door to physician time were not correlated with tPA treatment times. After adjusting for the other benchmarks and NIHSS, only door to CT remained significantly correlated with door to IV tPA (partial correlation coefficient=0.40, p<0.001). The ROC curve showed that a goal time of 20 minutes or less for door to CT initiation had the best sensitivity and specificity for predicting tPA administration within 60 minutes. Conclusion: In keeping with the recommended time goals, median times for the intermediate steps were within target. Our median tPA times, however, did not meet the 60 minute goal. Door to CT initiation was the variable that most strongly correlated with door to needle times. Process issues such as order entry and scheduling protocols may be barriers to obtaining CT within the 20 minute time frame identified by our analysis. Other barriers after the CT scan is obtained must be identified to facilitate faster tPA administration. Further evaluation of these factors is warranted to better ensure the timely delivery of tPA to stroke patients, thereby improving patient outcomes.

Clinicians Are From Mars and Pathologists Are From Venus

2000 ◽  
Vol 124 (7) ◽  
pp. 1040-1046 ◽  
Author(s):  
Seth M. Powsner ◽  
José Costa ◽  
Robert J. Homer
Keyword(s):  
Medical Errors ◽  
Medical Information ◽  
Potential Problem ◽  
Medical Center ◽  
Academic Medical Center ◽  
Open Book ◽  
Surgical Experience ◽  
Academic Medical ◽  
Pathology Reports ◽  
Attending Physicians

Abstract Context.—Text reports convey critical medical information from pathologists, radiologists, and subspecialty consultants. These reports must be clear and comprehensible to avoid medical errors. Pathologists have paid much attention to report completeness but have ignored the corresponding issue of report comprehension. This situation presents an increasingly serious potential problem. As laboratories are consolidated and as reports are disseminated in new ways (eg, via the World Wide Web), the target audience becomes more diverse and less likely to have any contact with pathologists beyond the written reports themselves. Objective.—To compare clinician comprehension with pathologist intent in written pathology reports. Methods.—Typical surgical pathology reports relevant to surgeons and covering a range of specimen complexity were taken from our hospital files. Questionnaires based on these cases were administered open-book-examination style to surgical attending physicians and trainees during surgical conferences at an academic medical center. Main Outcome Measures.—Scores from questionnaires. Results.—Surgeons misunderstood pathologists' reports 30% of the time. Surgical experience reduced but did not eliminate the problem. Streamlined report formatting exacerbated the problem. Conclusions.—A communication gap exists between pathologists and surgeons. Familiarity with report format and clinical experience help reduce this gap. Paradoxically, stylistic improvements to report formatting can interfere with comprehension and increase the number of misunderstandings. Further investigation is required to reduce the number of misunderstandings and, thus, medical errors.

In-Practice Endocrine Surgery Fellowship: A Novel Training Model

2020 ◽  
pp. 019459982096279
Author(s):  
Hien T. Tierney ◽  
Leslie S. Eldeiry ◽  
Jeffrey R. Garber ◽  
Chia A. Haddad ◽  
Mark A. Varvares ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Medical Center ◽  
Academic Medical Center ◽  
Training Model ◽  
Time Frame ◽  
Fellowship Training ◽  
Endocrine Surgery ◽  
Community Practice ◽  
Senior Surgeon ◽  
Academic Medical

Objective Endocrine surgery is an expanding field within otolaryngology. We hypothesized that a novel endocrine surgery fellowship model for in-practice otolaryngologists could result in expert-level training. Study Design Qualitative clinical study with chart review. Setting Urban community practice and academic medical center. Methods Two board-certified general otolaryngologists collaborated with a senior endocrine surgeon to increase their endocrine surgery expertise between March 2015 and December 2017. The senior surgeon provided intensive surgical training to both surgeons for all of their endocrine surgeries. Both parties collaborated with endocrinology to coordinate medical care and receive referrals. All patients undergoing endocrine surgery during this time frame were reviewed retrospectively. Results A total of 235 endocrine surgeries were performed. Of these, 198 thyroid surgeries were performed, including 98 total thyroidectomies (48%), 90 lobectomies (45%), and 10 completion thyroidectomies (5%). Sixty cases demonstrated papillary thyroid carcinoma, 11 follicular thyroid carcinoma, and 4 medullary thyroid carcinoma. Neck dissections were performed in 14 of the cases. Thirty-seven parathyroid explorations were performed. There were no reports of permanent hypoparathyroidism. Thirteen patients (5.5%) developed temporary hypoparathyroidism. Six patients (2.5%) developed postoperative seroma. Three patients (1.3%) developed postoperative hematomas requiring reoperation. One patient (0.4%) developed permanent vocal fold paralysis, and 3 patients (1.3%) had temporary dysphonia. Thirty-five of 37 (94.5%) parathyroid explorations resulted in biochemical resolution of the patient’s primary hyperparathyroidism. Conclusion This is the first description of a new fellowship paradigm where a senior surgeon provides fellowship training to attending surgeons already in practice.

scholarly journals Electronic Health Record Adoption – Maybe It’s not about the Money

2011 ◽  
Vol 02 (04) ◽  
pp. 460-471 ◽  
Author(s):  
A. Skinner ◽  
J. Windle ◽  
L. Grabenbauer
Keyword(s):  
Electronic Health Record ◽  
Patient Care ◽  
Resistance To Change ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Physician ◽  
Health Record ◽  
Record System ◽  
Intuitive Interfaces ◽  
Electronic Health

SummaryObjective: The slow adoption of electronic health record (EHR) systems has been linked to physician resistance to change and the expense of EHR adoption. This qualitative study was conducted to evaluate benefits, and clarify limitations of two mature, robust, comprehensive EHR Systems by tech-savvy physicians where resistance and expense are not at issue.Methods: Two EHR systems were examined – the paperless VistA / Computerized Patient Record System used at the Veterans‘ Administration, and the General Electric Centricity Enterprise system used at an academic medical center. A series of interviews was conducted with 20 EHR-savvy multi-institutional internal medicine (IM) faculty and house staff. Grounded theory was used to analyze the transcribed data and build themes. The relevance and importance of themes were constructed by examining their frequency, convergence, and intensity.Results: Despite eliminating resistance to both adoption and technology as drivers of acceptance, these two robust EHR’s are still viewed as having an adverse impact on two aspects of patient care, physician workflow and team communication. Both EHR’s had perceived strengths but also significant limitations and neither were able to satisfactorily address all of the physicians’ needs.Conclusion: Difficulties related to physician acceptance reflect real concerns about EHR impact on patient care. Physicians are optimistic about the future benefits of EHR systems, but are frustrated with the non-intuitive interfaces and cumbersome data searches of existing EHRs.

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

2020 ◽  
Vol 27 (7) ◽  
pp. 1116-1120 ◽  
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.

scholarly journals Aprepitant and Fosaprepitant Use in Children and Adolescents at an Academic Medical Center

2014 ◽  
Vol 19 (2) ◽  
pp. 127-131 ◽  
Author(s):  
Alexandra Shillingburg ◽  
Lisa Biondo
Keyword(s):  
Children And Adolescents ◽  
Pediatric Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Primary Prophylaxis ◽  
Emetogenic Chemotherapy ◽  
Record System ◽  
Patients Âgés ◽  
Academic Medical

OBJECTIVE: To describe the use of aprepitant and fosaprepitant, a neurokinin 1 (NK-1) receptor inhibitor, in children and adolescents at a large academic medical center, for the prevention and management of chemotherapy-induced nausea and vomiting (CINV). METHODS: A retrospective chart review was conducted using an electronic medical record system to evaluate the use of aprepitant and fosaprepitant in all pediatric patients that were discharged from a single academic medical center between February 25, 2009 and May 25, 2012. RESULTS: Twenty-six patients were included in this review and received a total of 287 doses over the span of 114 cycles. Mean age was 10.1 years, with a range of 11 months to 17 years old. In 16 of 26 patients, aprepitant was used as the primary prophylaxis. Of those patients who received primary prophylaxis, 6 of 16 received it for highly emetogenic chemotherapy, and 10 of 16 received it for moderately emetogenic chemotherapy. Intravenous fosaprepitant was used in 7 of 26 patients, ages 13 to 17 (median 14) years old. No adverse effects attributable to aprepitant were reported. CONCLUSIONS: Use of aprepitant and fosaprepitant in pediatric patients appeared to be well tolerated. No currently published reports data using aprepitant in a patient younger than 32 months old, whereas we reported its use in patients as young as 11 months old.

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