scholarly journals The State of Evidence in Patient Portals: Umbrella Review

10.2196/23851 ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. e23851
Author(s):  
Marcy G Antonio ◽  
Olga Petrovskaya ◽  
Francis Lau
Keyword(s):  
Knowledge Translation ◽  
Systematic Reviews ◽  
Business Models ◽  
Digital Health ◽  
Patient Portal ◽  
Umbrella Review ◽  
Patient Portals ◽  
Meta Level ◽  
Patient Reported ◽  
Over Time

Background Patient portals have emerged as a recognized digital health strategy. To date, research on patient portals has grown rapidly. However, there has been limited evaluation of the growing body of evidence on portal availability, use, clinical or health behavior and outcomes, and portal adoption over time. Objective This paper aims to comprehensively consolidate the current state of evidence on patient portals using the umbrella review methodology, introduce our approach for evaluating evidence for quantitative and qualitative findings presented in included systematic reviews, and present a knowledge translation tool that can be used to inform all stages of patient portal adoption. Methods For this study, a modified version of the Joanna Briggs Institute umbrella review method was used. Multiple databases were searched for systematic reviews focused on patient portals, and the final sample included 14 reviews. We conducted a meta-level synthesis of findings from quantitative, qualitative, and mixed methods primary studies reported in systematic reviews. We organized the umbrella review findings according to the Clinical Adoption Meta-Model (CAMM). Vote-counting, GRADE (Grading of Recommendations, Assessment, Development, and Evaluations), and CERQual (Confidence in the Evidence from Review of Qualitative Research) were used to assess the umbrella review evidence. Results Our knowledge translation tool summarizes the findings in the form of an evidence map. Organized by the CAMM categories, the map describes the following factors that influence portal adoption and effects over time: patient contexts, patient's interest and satisfaction, portal design, facilitators and barriers, providers' attitudes, service utilization, behavioral effects, clinical outcomes, and patient-reported outcomes. The map lists the theories and mechanisms recognized in the included portal research while identifying the need for business models and organizational theories that can inform all stages of portal adoption. Our GRADE and CERQual umbrella review evaluation resulted in the majority of evidence being rated as moderate to low, which reflects methodological issues in portal research, insufficient number of studies, or mixed results in specific focus areas. The 2 findings with a high rating of evidence were patients' interest in using portals for communication and the importance of a simple display of information in the portals. Over 40 portal features were identified in the umbrella review, with communication through secure messaging and appointment booking mentioned in all systematic reviews. Conclusions Our umbrella review provides a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews. Unsystematic and variable reporting of portal features undermines the ability to evaluate and compare portal effects and overlooks the specific context of portal use. Research designs sensitive to the social, organizational, policy, and temporal dimensions are needed to better understand the underlying mechanisms and context that leverage the identified factors to improve portal use and effects.

scholarly journals The State of Evidence in Patient Portals: Umbrella Review (Preprint)

2020 ◽  
Author(s):  
Marcy G Antonio ◽  
Olga Petrovskaya ◽  
Francis Lau
Keyword(s):  
Knowledge Translation ◽  
Systematic Reviews ◽  
Business Models ◽  
Digital Health ◽  
Patient Portal ◽  
Umbrella Review ◽  
Patient Portals ◽  
Meta Level ◽  
Patient Reported ◽  
Over Time

BACKGROUND Patient portals have emerged as a recognized digital health strategy. To date, research on patient portals has grown rapidly. However, there has been limited evaluation of the growing body of evidence on portal availability, use, clinical or health behavior and outcomes, and portal adoption over time. OBJECTIVE This paper aims to comprehensively consolidate the current state of evidence on patient portals using the umbrella review methodology, introduce our approach for evaluating evidence for quantitative and qualitative findings presented in included systematic reviews, and present a knowledge translation tool that can be used to inform all stages of patient portal adoption. METHODS For this study, a modified version of the Joanna Briggs Institute umbrella review method was used. Multiple databases were searched for systematic reviews focused on patient portals, and the final sample included 14 reviews. We conducted a meta-level synthesis of findings from quantitative, qualitative, and mixed methods primary studies reported in systematic reviews. We organized the umbrella review findings according to the Clinical Adoption Meta-Model (CAMM). Vote-counting, GRADE (Grading of Recommendations, Assessment, Development, and Evaluations), and CERQual (Confidence in the Evidence from Review of Qualitative Research) were used to assess the umbrella review evidence. RESULTS Our knowledge translation tool summarizes the findings in the form of an evidence map. Organized by the CAMM categories, the map describes the following factors that influence portal adoption and effects over time: patient contexts, patient's interest and satisfaction, portal design, facilitators and barriers, providers' attitudes, service utilization, behavioral effects, clinical outcomes, and patient-reported outcomes. The map lists the theories and mechanisms recognized in the included portal research while identifying the need for business models and organizational theories that can inform all stages of portal adoption. Our GRADE and CERQual umbrella review evaluation resulted in the majority of evidence being rated as moderate to low, which reflects methodological issues in portal research, insufficient number of studies, or mixed results in specific focus areas. The 2 findings with a high rating of evidence were patients' interest in using portals for communication and the importance of a simple display of information in the portals. Over 40 portal features were identified in the umbrella review, with communication through secure messaging and appointment booking mentioned in all systematic reviews. CONCLUSIONS Our umbrella review provides a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews. Unsystematic and variable reporting of portal features undermines the ability to evaluate and compare portal effects and overlooks the specific context of portal use. Research designs sensitive to the social, organizational, policy, and temporal dimensions are needed to better understand the underlying mechanisms and context that leverage the identified factors to improve portal use and effects.

scholarly journals Synthesising evidence on patient portals: a protocol for an umbrella review

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e024469 ◽  
Author(s):  
Olga Petrovskaya ◽  
Francis Lau ◽  
Marcy Antonio
Keyword(s):  
Delphi Study ◽  
Data Extraction ◽  
Final Report ◽  
Patient Portal ◽  
Umbrella Review ◽  
Patient Portals ◽  
Assessment Development ◽  
Meta Level ◽  
Ethical Approval ◽  
Table Data

IntroductionOver the last two decades, patient portals have emerged as a noticeable eHealth strategy. To date, research on patient portals has been rapidly increasing. Our umbrella review aims to provide a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews (SRs).MethodsWe will employ a modified version of the Joanna Briggs Institute umbrella review method. The search strategy encompasses multiple databases. The inclusion criterion is specific to SRs focused on patient portal. Patients or public were not involved in this work.AnalysisTwo researchers will independently screen titles/abstracts and then full-text articles against the inclusion/exclusion criteria. Methodological quality of included reviews will be assessed and data will be extracted from the final selection of reviews. These reviews will be categorised into quantitative, qualitative and/or mixed-synthesis groups based on information about the design of primary studies provided in the reviews. Correspondingly, we will create quantitative, qualitative and/or mixed-synthesis Excel data-extraction tables. Within each table, data will be extracted with the reference to primary studies as reported in the reviews, and will be synthesised into themes and then a smaller number of findings/outcomes. Modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) and Confidence in the Evidence from Reviews of Qualitative research (CERQual) tools will be applied to assess the strength of evidence at the level of each finding/outcome. The output of our umbrella review will consist of summary of findings tables and evidence profile tables. A narrative meta-level synthesis will be provided. We will use the clinical adoption meta-model as an organising framework.Ethics and disseminationAs an outcome of this review, we will create a guidance and roadmap to be used in a future Delphi study to gather feedback from Canadian eHealth stakeholders. We will also present at conferences and publish the final report. The umbrella review does not require ethical approval.PROSPERO registration numberCRD42018096657.

scholarly journals Refilling medications through an online patient portal: consistent improvements in adherence across racial/ethnic groups

2015 ◽  
Vol 23 (e1) ◽  
pp. e28-e33 ◽  
Author(s):  
Courtney R. Lyles ◽  
Urmimala Sarkar ◽  
Dean Schillinger ◽  
James D. Ralston ◽  
Jill Y. Allen ◽  
...  
Keyword(s):  
Medication Adherence ◽  
Health Behaviors ◽  
Ethnic Groups ◽  
Patient Portal ◽  
Patient Portals ◽  
Statin Adherence ◽  
Changes Over Time ◽  
Racial Ethnic ◽  
Over Time ◽  
Diabetes Patients

Abstract Objective Online patient portals are being widely implemented; however, no studies have examined whether portals influence health behaviors or outcomes similarly across patient racial/ethnic subgroups. We evaluated longitudinal changes in statin adherence to determine whether racial/ethnic minorities initiating use of the online refill function in patient portals had similar changes over time compared with Whites. Methods We examined a retrospective cohort of diabetes patients who were existing patient portal users. The primary exposure was initiating online refill use (either exclusively for all statin refills or occasionally for some refills), compared with using the portal for other tasks (eg, exchanging secure messages with providers). The primary outcome was change in statin adherence, measured as the percentage of time a patient was without a supply of statins. Adjusted generalized estimating equation models controlled for race/ethnicity as a primary interaction term. Results Fifty-eight percent of patient portal users were white, and all racial/ethnic minority groups had poorer baseline statin adherence compared with Whites. In adjusted difference-in-difference models, statin adherence improved significantly over time among patients who exclusively refilled prescriptions online, even after comparing changes over time with other portal users (4% absolute decrease in percentage of time without medication). This improvement was statistically similar across all racial/ethnic groups. Discussion Patient portals may encourage or improve key health behaviors, such as medication adherence, for engaged patients, but further research will likely be required to reduce underlying racial/ethnic differences in adherence. Conclusion In a well-controlled examination of diabetes patients’ behavior when using a new online feature for their healthcare management, patient portals were linked to better medication adherence across all racial/ethnic groups.

scholarly journals Mobile Access and Adoption of the Swedish National Patient Portal

2020 ◽  
Author(s):  
Maria Hägglund ◽  
Charlotte Blease ◽  
Isabella Scandurra
Keyword(s):  
Mobile Phone ◽  
Real World ◽  
Health Record ◽  
Patient Portal ◽  
Patient Portals ◽  
Real World Data ◽  
Mobile Access ◽  
National Patient ◽  
Administrative Tasks ◽  
Over Time

Patient portals are used as a means to facilitate communication, performing administrative tasks, or accessing one’s health record. In a retrospective analysis of real-world data from the Swedish National Patient Portal 1177.se, we describe the rate of adoption over time, as well as how patterns of device usage have changed over time. In Jan 2013, 53% of all visits were made from a computer, and 38% from a mobile phone. By June 2020, 77% of all visits were made from a mobile phone and only 20% from a computer. These results underline the importance of designing responsive patient portals that allow patients to use any device without losing functionality or usability.

scholarly journals P356 A comparison of innovative strategies to promote engagement with an IBD patient portal

2021 ◽  
Vol 15 (Supplement_1) ◽  
pp. S376-S377
Author(s):  
S Carlson ◽  
S McCartney ◽  
P Harrow
Keyword(s):  
Patient Satisfaction ◽  
Patient Engagement ◽  
High Intensity ◽  
Intervention Group ◽  
Patient Portal ◽  
Healthcare Outcomes ◽  
Patient Portals ◽  
Quality Of Data ◽  
Low Intensity ◽  
Patient Reported

Abstract Background Patient portals are available on most major electronic health record (EHR) platforms and present many opportunities to improve patient engagement with services, the quality of data captured and therefore healthcare outcomes and patient satisfaction. Our centre looks after 5100 patients with IBD. We recently adopted the EPIC Systems patient portal MyChart which allows patients to view results, letters and complete patient reported outcomes (PRO). At baseline, few patients were registered for this platform. Our aim was to compare patient engagement with MyChart using a low and higher cost approach and to evaluate patient satisfaction with the platform. Methods 160 consecutive patients were invited to join MyChart between September and October 2020. The low-intensity intervention group were invited to join MyChart via a standardised email without further communication. Newly registered patients and active patients were sent a portal message with disease-specific PRO questionnaire 7 days prior to clinic (HBI, SCCAI and IBD Control). Patients in the high-intensity intervention group received a telephone reminder to encourage completion at each step, which took on average 2 minutes, in addition to email. Engagement with the platform was measured prospectively. After clinic a patient-experience questionnaire was sent to all patients who signed up to the platform. Results 72 patients were included in the low intensity group and 88 in the high intensity group. At baseline only 33% patients were already signed up to MyChart. Significantly more patients newly registered with the patient portal following the high intensity intervention compared to the low (75% vs. 30%, p <0.0001). Overall, patients in the high intensity group were significantly more likely to complete the PRO compared to the low (53% vs. 28%, p=0.002). Patients already registered were 5 times more likely to complete the PRO in the high intensity group compared to low (p=0.017). Platform engagement was not significantly impacted by gender or ethnicity. There was a trend toward lower engagement in patients over 65. 63 patients provided feedback. 87% found MyChart easy to use and 94% said they would complete the PRO questionnaires again. Conclusion In our patient cohort, a higher intensity strategy significantly increased patient registration and engagement with a new patient portal at a minimal cost of time and resource. Healthcare providers can facilitate patient engagement with patient portals and overcome barriers to adoption to unlock transformative opportunities for better quality IBD care, disease monitoring and population-based research.

scholarly journals Using the Computer-based Health Evaluation System (CHES) to support self-management of symptoms and functional health: Evaluation of hematological patients’ usage of a web-based patient portal (Preprint)

2020 ◽  
Author(s):  
Jens Lehmann ◽  
Petra Buhl ◽  
Johannes M Giesinger ◽  
Lisa M Wintner ◽  
Monika Sztankay ◽  
...  
Keyword(s):  
Evaluation System ◽  
Functional Health ◽  
Self Management ◽  
Health Evaluation ◽  
Patient Portal ◽  
Structured Interviews ◽  
Patient Portals ◽  
Web Based ◽  
Patient Reported ◽  
Hospital Visits

BACKGROUND Patient portals offer the possibility to assess patient-reported outcome measures (PROMs) remotely and first evidence has demonstrated their potential benefits. OBJECTIVE In this study, we evaluated patients’ use of a web-based patient portal where patients can complete PROMs. The portal was developed to supplement routine monitoring at the Department of Internal Medicine V in Innsbruck. METHODS We included patients with cancer who were already participating in the monitoring at the hospital for usage of the patient portal. Patients were introduced to the portal and asked to complete questionnaires prior to their next hospital visits. We used system access logs and three consecutive semi-structured interviews to analyze patients’ usage and evaluation of the portal. RESULTS Between July 2017 and August 2020, we approached N=122 patients for participation in the study, of whom n=102 (83.6%) consented to use the patient portal. Patients were on average 60 (SD 10.4) years old. Of n=71 patients providing data at all study time points, n=26 (36.6%) patients consistently used the portal prior to their hospital visits. During an average session, patients viewed 5.3 different pages and spent 9.4 minutes logged on to the portal. Feedback from interviews was largely positive with no patients reporting difficulties navigating the survey and 50% of patients valuing the self-management tools provided in the portal. CONCLUSIONS Our study demonstrates how a patient portal can complement a routine PROM implementation at the hospital by reducing the burden of administration for the clinical team and offering an additional way for patients to engage with PROMs.

scholarly journals Feasibility of an Interactive Patient Portal for Monitoring Physical Activity, Remote Symptom Reporting, and Patient Education in Oncology: Qualitative Study (Preprint)

2019 ◽  
Author(s):  
Michael Marthick ◽  
Anna Janssen ◽  
Birinder S Cheema ◽  
Jennifer Alison ◽  
Tim Shaw ◽  
...  
Keyword(s):  
Physical Activity ◽  
Digital Health ◽  
Symptom Reporting ◽  
Patient Portal ◽  
Semistructured Interview ◽  
Web Portal ◽  
Patient Portals ◽  
Web Based ◽  
Qualitative Thematic Analysis ◽  
The Web

BACKGROUND Digital health interventions, such as the use of patient portals, have been shown to offer benefits to a range of patients including those with a diagnosis of cancer. OBJECTIVE This study aimed to explore the participant experience and perception of using an interactive Web-based portal for monitoring physical activity, remote symptom reporting, and delivering educational components. METHODS Participants who were currently under treatment or had recently completed intensive treatment for cancer were recruited to three cohorts and invited to join a Web-based portal to enhance their physical activity. Cohort 1 received Web portal access and an activity monitor; cohort 2 had additional summative messaging; and cohort 3 had additional personalized health coaching messaging. Following the 10-week intervention, participants were invited to participate in a semistructured interview. Interview recordings were transcribed and evaluated using qualitative thematic analysis. RESULTS A total of 17 semistructured interviews were carried out. Participants indicated that using the Web portal was feasible. Personalized messaging improved participant perceptions of the value of the intervention. There was a contrast between cohorts and levels of engagement with increasing health professional contact leading to an increase in engagement. Educational material needs to be tailored to the participants’ cancer treatment status, health literacy, and background. CONCLUSIONS Participants reported an overall positive experience using the Web portal and that personalized messaging positively impacted on their health behaviors. Future studies should focus more on design of interventions, ensuring appropriate tailoring of information and personalization of behavioral support messaging.

scholarly journals Patterns in Patient Access and Utilization of Online Medical Records: Analysis of MyChart (Preprint)

2017 ◽  
Author(s):  
Donald A Redelmeier ◽  
Nicole C Kraus
Keyword(s):  
Trend Analysis ◽  
Time Trend ◽  
Medical Information ◽  
Patient Portal ◽  
Ice Storm ◽  
Patient Portals ◽  
Adverse Weather ◽  
Utilization Data ◽  
Study Interval ◽  
Over Time

BACKGROUND Electronic patient portals provide a new method for sharing personal medical information with individual patients. OBJECTIVE Our aim was to review utilization patterns of the largest online patient portal in Canada's largest city. METHODS We conducted a 4-year time-trend analysis of aggregated anonymous utilization data of the MyChart patient portal at Sunnybrook Health Sciences Centre in Ontario, Canada, from January 1, 2012, through December 31, 2015. Prespecified analyses examined trends related to day (weekend vs weekday), season (July vs January), year (2012 vs 2015), and an extreme adverse weather event (ice storm of December 20-26, 2013). Primary endpoints included three measures of patient portal activity: registrations, logins, and pageviews. RESULTS We identified 32,325 patients who registered for a MyChart account during the study interval. Time-trend analysis showed no sign of attenuating registrations over time. Logins were frequent, averaged 734 total per day, and showed an increasing trend over time. Pageviews mirrored logins, averaged about 3029 total per day, and equated to about 5 pageviews during the average login. The most popular pageviews were clinical notes, followed by laboratory results and medical imaging reports. All measures of patient activity were lower on weekends compared to weekdays (P<.001) yet showed no significant changes related to seasons or extreme weather. No major security breach, malware attack, or software failure occurred during the study. CONCLUSIONS Online patient portals can provide a popular and reliable system for distributing personal medical information to active patients and may merit consideration for hospitals.

scholarly journals Defining Empowerment and Supporting Engagement Using Patient Views From the Citizen Health Information Portal: Qualitative Study (Preprint)

2017 ◽  
Author(s):  
Tracie Risling ◽  
Juan Martinez ◽  
Jeremy Young ◽  
Nancy Thorp-Froslie
Keyword(s):  
Qualitative Methodology ◽  
Digital Health ◽  
Patient Empowerment ◽  
Primary Objective ◽  
Patient Portal ◽  
Interpretive Description ◽  
Patient Portals ◽  
Information Portal ◽  
Use Of Technology ◽  
Self Reported Health Status

BACKGROUND The increasing presence of technology in health care has created new opportunities for patient engagement and with this, an intensified exploration of patient empowerment within the digital health context. While the use of technology, such as patient portals, has been positively received, a clear linkage between digital health solutions, patient empowerment, and health outcomes remains elusive. OBJECTIVE The primary objective of this research was to explore the views of participants enrolled in an electronic health record portal access trial regarding the resultant influence of this technology on their feelings of patient empowerment. METHODS The exploration of patient empowerment within a digital health context was done with participants in a tethered patient portal trial using interpretive description. Interpretive description is a qualitative methodology developed to pragmatically address clinical health questions. Patient demographics, self-reported health status, and self-identified technology adaptation contributed to the assessment of empowerment in this qualitative approach. RESULTS This research produced a view of patient empowerment within the digital health context summarized in two overarching categories: (1) Being Heard and (2) Moving Forward. In each of these, two subcategories further delineate the aspects of empowerment, as viewed by these participants: Knowing More and Seeing What They See under Being Heard, and Owning Future Steps and Promoting Future Care under Moving Forward. This work also highlighted an ongoing interconnectedness between the concepts of patient empowerment, engagement, and activation and the need to further articulate the unique aspects of each of these. CONCLUSIONS The results of this study contribute needed patient voice to the ongoing evolution of the concept of patient empowerment. In order to move toward more concrete and accurate measure of patient empowerment and engagement in digital health, there must be further consideration of what patients themselves identify as essential aspects of these complex concepts. This research has revealed relational and informational elements as two key areas of focus in the ongoing evolution of patient empowerment operationalization and measure.

Development of a person-centered patient portal in oncology using stakeholder co-design.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 221-221
Author(s):  
John Kildea ◽  
Tarek Hijal ◽  
Laurie Hendren
Keyword(s):  
Information Access ◽  
Modern Technology ◽  
Personal Health Information ◽  
Patient Portal ◽  
Care Providers ◽  
Patient Portals ◽  
Waiting Room ◽  
Complex Needs ◽  
Care Recipients ◽  
Patient Reported

221 Background: Patient portals are software products that provide care recipients (patients) with access to some or all of their personal health information (PHI) within a healthcare institution’s electronic medical record (EMR). Most patient portals are just that–windows into an EMR. However, in today’s connected world, a patient portal can offer much more than just access to PHI. By exploiting modern technology and by recognizing that care recipients are people with complex needs that extend beyond just the delivery of care, patient portals can be person-centered. Such person-centered needs include: the ability to plan ahead and know one’s position in a waiting list, to feel in control of one’s own care, to understand one’s treatment options, and to share in all decision-making about one’s care. Methods: We used stakeholder co-design, involving care recipients, care providers (clinicians) and technical experts at all levels, to design and develop a person-centered patient portal from within the healthcare system. Results: Our mobile-friendly patient portal, known as Opal (opalmedapps.com), contains the following: One-stop multi-speciality and multi-institutional operation; Appointment schedule with personalized appointment preparation guidelines; Appointment check-in and waiting room management tools; Monitoring of step-by-step radiotherapy treatment planning; Access to PHI contextualized with explanatory information; Access to personalized educational materials; Patient-reported outcomes questionnaires with response visualizations; An automated rules-based system to minimize clinician workload; Triggered notifications to alert patients and clinicians to actionable events. Conclusions: Opal is currently in beta release involving a small number of oncology patients at our centre who are providing feedback about its use and usefulness. Their initial feedback is very positive and enthusiastic. A full pilot study is starting by July 2018.

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