scholarly journals Patient Portal Implementation and Uptake: Qualitative Comparative Case Study

10.2196/18973 ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. e18973 ◽  
Author(s):  
Melita Avdagovska ◽  
Mark Ballermann ◽  
Karin Olson ◽  
Timothy Graham ◽  
Devidas Menon ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Current Status ◽  
Comparative Case Study ◽  
Patient Portal ◽  
Care Providers ◽  
Patient Portals ◽  
National Goal ◽  
Patient Centered ◽  
The Impact

Background Giving patients access to their health information is a provincial and national goal, and it is critical to the delivery of patient-centered care. With this shift, patient portals have become more prevalent. In Alberta, the Alberta Health Services piloted a portal (MyChart). There was a need to identify factors that promoted the use of this portal. Furthermore, it was imperative to understand why there was variability in uptake within the various clinics that participated in the pilot. Objective This study aims to identify potential factors that could improve the uptake of MyChart from the perspectives of both users and nonusers at pilot sites. We focused on factors that promoted the use of MyChart along with related benefits and barriers to its use, with the intention that this information could be incorporated into the plan for its province-wide implementation. Methods A qualitative comparative case study was conducted to determine the feasibility, acceptability, and initial perceptions of users and to identify ways to increase uptake. Semistructured interviews were conducted with 56 participants (27 patients, 21 providers, 4 nonmedical staff, and 4 clinic managers) from 5 clinics. Patients were asked about the impact of MyChart on their health and health care. Providers were asked about the impact on the patient-provider relationship and workflow. Managers were asked about barriers to implementation. The interviews were recorded, transcribed verbatim, and entered into NVivo. A thematic analysis was used to analyze the data. Results Results from a comparison of factors related to uptake of MyChart in 5 clinics (2 clinics with high uptake, 1 with moderate uptake, 1 with low uptake, and 1 with no uptake) are reported. Some theoretical constructs in our study, such as intention to use, perceived value, similarity (novelty) of the technology, and patient health needs, were similar to findings published by other research teams. We also identified some new factors associated with uptake, including satisfaction or dissatisfaction with the current status quo, performance expectancy, facilitating conditions, behavioral intentions, and use behavior. All these factors had an impact on the level of uptake in each setting and created different opportunities for end users. Conclusions There is limited research on factors that influence the uptake of patient portals. We identified some factors that were consistent with those reported by others but also several new factors that were associated with the update of MyChart, a new patient portal, in the clinics we studied. On the basis of our results, we posit that a shared understanding of the technology among patients, clinicians, and managers, along with dissatisfaction with nonportal-based communications, is foundational and must be addressed for patient portals to support improvements in care.

scholarly journals Patient Portal Implementation and Uptake: Qualitative Comparative Case Study (Preprint)

2020 ◽  
Author(s):  
Melita Avdagovska ◽  
Mark Ballermann ◽  
Karin Olson ◽  
Timothy Graham ◽  
Devidas Menon ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Current Status ◽  
Comparative Case Study ◽  
Patient Portal ◽  
Care Providers ◽  
Patient Portals ◽  
National Goal ◽  
Patient Centered ◽  
The Impact

BACKGROUND Giving patients access to their health information is a provincial and national goal, and it is critical to the delivery of patient-centered care. With this shift, patient portals have become more prevalent. In Alberta, the Alberta Health Services piloted a portal (MyChart). There was a need to identify factors that promoted the use of this portal. Furthermore, it was imperative to understand why there was variability in uptake within the various clinics that participated in the pilot. OBJECTIVE This study aims to identify potential factors that could improve the uptake of MyChart from the perspectives of both users and nonusers at pilot sites. We focused on factors that promoted the use of MyChart along with related benefits and barriers to its use, with the intention that this information could be incorporated into the plan for its province-wide implementation. METHODS A qualitative comparative case study was conducted to determine the feasibility, acceptability, and initial perceptions of users and to identify ways to increase uptake. Semistructured interviews were conducted with 56 participants (27 patients, 21 providers, 4 nonmedical staff, and 4 clinic managers) from 5 clinics. Patients were asked about the impact of MyChart on their health and health care. Providers were asked about the impact on the patient-provider relationship and workflow. Managers were asked about barriers to implementation. The interviews were recorded, transcribed verbatim, and entered into NVivo. A thematic analysis was used to analyze the data. RESULTS Results from a comparison of factors related to uptake of MyChart in 5 clinics (2 clinics with high uptake, 1 with moderate uptake, 1 with low uptake, and 1 with no uptake) are reported. Some theoretical constructs in our study, such as intention to use, perceived value, similarity (novelty) of the technology, and patient health needs, were similar to findings published by other research teams. We also identified some new factors associated with uptake, including satisfaction or dissatisfaction with the current status quo, performance expectancy, facilitating conditions, behavioral intentions, and use behavior. All these factors had an impact on the level of uptake in each setting and created different opportunities for end users. CONCLUSIONS There is limited research on factors that influence the uptake of patient portals. We identified some factors that were consistent with those reported by others but also several new factors that were associated with the update of MyChart, a new patient portal, in the clinics we studied. On the basis of our results, we posit that a shared understanding of the technology among patients, clinicians, and managers, along with dissatisfaction with nonportal-based communications, is foundational and must be addressed for patient portals to support improvements in care.

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

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.

scholarly journals Viewpoint: Health literacy and patient portals

2015 ◽  
Vol 7 (2) ◽  
pp. 172 ◽  
Author(s):  
Yulong Gu ◽  
Martin Orr ◽  
Jim Warren
Keyword(s):  
Health Care ◽  
Health Literacy ◽  
Health Information ◽  
Health Care Providers ◽  
Easy Access ◽  
Patient Portal ◽  
Care Providers ◽  
Patient Portals ◽  
Health Consumer ◽  
Improve Patient

Health literacy has been described as the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. Improving health literacy may serve to promote concordance with therapy, engage patients in their own health care, and improve health outcomes. Patient portal technology aims at enabling patients and families to have easy access to key information in their own medical records and to communicate with their health care providers electronically. However, there is a gap in our understanding of how portals will improve patient outcome. The authors believe patient portal technology presents an opportunity to improve patient concordance with prescribed therapy, if adequate support is provided to equip patients (and family/carers) with the knowledge needed to utilise the health information available via the portals. Research is needed to understand what a health consumer will use patient portals for and how to support a user to realise the technology?s potential.

Interprofessional Intervention to Support Mature Women: A Case Study

2015 ◽  
Vol 21 (3) ◽  
pp. 134-143 ◽  
Author(s):  
Judith M. Pechacek ◽  
Diana Drake ◽  
Carrie Ann Terrell ◽  
Carolyn Torkelson
Keyword(s):  
Women’S Health ◽  
Women's Health ◽  
Health Care Providers ◽  
Interprofessional Education ◽  
Well Being ◽  
Collaborative Practice ◽  
Health Needs ◽  
Care Providers ◽  
The Impact

Understanding the impact interprofessional teamwork has on patient outcomes is of great interest to health care providers, educators, and administrators. This article describes one clinical team, Women’s Health Specialists, and their implementation of an interprofessional health intervention course: “Mindfulness and Well-being: The Mature Woman” (MW: MW) to support mature women’s health needs in midlife (age 40–70 years) and empower patient involvement in self-care. The provider team works to understand how their interprofessional education and collaborative practice (IPECP) interventions focused on supporting midlife women are associated with improved quality and clinical outcomes. This case study describes the work of the Women’s Health Specialists clinic in partnership with the National Center for Interprofessional Education and Collaborative Practice to study the impact an interprofessional team has on the health needs of women in midlife. This article summarizes the project structure, processes, outputs, and outcomes. Data collection, analysis, strategy, and next steps for future midlife women’s projects are also discussed.

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 Care Pathways in Persistent Orofacial Pain

2016 ◽  
Vol 2 (1) ◽  
pp. 48-57 ◽  
Author(s):  
M. Breckons ◽  
S.M. Bissett ◽  
C. Exley ◽  
V. Araujo-Soares ◽  
J. Durham
Keyword(s):  
Health Care Providers ◽  
Orofacial Pain ◽  
Care Pathway ◽  
Comparative Method ◽  
Qualitative Interviews ◽  
Care Pathways ◽  
Care Providers ◽  
Patient Centered ◽  
Centered Care ◽  
The Impact

Persistent orofacial pain is relatively common and known to have an adverse effect on quality of life. Previous studies suggest that the current care pathway may be problematic, but it is not well understood which health services patients access and what their experience is. The aim of this study was to explore care pathways and their impact from the perspective of patients. Qualitative interviews were conducted with a maximum variation sample of patients recruited from primary (community based) and secondary (specialist hospital based) care in the United Kingdom. Questions focused on the stages in their pathway and the impact of the care that they had received. Interviews were digitally recorded and transcribed verbatim, and analysis followed principles of the constant comparative method. NVivo 10 was used to help organize and analyze data. Twenty-two patients were interviewed at baseline, and 18 took part in a second interview at 12 mo. Three main themes emerged from the data: the “fluidity of the care pathway,” in which patients described moving among health care providers in attempts to have their pain diagnosed and managed, occurring alongside a “failure to progress,” where despite multiple appointments, patients described frustration at delays in obtaining a diagnosis and effective treatment for their pain. Throughout their care pathways, patients described the “effects of unmanaged pain,” where the longer the pain went unmanaged, the greater its potential to negatively affect their lives. Findings of this study suggest that the current care pathway is inefficient and fails to meet patient needs. Future work needs to focus on working with stakeholder groups to redesign patient-centered care pathways. Knowledge Transfer Statement: Data from qualitative interviews conducted with patients with persistent orofacial pain suggest significant problems with the existing care pathway, consisting of delays to diagnosis, treatment, and referral. Patients describing their struggle to progress through the current care pathway highlighted the difficulties occurring while living with orofacial pain. This study suggests a need for a revised care pathway, which better meets the needs of people with persistent orofacial pain.

Communicating Oncologic Prognosis With Empathy: A Pilot Study of a Novel Communication Guide

2020 ◽  
Vol 37 (12) ◽  
pp. 1029-1036
Author(s):  
Megan Lippe ◽  
Phillips Farya ◽  
McCulloch Jennifer ◽  
Alexandra Stanley ◽  
Jones Barbara ◽  
...  
Keyword(s):  
Pilot Study ◽  
Health Care Providers ◽  
Intervention Group ◽  
Care Providers ◽  
Communication Tool ◽  
Prognostic Information ◽  
Patient Centered ◽  
Incurable Cancer ◽  
Post Test ◽  
The Impact

Background: Clear communication between patients, families, and health-care providers is imperative to maximize patient outcomes, particularly for patients diagnosed with incurable cancer who require prompt engagement in decision-making. In response to the need to engage in quality patient-centered communication, an interprofessional team, representing medicine, nursing, social work, spiritual care, and clinical psychology, explored extant literature and developed a simple, single-page communication guide that summarizes the prognosis for patients with incurable cancers. The tool was specifically designed to enhance communication for patients, families, and across all members of the treatment and patient support team. Purpose: The purpose of this pilot study was to evaluate the impact of the communication guide on patient’s accurate understanding of prognosis and the feasibility and acceptability of the intervention. Methods: The study employed a sequential explanatory mixed-method design. Using pre- and post-tests, participants completed a prognosis and treatment perception survey and were randomized into control or intervention groups based on preference for prognostic information. The oncologist utilized the communication guide with the participants in the intervention group. Finally, 6-week post-test surveys were completed, followed by an exit interview. Results: Key findings revealed participants prefer receiving detailed information about prognosis and have differing perceptions compared to the oncologists. Understandings of prognosis for patients and oncologists became more congruent following use of the communication guide. Participants found the tool useful and helpful. Conclusions: The communication tool serves as a promising mechanism to enhance patient-centered communication about prognosis for patients with incurable cancer.

scholarly journals Factors Affecting Portal Usage Among Chronically Ill Patients During the COVID-19 Pandemic in the Netherlands: Cross-sectional Study (Preprint)

2020 ◽  
Author(s):  
Qingxia Kong ◽  
Danique Riedewald ◽  
Marjan Askari
Keyword(s):  
Health Care ◽  
Life Satisfaction ◽  
Health Status ◽  
Health Care Providers ◽  
Waiting Time ◽  
Chronically Ill ◽  
Patient Portal ◽  
Care Providers ◽  
Patient Portals ◽  
Willingness To Recommend

BACKGROUND The COVID-19 pandemic has impacted the capacity of the regular health care system, which is reflected in limited access to nonurgent care for patients who are chronically ill in the Dutch health care system. Nevertheless, many of them still depend on health care assistance to manage their illnesses. Patient portals are used to provide continued health care (remotely) and offer self-management tools during COVID-19 and potentially after. However, little is known about the factors influencing portal use and users’ satisfaction among patients who are chronically ill during the COVID-19 pandemic. OBJECTIVE This study aims to examine predictors of patient portal use among patients who are chronically ill, the willingness to recommend the portal to others, and the likelihood of future use among portal nonusers. METHODS An online self-administered questionnaire was distributed among patients who are chronically ill via social media in May 2020. The questionnaire consisted of four parts: (1) demographics including age and hours of daily internet use; (2) physical health status including COVID-19 infection, perceived level of control, and hospital visits; (3) mental health status including depression and life satisfaction; and (4) portal use including response waiting time and awareness. Descriptive, correlation, univariate, and multivariate analyses were conducted to identify factors that affect portal use, users’ willingness to recommend, and nonusers’ likelihood of future portal use. RESULTS A total of 652 patients responded, and 461 valid questionnaires were included. Among the 461 patients, 67% (n=307) were identified as patient portal users. Of the nonusers, 55% (85/154) reported not being aware of the existence of a patient portal at their hospital. Significant predictors of portal use include level of control (<i>P</i>=.04), hospital visit time (<i>P</i>=.03), depression scale (<i>P</i>=.03), and status of life satisfaction (<i>P</i>=.02). Among portal users, waiting time to get a response via the portal (<i>P</i>&lt;.001) and maximum acceptable waiting time (<i>P</i>&lt;.001) were the strongest predictors for willingness to recommend the portal; among nonusers, the model predicted that those who were not aware of patient portals (<i>P</i>&lt;.001) and were willing to wait moderately long (<i>P</i>&lt;.001) were most likely to use the portal in the future. CONCLUSIONS This study provides insights into factors that influence portal use and willingness to recommend, based on which health care providers can improve the adoption of patient portals and their services. It suggests that health care providers should leverage efficient operations management to improve responsiveness and reduce waiting time to enhance user satisfaction and willingness to recommend use. Health care organizations need to increase portal awareness among nonusers and train their patients to increase both use and longer adoption of patient portals. Factors including depression and life satisfaction can influence portal use; therefore, future studies on determinants of portal use and nonuse in this specific population are needed.

scholarly journals Development of an Educational Program to Increase Patient Involvement in a Healthcare Patient Portal: A Quality Improvement Project (Preprint)

2018 ◽  
Author(s):  
Cheryl Stone ◽  
Becky Faett ◽  
Kathy Magdic
Keyword(s):  
Quality Improvement ◽  
Health Care Providers ◽  
Nurse Practitioner ◽  
The United States ◽  
Quality Improvement Project ◽  
Patient Portal ◽  
Care Providers ◽  
Patient Portals ◽  
Convenience Sample ◽  
Improvement Project

BACKGROUND Efforts in the United States to improve patient engagement and communication with health care providers have led to the creation of the meaningful use program. [1] The Centers for Medicare and Medicaid Services have created a three-stage process to encourage the adoption and use of electronic health records (EHR). Benefits of EHR use include the ability to provide accurate, up-to-date, legible, and complete information about patients at the point of care. One important component of EHR is the patient portal. Patient portals provide 24-hour access to portions of a patient medical record as well as a secure pathway to send messages to providers, ask for refills of medications, and schedule appointments. OBJECTIVE To assess if patients who have not used the patient portal will engage in using the portal after an in-office orientation on how to access and the benefits of using the patient portal. METHODS A quality improvement project was performed using a convenience sample of 60 participants who were scheduled for an appointment in an outpatient cardiology office and had not accessed the patient portal in the past 12 months. The participants were given a survey regarding their computer and internet access as well as their level of comfort using a computer. Each participant was assisted in creating a username and password as well as a security question and answer. The participant then accessed the portal and navigated through the portal with the guidance of the nurse practitioner. They also sent a message via the portal to the provider they were assigned to that day. Each participant was given a pamphlet and a printed power point to reinforce what they had learned. After two months, the nurse practitioner accessed the portal to determine if the enrolled participants had accessed the portal. The reasons for access and frequency were recorded. If there was no access, the participant was called by the nurse practitioner to determine the reason they had not accessed the portal. RESULTS Of the 60 participants, 54% were women, 46% men, 93% were Caucasian. Fifty-six point seven accessed the portal from home. Reasons for access included: 85% reviewed labs, 53% reviewed messages sent to them from the office and 23% sent messages to the office. Twenty-four participants did not access the portal. Of those participants, 33% stated that they had no clear reason to access the portal, 25% stated that they forgot their login information and 17% stated they no interest in the portal. CONCLUSIONS Patient portals are a useful tool for communication between patients and their providers. Providing an in-office orientation to the portal increased patient access to the portal.

Positioning Microbicides for HIV Prevention in Kenya

2015 ◽  
Vol 21 (2) ◽  
pp. 100-114 ◽  
Author(s):  
Elizabeth Ryan ◽  
Emily Bockh ◽  
Elizabeth E. Tolley ◽  
Allison P. Pack ◽  
Caroline Mackenzie ◽  
...  
Keyword(s):  
Hiv Prevention ◽  
Health Care Providers ◽  
Evaluation Study ◽  
Sexual Pleasure ◽  
Care Providers ◽  
Educational Materials ◽  
Communication Challenges ◽  
Awareness Raising ◽  
The Impact

This case study describes the experience of developing communication messages and materials to position microbicide gel—a product still in clinical trials—for HIV prevention in Kenya. A robust development process included stakeholder and audience consultations, a national message development workshop, two rounds of pretesting, and an evaluation study to evaluate the impact of the materials on intentions and attitudes related to microbicide use. Awareness-raising and in-depth educational materials for both potential microbicide users and health care providers were developed. The project team tested two different ways of positioning microbicides—one focused primarily on the HIV prevention benefits of the product and the other focused on other benefits, such as increased sexual pleasure and intimacy. This experience presented a number of unique social marketing and communication challenges related to the inherent characteristics of microbicides, the fact that they are not yet licensed for use, and the potential for inadvertently stigmatizing the product and encouraging condom migration. The project confirmed that marketing microbicides to women in a wide variety of sexual contexts—and gaining support of male partners—will be critical for avoiding stigmatization of the product. It also confirmed that the positioning of the product can impact interest in using microbicides and that in-depth counseling of users will be critical for ensuring correct use.

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