Online patient websites for electronic health record access among vulnerable populations: portals to nowhere?

Tieu, Lina; Schillinger, Dean; Sarkar, Urmimala; Hoskote, Mekhala; Hahn, Kenneth J.; Ratanawongsa, Neda; Ralston, James D.; Lyles, Courtney R.

doi:10.1093/jamia/ocw098

Cited by 184 publications

(147 citation statements)

References 38 publications

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“…Despite the complexity of the problem (de Lusignan et al, 2014;Mold et al, 2012Mold et al, , 2015Tieu et al, 2016;Woodman et al, 2015), there are efforts underway to enable each adult to have full access to their own medical records (Hankewitz, 2016;Kelsey & Cavendish, 2014;Suberg, 2017).…”

Section: Introductionmentioning

confidence: 99%

Hitching Healthcare to the Chain: An Introduction to Blockchain Technology in the Healthcare Sector

Engelhardt¹

2017

TIM Review

308

186

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Section: Introductionmentioning

confidence: 99%

Hitching Healthcare to the Chain: An Introduction to Blockchain Technology in the Healthcare Sector

Engelhardt¹

2017

TIM Review

308

186

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“…In addition, user-satisfaction, usability, and task analysis studies [12-15] have focused on older adults’ experiences navigating portal functionality and evaluating their performance of specific tasks. Results from these studies indicate that previous computer experience and adequate health literacy and numeracy are strong contributing factors to ones’ ability to successfully perform health management tasks using a patient portal.…”

Section: Introductionmentioning

confidence: 99%

Patient Portals as a Tool for Health Care Engagement: A Mixed-Method Study of Older Adults With Varying Levels of Health Literacy and Prior Patient Portal Use

Irizarry¹,

Shoemake²,

Nilsen³

et al. 2017

J Med Internet Res

151

156

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BackgroundGrowing evidence that patient engagement improves health outcomes and reduces health care costs has fueled health providers’ focus on patient portals as the primary access point for personal health information and patient-provider communication. Whereas much attention has been given to identifying characteristics of older adults who do and do not adopt patient portals and necessary adaptions to portal design, little is known about their attitudes and perceptions regarding patient portal use as a tool for engagement in their health care within the context of health literacy, experience navigating Web-based health information, and previous patient portal use.ObjectiveThe specific aims of this study were to explore attitudes toward portal adoption and its perceived usefulness as a tool for health care engagement among adults (65 years and older) who have varying levels of health literacy and degrees of prior patient portal use.MethodsA phone survey of 100 community dwelling adults gathered sociodemographic, health, and technology related information. Older adults were purposefully selected for 4 follow-up focus groups based on survey responses to health literacy and previous patient portal use. A mixed-method approach was used to integrate phone survey data with thematic analysis of 4 focus groups. Due to variability in attitudes between focus group participants, an individual case analysis was performed and thematic patterns were used as the basis for subgroup formation.ResultsDifferences in health literacy, comfort navigating health information on the Web, and previous portal experience explained some but not all differences related to the 7 themes that emerged in the focus groups analysis. Individual cases who shared attitudes were arranged into 5 subgroups from least to most able and willing to engage in health care via a patient portal. The subgroups’ overall portal adoption attitudes were: (1) Don’t want to feel pushed into anything, (2) Will only adopt if required, (3) Somebody needs to help me, (4) See general convenience of the portal for simple tasks and medical history, but prefer human contact for questions, and (5) Appreciates current features and excited about new possibilities .ConclusionsMost of the older adults are interested in using a patient portal regardless of health literacy level, previous patient portal adoption, or experience navigating health information on the Web. Research targeting informal caregivers of older adults who are unable or unwilling to engage with information technology in health care on their own is warranted. Health care organizations should consider tailored strategies to meet the needs of older adults (and their informal caregivers) and explore alternative workflows that integrate patient portal information into phone conversations and face-to-face contact with health care providers.

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“…Identifying potential barriers and tailoring improvements may improve portal sign-up. A study that analysed ease of initial portal use in 23 patients from vulnerable populations found a need for ‘tailored and accessible training and support to assist all vulnerable patients and/or caregivers with portal registration and use.’14 Another study looked at usability of three currently available patient portals, finding that the majority of patients had difficulty performing tasks such as laboratory interpretation and medication management 15. There is additional evidence that numeracy and internet experience have a significant impact on the success with which older adults used patient portals successfully 16…”

Section: Discussionmentioning

confidence: 99%

Engaging patients through an iBooks-based patient portal tutorial

et al. 2017

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IntroductionPatient portals or personal health records allow patients to access their health information and communicate with their physician’s office outside of their clinic visit. As such, their use has been observed to increase patient engagement and decrease administrative costs. Despite these advantages, patient adoption and successful use of patient portals remains low. Here we assess the feasibility and efficacy of an iBooks-based tutorial in increasing comfort and compliance with personal health record use.MethodsWe created and published a 5-min iBooks-based tutorial describing our institution’s patient portal features. We administered the tutorial, along with presurvey and postsurvey, to ophthalmology clinic patients.ResultsOf 70 participants, 50% had already registered for our institution’s patient portal. Registered patients had viewed labs (74%, n=26) and messaged providers (57%, n=20) but rarely used other features such as scheduling appointments (17%, n=6) or requesting refills (26%, n=9). After the tutorial, comfort levels in knowledge on how to use portal features increased by 20%–80%, depending on portal feature and registration status. Main barriers to portal usage were preference for telephone-based communication (26%, n=18) and knowledge of portal existence (21%, n=15). The majority (86%, n=60) agreed the tutorial would increase their utilisation of the patient portal.ConclusionTutorials increase knowledge and awareness of patient portal features, allowing these features to be fully used. An iBooks-based approach allows patients to successfully access and use tutorial content outside of the clinic.

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Online patient websites for electronic health record access among vulnerable populations: portals to nowhere?

Cited by 184 publications

References 38 publications

Hitching Healthcare to the Chain: An Introduction to Blockchain Technology in the Healthcare Sector

Hitching Healthcare to the Chain: An Introduction to Blockchain Technology in the Healthcare Sector

Patient Portals as a Tool for Health Care Engagement: A Mixed-Method Study of Older Adults With Varying Levels of Health Literacy and Prior Patient Portal Use

Engaging patients through an iBooks-based patient portal tutorial

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