scholarly journals Implications of Patient Portal Transparency in Oncology: Qualitative Interview Study on the Experiences of Patients, Oncologists, and Medical Informaticists (Preprint)

2017 ◽  
Author(s):  
Jordan M Alpert ◽  
Bonny B Morris ◽  
Maria D Thomson ◽  
Khalid Matin ◽  
Richard F Brown
Keyword(s):  
Health Knowledge ◽  
Medical Information ◽  
Patient Portal ◽  
Patient Portals ◽  
Face To Face ◽  
Advantages And Disadvantages ◽  
Communication Processes ◽  
Qualitative Interview Study ◽  
Unrestricted Access ◽  
Patient Provider Communication

BACKGROUND Providing patients with unrestricted access to their electronic medical records through patient portals has impacted patient-provider communication and patients’ personal health knowledge. However, little is known about how patient portals are used in oncology. OBJECTIVE The aim of this study was to understand attitudes of the portal’s adoption for oncology and to identify the advantages and disadvantages of using the portal to communicate and view medical information. METHODS In-depth semistructured interviews were conducted with 60 participants: 35 patients, 13 oncologists, and 12 medical informaticists. Interviews were recorded, transcribed, and thematically analyzed to identify critical incidents and general attitudes encountered by participants. RESULTS Two primary themes were discovered: (1) implementation practices influence attitudes, in which the decision-making and execution process of introducing portals throughout the hospital did not include the input of oncologists. Lack of oncologists’ involvement led to a lack of knowledge about portal functionality, such as not knowing the time period when test results would be disclosed to patients; (2) perceptions of portals as communication tools varies by user type, meaning that each participant group (patients, oncologists, and medical informaticists) had varied opinions about how the portal should be used to transmit and receive information. Oncologists and medical informaticists had difficulty understanding one another’s culture and communication processes in their fields, while patients had preferences for how they would like to receive communication, but it largely depended upon the type of test being disclosed. CONCLUSIONS The majority of patients (54%, 19/35) who participated in this study viewed lab results or scan reports via the portal before being contacted by a clinician. Most were relatively comfortable with this manner of disclosure but still preferred face-to-face or telephone communication. Findings from this study indicate that portal education is needed for both patients and oncologists, especially when portals are implemented across entire health systems since highly specialized areas of medicine may have unique needs and uses. Patient portals in oncology can potentially alter the way diagnoses are delivered and how patients and oncologists communicate. Therefore, communication about the portal should be established during initial consultations so patients can decide whether they want to be informed in such a manner.

scholarly journals Insights Into Older Adult Patient Concerns Around the Caregiver Proxy Portal Use: Qualitative Interview Study (Preprint)

2018 ◽  
Author(s):  
Celine Latulipe ◽  
Sara A. Quandt ◽  
Kathryn Altizer Melius ◽  
Alain Bertoni ◽  
David P. Miller Jr ◽  
...  
Keyword(s):  
Health Care ◽  
Chronic Illness ◽  
Older Adult ◽  
Medical Information ◽  
Personal Information ◽  
Comfort Level ◽  
Adult Patients ◽  
Patient Portal ◽  
Patient Portals ◽  
Qualitative Interview Study

BACKGROUND Electronic patient portals have become common and offer many potential benefits for patients’ self-management of health care. These benefits could be especially important for older adult patients dealing with significant chronic illness, many of whom have caregivers, such as a spouse, adult child, or other family member or friend, who help with health care management. Patient portals commonly contain large amounts of personal information, including diagnoses, health histories, medications, specialist appointments, lab results, and billing and insurance information. Some health care systems provide proxy accounts for caregivers to access a portal on behalf of a patient. It is not well known how much and in what way caregivers are using patient portals on behalf of patients and whether patients see any information disclosure risks associated with such access. OBJECTIVE The objective of this study was to examine how older adult patients perceive the benefits and risks of proxy patient portal access by their caregivers. METHODS We conducted semistructured interviews with 10 older adult patients with chronic illness. We asked them about their relationship with their caregivers, their use of their patient portal, their caregiver’s use of the portal, and their perceptions about the benefits and risks of their caregiver’s use of the portals. We also asked them about their comfort level with caregivers having access to information about a hypothetical diagnosis of a stigmatized condition. Two investigators conducted a thematic analysis of the qualitative data. RESULTS All patients identified caregivers. Some had given caregivers access to their portals, in all cases by sharing log-in credentials, rather than by setting up an official proxy account. Patients generally saw benefits in their caregivers having access to the information and functions provided by the portal. Patients generally reported that they would be uncomfortable with caregivers learning of stigmatized conditions and also with caregivers (except spouses) accessing financial billing information. CONCLUSIONS Patients share their electronic patient portal credentials with caregivers to receive the benefits of those caregivers having access to important medical information but are unaware of all the information those caregivers can access. Better portal design could alleviate these unwanted information disclosures.

Electronic Health Record Patient Portals and the Blockchain Technology

2021 ◽  
pp. 218-227
Author(s):  
Jorge Tavares
Keyword(s):  
Medical Information ◽  
Healthcare Providers ◽  
Appointment Scheduling ◽  
Health Record ◽  
Patient Portal ◽  
Patient Portals ◽  
Blockchain Technology ◽  
Electronic Health ◽  
Implementation Of Ehr ◽  
E Mail

The electronic health records (EHR) patient portals are an integrated eHealth technology that combines an EHR system and a patient portal, giving patients access to their medical records, exam results, and services, such as appointment scheduling, notification systems, and e-mail access to their physician. EHR patient portals empower patients to carry out self-management activities and facilitate communication with healthcare providers, enabling the patient and healthcare provider to access the medical information quickly. Worldwide governmental initiatives have aimed to promote the use of EHR patient portals. The implementation of EHR patient portals encompasses several challenges, including security, confidentiality concerns, and interoperability between systems. New technological approaches like blockchain could address these issues and enable a successful worldwide implementation of EHR patient portals.

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

Evaluating Recruitment Strategies for a Randomized Clinical Trial with Heart Failure Patients

2020 ◽  
pp. 019394592097022
Author(s):  
Samantha Conley ◽  
Meghan O’Connell ◽  
Sarah Linsky ◽  
Lesa Moemeka ◽  
James W. Darden ◽  
...  
Keyword(s):  
Heart Failure ◽  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Support Groups ◽  
Behavioral Therapy ◽  
Online Advertising ◽  
Recruitment Strategies ◽  
Patient Portal ◽  
Patient Portals ◽  
Face To Face

Recruiting participants with chronic medical conditions is time-consuming and expensive. Electronic medical record databases and patient portals may enable outreach to larger numbers of patients in comparison to face-to-face methods. We aimed to describe the yields, benefits, and limitations of recruitment strategies used for a randomized clinical trial of cognitive behavioral therapy for insomnia among patients with chronic stable heart failure (NCT02660385). We used multiple recruitment strategies including clinic-based recruitment, letters to patients identified from electronic databases, the patient portal, brochures and posters placed in clinics, presentations to heart failure support groups, and online advertising. We screened 10,291 medical records, enrolled 231 participants, and 195 participants completed baseline data collection. We enrolled 92 (23%) participants using clinic-based recruitment, 24 and 29 (6% and 10%) using letters to patients from two electronic databases, and 42 (55%) via the patient portal. Multiple recruitment strategies and flexibility are needed to achieve recruitment goals.

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

2018 ◽  
Author(s):  
Yauheni Solad ◽  
Shrawan Patel ◽  
Allen Hsiao ◽  
Ashish Atreja
Keyword(s):  
Medical Information ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Portal ◽  
New Haven ◽  
Patient Portals ◽  
Digital Platform ◽  
Care Plans ◽  
Number Of Patients ◽  
Haven Hospital

BACKGROUND Patient portals provide a simplified route for health providers to share medical information with individual patients, and are incentivized under Meaningful Use. Currently there are numerous friction factors in the onboarding process of patient portals that limits patients signing up for them. As a result, health systems are spending significant resources to drive the adoption of patient portals, with limited success. OBJECTIVE To evaluate the effectiveness of a innovative rules-driven digital patient engagement strategy for patients to sign up for online patient portal at an academic medical center. METHODS Rx.Universe is a digital platform integrated into provider EMR systems that enables physicians to directly “prescribe” mobile health applications and/or digital care bundles to patients. Rx.Universe Bulk Prescription feature was used to prescribe—via SMS—a direct link to the MyChart login page with the patient’s unique code and personal information embedded within the link. This removed several key barriers to adoption: patients needing to copy and paste access codes, fill in their personal data and complete this process within 30 days—after which their unique access code expires. The Rx.Universe engagement dashboard displayed the total number of patients who received prescribed messages, the number of unsuccessful prescriptions, prescriptions opened in the first 24 hours, and total prescriptions opened. RESULTS We digitally prescribed MyChart Activation to 23,485 patients under the care of Yale-New Haven Hospital over a period of 2 days. Of these prescriptions, 21,997 (93.66%) were successfully delivered and 1488 (6.33%) failed to be delivered because of incorrect cell phone numbers in EHR. Of the prescriptions successfully prescribed, 2170 (9.86%) were clicked within 24 hours of being prescribed with a total of 2378 (10.81%) clicked within a week. CONCLUSIONS Digital Medicine Platforms offer new channel for onboarding and following up patients through customized digital care plans. The power of this approach in removing barriers for patients is highlighted by the fact that Yale-New Haven Hospital met their yearly MyChart adoption target through this campaign within a week. Furthermore, the data could be assessed and acted upon in real-time as opposed to the usual weeks. This technology can be extended to close the care gaps for hospitals and Accountable Care Organizations (ACO) in a scalable manner for a subpopulation, with manual processes reserved for patients unable to be reached in an automated fashion.

scholarly journals Patient Portal Use in Diabetes Management: Literature Review (Preprint)

2018 ◽  
Author(s):  
Ran Sun ◽  
Mary T Korytkowski ◽  
Susan M Sereika ◽  
Melissa I Saul ◽  
Dan Li ◽  
...  
Keyword(s):  
Literature Review ◽  
English Language ◽  
Diabetes Management ◽  
Personal Health Record ◽  
Patient Portal ◽  
Patient Portals ◽  
Personal Traits ◽  
Patient Provider Communication ◽  
Barriers To Use ◽  
Improve Patient

BACKGROUND Health information technology tools (eg, patient portals) have the potential to promote engagement, improve patient-provider communication, and enhance clinical outcomes in the management of chronic disorders such as diabetes mellitus (DM). OBJECTIVES The aim of this study was to report the findings of a literature review of studies reporting patient portal use by individuals with type 1 or type 2 DM. We examined the association of the patient portal use with DM-related outcomes and identified opportunities for further improvement in DM management. METHODS Electronic literature search was conducted through PubMed and PsycINFO databases. The keywords used were “patient portal*,” “web portal,” “personal health record,” and “diabetes.” Inclusion criteria included (1) published in the past 10 years, (2) used English language, (3) restricted to age ≥18 years, and (4) available in full text. RESULTS This review included 6 randomized controlled trials, 16 observational, 4 qualitative, and 4 mixed-methods studies. The results of these studies revealed that 29% to 46% of patients with DM have registered for a portal account, with 27% to 76% of these patients actually using the portal at least once during the study period. Portal use was associated with the following factors: personal traits (eg, sociodemographics, clinical characteristics, health literacy), technology (eg, functionality, usability), and provider engagement. Inconsistent findings were observed regarding the association of patient portal use with DM-related clinical and psychological outcomes. CONCLUSIONS Barriers to use of the patient portal were identified among patients and providers. Future investigations into strategies that engage both physicians and patients in use of a patient portal to improve patient outcomes are needed.

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.

Palliative care utilisation: family carers’ behaviours and determinants—a qualitative interview study

2020 ◽  
pp. bmjspcare-2020-002207
Author(s):  
Anne-Lore Scherrens ◽  
Kim Beernaert ◽  
Laurence Magerat ◽  
Luc Deliens ◽  
Benedicte Deforche ◽  
...  
Keyword(s):  
Palliative Care ◽  
Health Knowledge ◽  
Healthcare Services ◽  
Family Carers ◽  
Face To Face ◽  
Behavioural Model ◽  
Behavioural Determinants ◽  
Care Utilisation ◽  
Qualitative Interview Study ◽  
Seriously Ill

ObjectivesMost research on starting palliative care focuses on the role of healthcare services and professional carers. However, patients and their family carers may also play a role. Especially opportunities for starting palliative care might exist among family carers. This study focused on family carers by identifying their behaviours and underlying determinants that might contribute to starting palliative care.MethodsA qualitative study with 16 family carers of deceased persons who used palliative care was conducted using semistructured, face-to-face interviews. Constant comparison analysis was used to identify groups of behaviours that influenced starting palliative care and related determinants. The behavioural determinants were matched with concepts in existing behavioural theories. A preliminary behavioural model was developed.ResultsMost reported behaviours regarding starting palliative care were related to communicating with the seriously ill person, other family members and professional carers; seeking information and helping the seriously ill person process information from professional carers; and organising and coordinating care. Determinants facilitating and hindering these behaviours included awareness (eg, of poor health), knowledge (eg, concerning palliative care), attitudes (eg, negative connotations of palliative care) and social influences (eg, important others’ opinions about palliative care).ConclusionsThis study identified relevant family carers’ behaviours and related determinants that can contribute to starting palliative care. As these determinants are changeable, the palliative care behavioural model that resulted from this study can serve as a basis for the development of behavioural interventions aiming at supporting family carers in performing behaviours that might contribute to starting palliative care.

scholarly journals Older adults using a patient portal: registration and experiences, one year after implementation

2018 ◽  
Vol 4 ◽  
pp. 205520761879788 ◽  
Author(s):  
Gaby Anne Wildenbos ◽  
Karim Maasri ◽  
Monique Jaspers ◽  
Linda Peute
Keyword(s):  
Older Adults ◽  
Medical History ◽  
Older Adult ◽  
Medical Information ◽  
Data Extraction ◽  
Adult Patients ◽  
Patient Portal ◽  
Patient Portals ◽  
History Information ◽  
One Year

Background and objectives The interest of older adults in using patient portals is rising, yet subject to functional and usability barriers. This study aims to gain insight into registration rates and experiences of older adult patients using a patient portal, one year after implementation in an academic hospital. Methods Registration rates for one year were collected via automated data extraction. Older adult patients’ experiences were collected through a survey, available via the portal in the last three months of the year. Results Older adults were a large user group of the patient portal and appreciated its functionalities. In one year, 10,679 older adult patients (aged 56+) registered, which constituted 47% of total portal registrations. The 131 older adult survey respondents had a mean age of 64.5 years and 40% indicated that they liked to review their medical information and appointments via the portal. Yet, older adults experienced user interaction issues and had higher expectations of content within the portal and patient/provider communication through the portal. Of the survey respondents, 22% experienced usability issues at login and in viewing test results, 15% commented on late or no responses by providers on patients’ sent messages and 24% expected the portal to provide medical history information. Implications: Patient portal designs should be optimized to usability needs of older adults. Portals preferably include medical history information, physicians’ notes and require prompt responses of providers.

Improving healthcare through digital connection? Findings from a qualitative study about patient portals in New Zealand

2018 ◽  
Vol 24 (5) ◽  
pp. 404 ◽  
Author(s):  
Phoebe Elers ◽  
Frances Nelson
Keyword(s):  
New Zealand ◽  
Primary Healthcare ◽  
Information Seeking ◽  
Structured Interview ◽  
Accurate Information ◽  
Patient Portal ◽  
Patient Portals ◽  
Medical Treatments ◽  
Patient Provider Communication ◽  
Primary Care Practices

Research has shown that patient portals can improve patient–provider communication and patient satisfaction. Yet few studies have examined patient portals in New Zealand. In this study, GPs from nine primary care practices were interviewed using a semi-structured interview technique to ascertain how they thought patient portals influence the delivery of primary healthcare. The interviews were transcribed and thematically analysed. The three themes detected were: patient portal usage, health information seeking and the changing consultation. Although most of the participants indicated that patient portals are not being effectively utilised, they were optimistic about the role of information technology in primary healthcare for providing accurate information and to connect with patients in modern terms. Participants reported that some patients have become more informed and compliant with medical treatments and interventions after using patient portals. It seems that patient portals have the potential to enhance patient–provider relationships and help patients manage more aspects of their health care.

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