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

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

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

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

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

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

scholarly journals Assessing Users’ Privacy and Security Concerns of Smart Home Technologies

i-com ◽  
2019 ◽  
Vol 18 (3) ◽  
pp. 197-216 ◽  
Author(s):  
Verena Zimmermann ◽  
Paul Gerber ◽  
Karola Marky ◽  
Leon Böck ◽  
Florian Kirchbuchner
Keyword(s):  
Smart Home ◽  
Elderly Care ◽  
Security And Privacy ◽  
Structured Interviews ◽  
Privacy And Security ◽  
Privacy Concerns ◽  
Private Lives ◽  
Societal Level ◽  
Home Users

AbstractSmart Home technologies have the potential to increase the quality of life, home security and facilitate elderly care. Therefore, they require access to a plethora of data about the users’ homes and private lives. Resulting security and privacy concerns form a relevant barrier to adopting this promising technology. Aiming to support end users’ informed decision-making through addressing the concerns we first conducted semi-structured interviews with 42 potential and little-experienced Smart Home users. Their diverse concerns were clustered into four themes that center around attacks on Smart Home data and devices, the perceived loss of control, the trade-off between functionality and security, and user-centric concerns as compared to concerns on a societal level. Second, we discuss measures to address the four themes from an interdisciplinary perspective. The paper concludes with recommendations for addressing user concerns and for supporting developers in designing user-centered Smart Home technologies.

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

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

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

scholarly journals Educating Clinicians to Improve Telemedicine Access for Patients with Limited English Proficiency

Challenges ◽  
2021 ◽  
Vol 12 (2) ◽  
pp. 34
Author(s):  
Tiffany M. Shin ◽  
Pilar Ortega ◽  
Karol Hardin
Keyword(s):  
Medical Education ◽  
Limited English Proficiency ◽  
English Language ◽  
English Proficiency ◽  
Care Delivery ◽  
The United States ◽  
Patient Portals ◽  
Medical Interpreters ◽  
Language Needs ◽  
Electronic Health Information

The COVID-19 pandemic prompted the rapid incorporation of telemedicine into healthcare systems, resulting in increased access challenges for patients in the United States with limited English proficiency (LEP). Non-English-language speakers face challenges with telemedicine that magnify pre-existing barriers to language-appropriate care, such as difficulty accessing professional medical interpreters and navigating both electronic health information and online patient portals. Improved medical education on telehealth would increase equitable care for linguistic minorities. Medical education targeting telehealth care delivery should include clinician instruction on working with interpreters in telehealth contexts, increasing patient access to telehealth resources, and addressing patients’ language needs for telemedicine.

Technology and social media use by oncology patients with limited english proficiency at a safety net hospital.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e18533-e18533
Author(s):  
Victor Yundeh Chiu ◽  
Jacob S. Berkowitz ◽  
Joshua Rodriguez ◽  
Kristina Lee ◽  
Joe Torres ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Social Media ◽  
Limited English Proficiency ◽  
English Proficiency ◽  
Media Use ◽  
Internet Access ◽  
Safety Net ◽  
Oncology Patients ◽  
Social Media Use ◽  
Safety Net Hospital

e18533 Background: Prior studies have shown that when patients with cancer engage with social media, they have positive outcomes, including clinical trial participation, volunteerism and advocacy, and diminished levels of anxiety. However, active users of social media tend to be white, well-educated, and of higher socioeconomic status. Little is known about the use of technology and social media by underserved oncology populations, particularly patients with limited English proficiency (LEP). We sought to characterize current technology use by patients at Olive View—UCLA Medical Center (OVMC), a safety net hospital in Los Angeles County. Methods: We developed an anonymous online survey (Qualtrics, Provo, UT) comprised of 39 questions. The survey was administered, via touchscreen tablets from January 2020 through January 2021, to a convenience sample of patients seen in OVMC’s outpatient medical oncology clinic. The survey was available in English and Spanish, and we excluded patients who were not fluent in either language. Patients were categorized as having LEP versus English proficiency (EP) by self-assessment, on a 5-point Likert scale, of their comfort in speaking English. Differences between the LEP and EP groups were assessed using Pearson’s chi-squared test and Fisher’s exact test. Results: Of 113 patients who were offered the survey, 10 (9%) declined participation because of illiteracy in their primary language or inability to use a tablet. Reponses were recorded for 50 patients with LEP and 53 with EP. The LEP and EP groups, respectively, were similar in their representation of women (62% and 64%) and mean age (58 years and 51 years). High school completion rates were 32% for the LEP group and 70% for the EP group. A higher proportion of the LEP group identified as Hispanic/Latinx (84%) compared to the EP group (58%). The LEP group was less likely than the EP group to have internet access (63% vs. 98%, P< 0.01). However, among patients with internet access, social media use was similar in the LEP and EP groups (65% vs. 71%, P= 0.7). Facebook was the most used platform by the LEP (22%) and EP (32%) groups; other platforms (e.g., Twitter, Instagram) were used by very few respondents. The LEP group was less likely than the EP group to have activated the OVMC online patient portal (19% vs. 47%, P< 0.01) and less likely to perceive websites as helpful for learning about clinical trials (30% vs. 53%, P= 0.03). Conclusions: A notable proportion of safety net oncology patients at OVMC do not engage with tablet technology because of illiteracy or lack of comfort with touchscreens. Patients with LEP are less likely to have internet access, but those with access use social media about as often as patients with EP, and prefer Facebook over other platforms. For patients with LEP, engagement efforts, including clinical trial outreach, should continue to include non–internet-based resources in patients’ native languages.

scholarly journals Computer use, language, and literacy in safety net clinic communication

2016 ◽  
Vol 24 (1) ◽  
pp. 106-112 ◽  
Author(s):  
Neda Ratanawongsa ◽  
Jennifer L Barton ◽  
Courtney R Lyles ◽  
Michael Wu ◽  
Edward H Yelin ◽  
...  
Keyword(s):  
Health Literacy ◽  
Computer Use ◽  
Limited English Proficiency ◽  
English Proficiency ◽  
Interaction Analysis ◽  
Safety Net ◽  
Language And Literacy ◽  
Limited Health Literacy ◽  
Safety Net Clinic ◽  
Analysis System

Objective: Patients with limited health literacy (LHL) and limited English proficiency (LEP) experience suboptimal communication and health outcomes. Electronic health record implementation in safety net clinics may affect communication with LHL and LEP patients. We investigated the associations between safety net clinician computer use and patient-provider communication for patients with LEP and LHL. Materials and Methods: We video-recorded encounters at 5 academically affiliated US public hospital clinics between English- and Spanish-speaking patients with chronic conditions and their primary and specialty care clinicians. We analyzed changes in communication behaviors (coded with the Roter Interaction Analysis System) with each additional point on a clinician computer use score, controlling for clinician type and visit length and stratified by English proficiency and health literacy status. Results: Greater clinician computer use was associated with more biomedical statements (+12.4, P = .03) and less positive affect (−0.6, P &lt; .01) from LEP/LHL patients. In visits with patients with adequate English proficiency/health literacy, greater clinician computer use was associated with less positive patient affect (−0.9, P &lt; .01), fewer clinician psychosocial statements (−3.5, P &lt; .05), greater clinician verbal dominance (+0.09, P &lt; .01), and lower ratings on quality of care and communication. Conclusion: Higher clinician computer use was associated with more biomedical focus with LEP/LHL patients, and clinician verbal dominance and lower ratings with patients with adequate English proficiency and health literacy. Discussion: Implementation research should explore interventions to enhance relationship-centered communication for diverse patient populations in the computer era.

scholarly journals Community Partnering for Behavioral Health Equity: Public Agency and Community Leaders’ Views of its Promise and Challenge

2018 ◽  
Vol 28 (Supp) ◽  
pp. 397-406 ◽  
Author(s):  
Elizabeth Bromley ◽  
Chantal Figueroa ◽  
Enrico G. Castillo ◽  
Farbod Kadkhoda ◽  
Bowen Chung ◽  
...  
Keyword(s):  
Los Angeles ◽  
Behavioral Health ◽  
Health Systems ◽  
Safety Net ◽  
Relationship Building ◽  
Health Improvement ◽  
System Transformation ◽  
Structured Interviews ◽  
Community Based ◽  
Public Agency

Objective: To understand potential for multi-sector partnerships among com­munity-based organizations and publicly funded health systems to implement health improvement strategies that advance health equity.Setting: In 2014, the Los Angeles County (LAC) Board of Supervisors approved the Health Neighborhood Initiative (HNI) that aims to: 1) improve coordination of health services for behavioral health clients across safety-net providers within neighborhoods; and 2) address social determinants of health through community-driven, public agency sponsored partnerships with community-based organizations.Design: Key stakeholder interviewing dur­ing HNI planning and early implementation to elicit perceptions of multi-sector partner­ships and innovations required for partner­ships to achieve system transformation and health equity.Participants: Twenty-five semi-structured interviews with 49 leaders from LAC health systems, community-based organizations; and payers.Main Outcomes Means: Grounded the­matic analysis of interview data.Results: Leaders perceived partnerships within and beyond health systems as transformative in their potential to: improve access, value, and efficiency; align priori­ties of safety-net systems and communities; and harness the power of communities to impact health. Leaders identified trust as critical to success in partnerships but named lack of time for relationship-building, limitations in service capacity, and ques­tions about sustainability as barriers to trust-building. Leaders described the need for procedural innovations within health systems that would support equitable part­nerships including innovations that would increase transparency and normalize infor­mation exchange, share agenda-setting and decision-making power with partners, and institutionalize partnering through training and accountability.Conclusions: Leaders described improv­ing procedural justice in public agencies’ relationships with communities as key to effective partnering for health eq­uity.Ethn Dis.2018;28(Suppl 2):397-406; doi:10.18865/ed.28.S2.397.

scholarly journals A survey of cybersecurity vulnerabilities in healthcare systems

2021 ◽  
Vol 8 (12) ◽  
pp. 48-55
Author(s):  
Abdullah Mohammed Alodaynan ◽  
◽  
Adwan Alownie Alanazi ◽  
Keyword(s):  
Health Systems ◽  
Healthcare Systems ◽  
Patient Data ◽  
Security And Privacy ◽  
Privacy And Security ◽  
Related Services ◽  
Unauthorized Access ◽  
Security Issues ◽  
Patient File ◽  
Different Levels

The security of healthcare servers and their applications from unauthorized access and hacking effect of patient file safety as a result of missing or modified data. Therefore, it is necessary to protect those servers and health systems and to know the cyber weaknesses in them and other related services to prevent them before they occur and treat them if they occur as soon as possible to reach the highest level of security and confidentiality of patient data and their privacy in addition to the safety of systems from malfunctions as a result of the attack. This research revolves around the concept of penetration and the motives of the attackers, in addition to the methods of penetration and vulnerability with mentioning some common attacks and clarifying their method of operation, and determining their effects on the victim. The research also deals with the most important basics and requirements to achieve privacy and security for health systems at different levels, including systems, users, and devices, with some intrusion protection techniques mentioned, and some challenges and solutions will be discussed in addition to some security issues in general, the research aims to gain the best level of security and privacy in the infrastructure of health systems.

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