scholarly journals Growth of Secure Messaging Through a Patient Portal as a Form of Outpatient Interaction across Clinical Specialties

2015 ◽  
Vol 06 (02) ◽  
pp. 288-304 ◽  
Author(s):  
S.E. Davis ◽  
J.A. Shenson ◽  
Q. Chen ◽  
S.T. Rosenbloom ◽  
G.P. Jackson ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Medical Center ◽  
Patient Portal ◽  
Care Providers ◽  
Patient Portals ◽  
Healthcare Organizations ◽  
Secure Messaging ◽  
Medical Specialties ◽  
Face To Face ◽  
Clinic Visits

SummaryObjective: Patient portals are online applications that allow patients to interact with healthcare organizations. Portal adoption is increasing, and secure messaging between patients and health-care providers is an emerging form of outpatient interaction. Research about portals and messaging has focused on medical specialties. We characterized adoption of secure messaging and the contribution of messaging to outpatient interactions across diverse clinical specialties after broad portal deployment.Methods: This retrospective cohort study at Vanderbilt University Medical Center examined use of patient-initiated secure messages and clinic visits in the three years following full deployment of a patient portal across adult and pediatric specialties. We measured the proportion of outpatient interactions (i.e., messages plus clinic visits) conducted through secure messaging by specialty over time. Generalized estimating equations measured the likelihood of message-based versus clinic outpatient interaction across clinical specialties.Results: Over the study period, 2,422,114 clinic visits occurred, and 82,159 unique portal users initiated 948,428 messages to 1,924 recipients. Medicine participated in the most message exchanges (742,454 messages; 78.3% of all messages sent), followed by surgery (84,001; 8.9%) and obstetrics/gynecology (53,424; 5.6%). The proportion of outpatient interaction through messaging increased from 12.9% in 2008 to 33.0% in 2009 and 39.8% in 2010 (p<0.001). Medicine had the highest proportion of outpatient interaction conducted through messaging in 2008 (23.3% of out-patient interactions in medicine). By 2010, this proportion was highest for obstetrics/gynecology (83.4%), dermatology (71.6%), and medicine (56.7%). Growth in likelihood of message-based interaction was greater for anesthesiology, dermatology, obstetrics/gynecology, pediatrics, and psychiatry than for medicine (p<0.001).Conclusions: This study demonstrates rapid adoption of secure messaging across diverse clinical specialties, with messaging interactions exceeding face-to-face clinic visits for some specialties. As patient portal and secure messaging adoption increase beyond medicine and primary care, research is needed to understand the implications for provider workload and patient care.Citation: Cronin RM, Davis SE, Shenson JA, Chen Q, Rosenbloom ST, Jackson GP. Growth of secure messaging through a patient portal as a form of outpatient interaction across clinical specialties. Appl Clin Inf 2015; 6: 288–304http://dx.doi.org/10.4338/ACI-2014-12-RA-0117

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

2020 ◽  
Vol 11 (05) ◽  
pp. 764-768
Author(s):  
Karolin Ginting ◽  
Adrienne Stolfi ◽  
Jordan Wright ◽  
Abiodun Omoloja
Keyword(s):  
Decision Making ◽  
Health Care Providers ◽  
Medical Decision Making ◽  
Pediatric Population ◽  
Private Insurance ◽  
Medical Decision ◽  
Ambulatory Setting ◽  
Patient Portal ◽  
Care Providers ◽  
Patient Portals

Abstract Background Electronic health record (EHR) patient portals are a secure electronic method of communicating with health care providers. In addition to sending secure messages, images, and videos generated by families can be sent to providers securely. With the widespread use of smart phones, there has been an increase in patient-generated images (PGI) sent to providers via patient portals. There are few studies that have evaluated the role of PGI in medical decision-making. Objectives The study aimed to characterize PGI sent to providers via a patient portal, determine how often PGI-affected medical decision-making, and determine the rate of social PGI sent via patient portal. Methods A retrospective chart review of PGI uploaded to a children's hospital's ambulatory patient portal from January 2011 to December 2017 was conducted. Data collected included patient demographics, number and type of images sent, person sending images (patient or parent/guardian), and whether an image-affected medical decision-making. Images were classified as medical related (e.g., blood glucose readings and skin rashes), nonmedical or administrative related (e.g., medical clearance or insurance forms), and social (e.g., self-portraits and camp pictures). Results One hundred forty-three individuals used the portal a total of 358 times, sending 507 images over the study period. Mean (standard deviation) patient age was 9.5 (5.9) years, 50% were females, 89% were White, and 64% had private insurance. About 9% of images were sent directly by patients and the rest by parents/guardians. A total of 387 (76%) images were sent for medical related reasons, 20% for nonmedical, and 4% were deemed social images. Of the 387 medical related images, 314 (81%) affected medical decision-making. Conclusion PGI-affected medical decision-making in most cases. Additional studies are needed to characterize use of PGI in the pediatric population.

scholarly journals Viewpoint: Health literacy and patient portals

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

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

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

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

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

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

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

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

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

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

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

Online Medical Records: A Decade of Experience

1999 ◽  
Vol 38 (04/05) ◽  
pp. 308-312 ◽  
Author(s):  
D. Z. Sands ◽  
D. M. Rind ◽  
C. Safran
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Services ◽  
Medical Center ◽  
Work Flow ◽  
Care Providers ◽  
Electronic Patient Records ◽  
Face To Face ◽  
Care Services ◽  
Practice Of Medicine

AbstractThe electronic patient record at the Beth Israel Deaconess Medical Center has fundamentally changed the practice of medicine in ways that its developers never foresaw. This type of highly interactive and work flow enabled program is creating new collaborative roles for computers in complex organizations [4]. With the system able to supervise and monitor care, computers are able to perform many care coordination and documentation functions, freeing people to concentrate more on interpersonal interactions and provision of health care services. One of the challenges in the design of electronic patient records to assist health care providers is how to support collaboration while not requiring that people meet face-to-face. Moreover, a greater challenge for each of us as clinicians is to use this technology as a bridge (rather than a barrier) towards better patient-doctor relationships.

scholarly journals Long-term Patterns of Patient Portal Use for Pediatric Patients at an Academic Medical Center

2017 ◽  
Vol 08 (03) ◽  
pp. 779-793 ◽  
Author(s):  
Robert Cronin ◽  
Sharon Davis ◽  
Ellen Yan ◽  
Gretchen Jackson ◽  
Bryan Steitz
Keyword(s):  
Pediatric Patients ◽  
Medical Center ◽  
Academic Medical Center ◽  
Medical Specialty ◽  
Patient Portal ◽  
Patient Portals ◽  
Secure Messaging ◽  
Patients Âgés ◽  
Academic Medical

SummaryBackground: Patient portal adoption has increased over the last two decades. Most research about patient portals has focused on adult populations in the primary care and medical specialty settings.Objective: We describe initial and long-term portal use by pediatric patients and their caregivers in a broadly deployed patient portal at an academic medical center.Methods: We analyzed portal usage for pediatric patients and their caregivers from 2008 to 2014. We recorded usage events with time stamps; user role defined as self, surrogate (i.e., parent or guardian), or delegate; and functions accessed. Usage events were grouped into sessions to calculate descriptive statistics by patient age, user role, and active use over time.Results: From 2008 to 2014, the number of portal accounts increased from 633 to 17,128. 15.9% of pediatric patients had their own account; 93.6%, a surrogate account; and 2.2% a delegate account. During the study period, 15,711 unique users initiated 493,753 sessions and accessed 1,491,237 functions. Most commonly used functions were secure messaging (accessed in 309,204 sessions; 62.6%); test results (174,239; 35.3%) and appointments (104,830; 21.2%). Function usage was greatest for patients ages 0-2 years (136,245 functions accessed; 23.1%) and 15-17 years (109,241;18.5%). Surrogate users conducted 83.2% of logins for adolescent patients. Portal accounts were actively used for < 1 year for 9,551 patients (55.8%), 1-2 years for 2,826 patients (16.5%), 2–3 years for 1,968 patients (11.5%) and over 3 years for 2,783 patients (16.3%).Conclusion: Pediatric patients and caregivers have avidly used messaging, test result, and appointment functions. The majority of access was done by surrogates. Adolescent portal usage increased with age. Most accounts for pediatric patients were only used actively for a few years, with peak usage for patients in early childhood and late adolescence.Citation: Steitz BD, Cronin RM, Davis SE, Yan Z, Jackson GP. Long-term Patterns of Patient Portal Use for Pediatric Patients at an Academic Medical Center. Appl Clin Inform 2017; 8: 779–793 https://doi.org/10.4338/ACI-2017-01-RA-0005

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

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

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

scholarly journals Usability Assessment of Secure Messaging for Clinical Document Sharing between Health Care Providers and Patients

2018 ◽  
Vol 09 (02) ◽  
pp. 467-477 ◽  
Author(s):  
Michelle Jahn ◽  
Brian Porter ◽  
Himalaya Patel ◽  
Alan Zillich ◽  
Steven Simon ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Task Completion ◽  
Care Providers ◽  
Patient Portals ◽  
Secure Messaging ◽  
Web Based ◽  
Usability Assessment ◽  
Clinical Document ◽  
User Groups

Background Web-based patient portals feature secure messaging systems that enable health care providers and patients to communicate information. However, little is known about the usability of these systems for clinical document sharing. Objective This article evaluates the usability of a secure messaging system for providers and patients in terms of its ability to support sharing of electronic clinical documents. Methods We conducted usability testing with providers and patients in a human–computer interaction laboratory at a Midwestern U.S. hospital. Providers sent a medication list document to a fictitious patient via secure messaging. Separately, patients retrieved the clinical document from a secure message and returned it to a fictitious provider. We collected use errors, task completion, task time, and satisfaction. Results Twenty-nine individuals participated: 19 providers (6 physicians, 6 registered nurses, and 7 pharmacists) and 10 patients. Among providers, 11 (58%) attached and sent the clinical document via secure messaging without requiring assistance, in a median (range) of 4.5 (1.8–12.7) minutes. No patients completed tasks without moderator assistance. Patients accessed the secure messaging system within 3.6 (1.2–15.0) minutes; retrieved the clinical document within 0.8 (0.5–5.7) minutes; and sent the attached clinical document in 6.3 (1.5–18.1) minutes. Although median satisfaction ratings were high, with 5.8 for providers and 6.0 for patients (scale, 0–7), we identified 36 different use errors. Physicians and pharmacists requested additional features to support care coordination via health information technology, while nurses requested features to support efficiency for their tasks. Conclusion This study examined the usability of clinical document sharing, a key feature of many secure messaging systems. Our results highlight similarities and differences between provider and patient end-user groups, which can inform secure messaging design to improve learnability and efficiency. The observations suggest recommendations for improving the technical aspects of secure messaging for clinical document sharing.

scholarly journals Participants’ views and experiences from setting up a shared patient portal for primary and specialist health services- a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Torunn Hatlen Nøst ◽  
Arild Faxvaag ◽  
Aslak Steinsbekk
Keyword(s):  
Health Care ◽  
Qualitative Study ◽  
Health Services ◽  
Health Care Providers ◽  
Access To Health Care ◽  
Patient Involvement ◽  
Patient Portal ◽  
Care Providers ◽  
Structured Interviews ◽  
Patient Portals

Abstract Background Recently, there has been an increasing focus among healthcare organisations on implementing patient portals. Previous studies have mainly focussed on the experiences of patient portal use. Few have investigated the processes of deciding what content and features to make available, in particular for shared portals across healthcare domains. The aim of the study was to investigate views on content and experiences from the configuration process among participants involved in setting up a shared patient portal for primary and specialist health services. Methods A qualitative study including 15 semi-structured interviews with persons participating in patient portal configuration was conducted from October 2019 to June 2020. Results Whether a shared patient portal for all the health services in the region should be established was not questioned by any of the informants. It was experienced as a good thing to have numerous participants present in the discussions on configuration, but it also was said to increase the complexity of the work. The informants considered a patient portal to be of great value for patient care, among other things because it would lead to improvements in patient follow-up and increased patient empowerment. Nevertheless, some informants advocated caution as they thought the patient portal possibly could lead to an increase in healthcare providers’ workloads and to anxiety and worries, as well as to inequality in access to health care among patients. The findings were categorized into the themes ‘A tool for increased patient involvement’, ‘Which information should be available for the patient’, ‘Concerns about increased workload’, ‘Too complex to use versus not interesting enough’, ‘Involving all services’ and ‘Patient involvement’. Conclusions Establishing a shared patient portal for primary and specialist health services was considered unproblematic. There was, however, variation in opinions on which content and features to include. This variation was related to concerns about increasing the workload for health care providers, causing anxiety and inequality among patients, and ensuring that the solution would be interesting enough to adopt.

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