The Effect of Patient Portals on Quality Outcomes and Its Implications to Meaningful Use: A Systematic Review

Background Patient portals are digital health tools adopted by health care organizations. The portals are generally connected to the electronic health record of the health care organization and offer patients functionalities such as access to the medical record, ability to order repeat prescriptions, make appointments, or message the health care provider. Patient portals may be beneficial for both patients and the health care system. Patient portals can widely differ from one context to another due to the differences in the portal functionalities and capabilities and it is anticipated that outcomes associated with the functionalities also differ. Current systematic reviews report outcomes associated with patient portal uptake but do not explicitly specify the patient portal functionalities. Objective The aim of this systematic review is to synthesize the evidence on health and health care quality outcomes associated with patient portal use among adult (18 years or older) patients. The review research questions are as follows: What kind of health outcomes do tethered patient portals and patient portal functionalities contribute to in adult patients (18 years or older)? and What kind of health care quality outcomes, including health care utilization outcomes, do tethered patient portals and patient portal functionalities contribute to in adult patients (18 years or older)? Methods The systematic review will be conducted by searching the MEDLINE, EMBASE, and Scopus databases for relevant literature. The review inclusion criteria will be studies about adult patients (18 years or older), studies only about tethered patient portals, and studies with or without a comparator. We will report patient portal–associated health and health care quality outcomes based on the patient portal functionalities. All quantitative primary study types will be included. Risk of bias of included studies will be assessed using the Cochrane Collaboration’s tool for assessing risk of bias in randomized trials and the National Heart, Lung, and Blood Institute’s quality assessment tools. Data will be synthesized using narrative synthesis and will be reported according to the patient portal functionalities, country, disease, and health care system model. Results Searches will be conducted in September 2019, and the review is anticipated to be completed by the end of June 2020. Conclusions This systematic review will provide an overview of health and health care quality outcomes associated with patient portal use among adult patients, providing detailed information about the functionalities of the portals and their associations with the outcomes. The review could potentially help patient portal evaluation studies by providing insights into outcomes associated with the different functionalities of patient portals. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42019141131; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141131 International Registered Report Identifier (IRRID) PRR1-10.2196/14975

Download Full-text

Quantifying Patient Portal Use: Systematic Review of Utilization Metrics

Journal of Medical Internet Research ◽

10.2196/23493 ◽

2021 ◽

Vol 23 (2) ◽

pp. e23493

Author(s):

Lauren L Beal ◽

Jacob M Kolman ◽

Stephen L Jones ◽

Aroub Khleif ◽

Terri Menser

Keyword(s):

Systematic Review ◽

Impact Factor ◽

Full Text ◽

A Priori ◽

Meaningful Use ◽

Patient Portal ◽

Patient Portals ◽

The Us ◽

Full Text Review ◽

Number Of Citations

Background Use of patient portals has been associated with positive outcomes in patient engagement and satisfaction. Portal studies have also connected portal use, as well as the nature of users’ interactions with portals, and the contents of their generated data to meaningful cost and quality outcomes. Incentive programs in the United States have encouraged uptake of health information technology, including patient portals, by setting standards for meaningful use of such technology. However, despite widespread interest in patient portal use and adoption, studies on patient portals differ in actual metrics used to operationalize and track utilization, leading to unsystematic and incommensurable characterizations of use. No known review has systematically assessed the measurements used to investigate patient portal utilization. Objective The objective of this study was to apply systematic review criteria to identify and compare methods for quantifying and reporting patient portal use. Methods Original studies with quantifiable metrics of portal use published in English between 2014 and the search date of October 17, 2018, were obtained from PubMed using the Medical Subject Heading term “Patient Portals” and related keyword searches. The first search round included full text review of all results to confirm a priori data charting elements of interest and suggest additional categories inductively; this round was supplemented by the retrieval of works cited in systematic reviews (based on title screening of all citations). An additional search round included broader keywords identified during the full-text review of the first round. Second round results were screened at abstract level for inclusion and confirmed by at least two raters. Included studies were analyzed for metrics related to basic use/adoption, frequency of use, duration metrics, intensity of use, and stratification of users into “super user” or high utilizers. Additional categories related to provider (including care team/administrative) use of the portal were identified inductively. Additional analyses included metrics aligned with meaningful use stage 2 (MU-2) categories employed by the US Centers for Medicare and Medicaid Services and the association between the number of portal metrics examined and the number of citations and the journal impact factor. Results Of 315 distinct search results, 87 met the inclusion criteria. Of the a priori metrics, plus provider use, most studies included either three (26 studies, 30%) or four (23 studies, 26%) metrics. Nine studies (10%) only reported the patient use/adoption metric and only one study (1%) reported all six metrics. Of the US-based studies (n=76), 18 (24%) were explicitly motivated by MU-2 compliance; 40 studies (53%) at least mentioned these incentives, but only 6 studies (8%) presented metrics from which compliance rates could be inferred. Finally, the number of metrics examined was not associated with either the number of citations or the publishing journal’s impact factor. Conclusions Portal utilization measures in the research literature can fall below established standards for “meaningful” or they can substantively exceed those standards in the type and number of utilization properties measured. Understanding how patient portal use has been defined and operationalized may encourage more consistent, well-defined, and perhaps more meaningful standards for utilization, informing future portal development.

Download Full-text

How to Quantify Patient Portal Use: A Systematic Review of Utilization Metrics (Preprint)

10.2196/preprints.23493 ◽

2020 ◽

Author(s):

Lauren L Beal ◽

Jacob M Kolman ◽

Stephen L Jones ◽

Aroub Khleif ◽

Terri Menser

Keyword(s):

Systematic Review ◽

A Priori ◽

Meaningful Use ◽

Research Literature ◽

Patient Portal ◽

Patient Portals ◽

Adoption Studies ◽

Full Text Review ◽

The Usa ◽

October 17

BACKGROUND Use of patient portals has been associated with positive outcomes in patient engagement and satisfaction; portal studies have also connected portal use as well as the nature of users’ interactions with portals and the contents of their generated data to meaningful cost and quality outcomes. Incentive programs in the USA have encouraged uptake of health information technology, including portals, by setting standards for meaningful use of such technology. However, despite widespread interest in patient portal use and adoption, studies on patient portals differ in actual metrics used to operationalize and track utilization, leading to unsystematic and incommensurable characterizations of use. OBJECTIVE No review has systematically assessed the measurements used to investigate patient portal utilization. Therefore, the objective of this study is to apply systematic review criteria to identify and compare methods for quantifying and reporting patient portal use. METHODS Original studies with quantifiable metrics of portal use, available in English between 2014 and the search date of October 17, 2018, were obtained from PubMed, using the Medical Subject Heading term “patient portals” and related keyword searches. The first search round included full text review of all results to confirm a priori data charting elements of interest and suggest additional categories inductively; this round was supplemented by retrieval of works cited in systematic reviews (based on title screening). An additional search round included broader keywords. Studies were screened at abstract-level for inclusion, confirmed by at least two raters. Included studies were analyzed for metrics related to basic use / adoption; frequency of use; duration metrics; intensity; and stratification of users into “super user” or high-utilization types. Additional categories related to provider (including care team / administrative) use of the portal were identified inductively. Analysis of whether metrics aligned with Meaningful Use Stage 2 categories (MU-2) employed by the US Centers for Medicare and Medicaid Services was also conducted. RESULTS Of 315 distinct search results, 87 met inclusion criteria. Of the a priori metrics, plus provider use, most studies included either three types (27 studies, 31.03%) or four types (22, 25.29%) of metrics. Nine studies (10.34%) only reported the patient use / adoption metric, and only one study (1.15%) reported all six. Of the U.S.-based studies (76), 18 were explicitly motivated by MU-2 compliance; 40 (52.63%) at least mentioned these incentives, but only 6 (7.89%) presented metrics from which compliance rates could be inferred. CONCLUSIONS Portal utilization measures in the research literature can fall below established standards for “meaningful” or they can substantively exceed those standards in the type and number of utilization properties measured. Understanding how patient portal use has been defined and operationalized may encourage more consistent, well-defined, and perhaps more meaningful standards for utilization, informing future portal development.

Download Full-text

Patient Portal Functionalities and Uptake: Systematic Review Protocol (Preprint)

10.2196/preprints.14975 ◽

2019 ◽

Author(s):

Abrar Alturkistani ◽

Geva Greenfield ◽

Felix Greaves ◽

Shirin Aliabadi ◽

Rosemary H Jenkins ◽

...

Keyword(s):

Systematic Review ◽

Health Care ◽

Health Care System ◽

Health Care Quality ◽

Care Quality ◽

Risk Of Bias ◽

Adult Patients ◽

Patient Portal ◽

Patient Portals ◽

Quality Outcomes

BACKGROUND Patient portals are digital health tools adopted by health care organizations. The portals are generally connected to the electronic health record of the health care organization and offer patients functionalities such as access to the medical record, ability to order repeat prescriptions, make appointments, or message the health care provider. Patient portals may be beneficial for both patients and the health care system. Patient portals can widely differ from one context to another due to the differences in the portal functionalities and capabilities and it is anticipated that outcomes associated with the functionalities also differ. Current systematic reviews report outcomes associated with patient portal uptake but do not explicitly specify the patient portal functionalities. OBJECTIVE The aim of this systematic review is to synthesize the evidence on health and health care quality outcomes associated with patient portal use among adult (18 years or older) patients. The review research questions are as follows: What kind of health outcomes do tethered patient portals and patient portal functionalities contribute to in adult patients (18 years or older)? and What kind of health care quality outcomes, including health care utilization outcomes, do tethered patient portals and patient portal functionalities contribute to in adult patients (18 years or older)? METHODS The systematic review will be conducted by searching the MEDLINE, EMBASE, and Scopus databases for relevant literature. The review inclusion criteria will be studies about adult patients (18 years or older), studies only about tethered patient portals, and studies with or without a comparator. We will report patient portal–associated health and health care quality outcomes based on the patient portal functionalities. All quantitative primary study types will be included. Risk of bias of included studies will be assessed using the Cochrane Collaboration’s tool for assessing risk of bias in randomized trials and the National Heart, Lung, and Blood Institute’s quality assessment tools. Data will be synthesized using narrative synthesis and will be reported according to the patient portal functionalities, country, disease, and health care system model. RESULTS Searches will be conducted in September 2019, and the review is anticipated to be completed by the end of June 2020. CONCLUSIONS This systematic review will provide an overview of health and health care quality outcomes associated with patient portal use among adult patients, providing detailed information about the functionalities of the portals and their associations with the outcomes. The review could potentially help patient portal evaluation studies by providing insights into outcomes associated with the different functionalities of patient portals. CLINICALTRIAL International Prospective Register of Systematic Reviews (PROSPERO) CRD42019141131; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141131 INTERNATIONAL REGISTERED REPORT PRR1-10.2196/14975

Download Full-text

Effectiveness and meaningful use of paediatric surgical safety checklists and their implementation strategies: a systematic review with narrative synthesis

BMJ Open ◽

10.1136/bmjopen-2017-016298 ◽

2017 ◽

Vol 7 (10) ◽

pp. e016298 ◽

Cited By ~ 10

Author(s):

Janaka Lagoo ◽

Steven R Lopushinsky ◽

Alex B Haynes ◽

Paul Bain ◽

Helene Flageole ◽

...

Keyword(s):

Systematic Review ◽

High Risk ◽

Implementation Strategy ◽

Citation Index ◽

Improve Patient Safety ◽

Implementation Strategies ◽

Meaningful Use ◽

Narrative Synthesis ◽

Surgical Safety ◽

Full Text Review

ObjectiveTo examine the effectiveness and meaningful use of paediatric surgical safety checklists (SSCs) and their implementation strategies through a systematic review with narrative synthesis.Summary background dataSince the launch of the WHO SSC, checklists have been integrated into surgical systems worldwide. Information is sparse on how SSCs have been integrated into the paediatric surgical environment.MethodsA broad search strategy was created using Pubmed, Embase, CINAHL, Cochrane Central, Web of Science, Science Citation Index and Conference Proceedings Citation Index. Abstracts and full texts were screened independently, in duplicate for inclusion. Extracted study characteristic and outcomes generated themes explored through subgroup analyses and idea webbing.Results1826 of 1921 studies were excluded after title and abstract review (kappa 0.77) and 47 after full-text review (kappa 0.86). 20 studies were of sufficient quality for narrative synthesis. Clinical outcomes were not affected by SSC introduction in studies without implementation strategies. A comprehensive SSC implementation strategy in developing countries demonstrated improved outcomes in high-risk surgeries. Narrative synthesis suggests that meaningful compliance is inconsistently measured and rarely achieved. Strategies involving feedback improved compliance. Stakeholder-developed implementation strategies, including team-based education, achieved greater acceptance. Three studies suggest that parental involvement in the SSC is valued by parents, nurses and physicians and may improve patient safety.ConclusionsA SSC implementation strategy focused on paediatric patients and their families can achieve high acceptability and good compliance. SSCs’ role in improving measures of paediatric surgical outcome is not well established, but they may be effective when used within a comprehensive implementation strategy especially for high-risk patients in low-resource settings.

Download Full-text

Using Patient Portals to Improve Patient Outcomes: Systematic Review (Preprint)

10.2196/preprints.15038 ◽

2019 ◽

Author(s):

Hae-Ra Han ◽

Kelly T Gleason ◽

Chun-An Sun ◽

Hailey N Miller ◽

Soo Jin Kang ◽

...

Keyword(s):

Systematic Review ◽

Medication Adherence ◽

Clinical Outcomes ◽

Patient Outcomes ◽

Service Use ◽

The United States ◽

Preventive Service ◽

Patient Portal ◽

Patient Portals ◽

Wide Range

BACKGROUND With the advent of electronic health record (EHR) systems, there is increasing attention on the EHR system with regard to its use in facilitating patients to play active roles in their care via secure patient portals. However, there is no systematic review to comprehensively address patient portal interventions and patient outcomes. OBJECTIVE This study aimed to synthesize evidence with regard to the characteristics and psychobehavioral and clinical outcomes of patient portal interventions. METHODS In November 2018, we conducted searches in 3 electronic databases, including PubMed, EMBASE, and Cumulative Index to Nursing and Allied Health Literature, and a total of 24 articles met the eligibility criteria. RESULTS All but 3 studies were conducted in the United States. The types of study designs varied, and samples predominantly involved non-Hispanic white and highly educated patients with sizes ranging from 50 to 22,703. Most of the portal interventions used tailored alerts or educational resources tailored to the patient’s condition. Patient portal interventions lead to improvements in a wide range of psychobehavioral outcomes, such as health knowledge, self-efficacy, decision making, medication adherence, and preventive service use. Effects of patient portal interventions on clinical outcomes including blood pressure, glucose, cholesterol, and weight loss were mixed. CONCLUSIONS Patient portal interventions were overall effective in improving a few psychological outcomes, medication adherence, and preventive service use. There was insufficient evidence to support the use of patient portals to improve clinical outcomes. Understanding the role of patient portals as an effective intervention strategy is an essential step to encourage patients to be actively engaged in their health care.

Download Full-text

Patient Portals Facilitating Engagement With Inpatient Electronic Medical Records: A Systematic Review (Preprint)

10.2196/preprints.12779 ◽

2018 ◽

Author(s):

Ronald Dendere ◽

Christine Slade ◽

Andrew Burton-Jones ◽

Clair Sullivan ◽

Andrew Staib ◽

...

Keyword(s):

Systematic Review ◽

Health Care ◽

Health Outcomes ◽

Electronic Medical Records ◽

Patient Engagement ◽

Medical Records ◽

Provider Communication ◽

Patient Portals ◽

High Quality ◽

Patient Provider Communication

BACKGROUND Engaging patients in the delivery of health care has the potential to improve health outcomes and patient satisfaction. Patient portals may enhance patient engagement by enabling patients to access their electronic medical records (EMRs) and facilitating secure patient-provider communication. OBJECTIVE The aim of this study was to review literature describing patient portals tethered to an EMR in inpatient settings, their role in patient engagement, and their impact on health care delivery in order to identify factors and best practices for successful implementation of this technology and areas that require further research. METHODS A systematic search for articles in the PubMed, CINAHL, and Embase databases was conducted using keywords associated with patient engagement, electronic health records, and patient portals and their respective subject headings in each database. Articles for inclusion were evaluated for quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR) for systematic review articles and the Quality Assessment Tool for Studies with Diverse Designs for empirical studies. Included studies were categorized by their focus on input factors (eg, portal design), process factors (eg, portal use), and output factors (eg, benefits) and by the valence of their findings regarding patient portals (ie, positive, negative, or mixed). RESULTS The systematic search identified 58 articles for inclusion. The inputs category was addressed by 40 articles, while the processes and outputs categories were addressed by 36 and 46 articles, respectively: 47 articles addressed multiple themes across the three categories, and 11 addressed only a single theme. Nineteen articles had high- to very high-quality, 21 had medium quality, and 18 had low- to very low-quality. Findings in the inputs category showed wide-ranging portal designs; patients’ privacy concerns and lack of encouragement from providers were among portal adoption barriers while information access and patient-provider communication were among facilitators. Several methods were used to train portal users with varying success. In the processes category, sociodemographic characteristics and medical conditions of patients were predictors of portal use; some patients wanted unlimited access to their EMRs, personalized health education, and nonclinical information; and patients were keen to use portals for communicating with their health care teams. In the outputs category, some but not all studies found patient portals improved patient engagement; patients perceived some portal functions as inadequate but others as useful; patients and staff thought portals may improve patient care but could cause anxiety in some patients; and portals improved patient safety, adherence to medications, and patient-provider communication but had no impact on objective health outcomes. CONCLUSIONS While the evidence is currently immature, patient portals have demonstrated benefit by enabling the discovery of medical errors, improving adherence to medications, and providing patient-provider communication, etc. High-quality studies are needed to fully understand, improve, and evaluate their impact.

Download Full-text