A multidisciplinary approach to designing and evaluating Electronic Medical Record portal messages that support patient self-care

Abstract

We describe a project intended to improve the use of Electronic Medical Record (EMR) patient portal information by older adults with diverse numeracy and literacy abilities, so that portals can better support patient-centered care. Patient portals are intended to bridge patients and providers by ensuring patients have continuous access to their health information and services. However, they are underutilized, especially by older adults with low health literacy, because they often function more as information repositories than as tools to engage patients. We outline an interdisciplinary approach to designing and evaluating portal-based messages that convey clinical test results so as to support patient-centered care. We first describe a theory-based framework for designing effective messages for patients. This involves analyzing shortcomings of the standard portal message format (presenting numerical test results with little context to guide comprehension) and developing verbally, graphically, video- and computer agent-based formats that enhance context. The framework encompasses theories from cognitive and behavioral science (health literacy, fuzzy trace memory, behavior change) as well as computational/engineering approaches (e.g., image and speech processing models). We then describe an approach to evaluating whether the formats improve comprehension of and responses to the messages about test results, focusing on our methods. The approach combines quantitative (e.g., response accuracy, Likert scale responses) and qualitative (interview) measures, as well as experimental and individual difference methods in order to investigate which formats are more effective, and whether some formats benefit some types of patients more than others. We also report the results of two pilot studies conducted as part of developing the message formats.

A Systematic Review of Patient-Facing Visualizations of Personal Health Data

“…43,44 In some articles (n ¼ 4, 15%), randomization was employed to vary either the order in which visualizations were presented or conditions that participants viewed. [45][46][47][48] Outcomes pertinent to the visualizations included comprehension (including accuracy and perceived confidence in interpretation), risk perception, behavioral intention (i.e., intention to act in response to the visualization), satisfaction, and preferences. The level of detail in study findings related to visualizations versus other outcomes, for example, usability of an application in which visualizations are embedded, varied widely.…”

Facilitating Organizational Change to Accommodate an Inpatient Portal

“…31 Similarly, several researchers have highlighted the important role of culture in their assessment of inpatient portal implementation. [32][33][34] The themes we identified on the changing perspectives of care team members suggests that our AMC was experiencing a cultural transformation in "how things are perceived and done," 35 where the introduction of the inpatient portal precipitated fundamental shifts in how care team members thought about and used a new technological application as part of the care process.…”

Numbers, graphs and words – do we really understand the lab test results accessible via the patient portals?

“…Direct patient use of test data is consistent with trends toward patient-centered care and the medical home concept, which aims to achieve greater patient involvement in both medical decision making and health self-management [ 5 ]. These care approaches expect the “digitally engaged patient” to self-monitor and self-care for themselves and their families through the skillful use of enhanced digital technologies [ 6 ] (see also [ 7 – 11 ]). Yet managing their own health has been shown to place heavy demands on laypersons, who are now expected to correctly interpret their test results, evaluate the pros and cons of different treatments, and decide on a preferred course of action [ 12 , 13 ].…”

“…Correspondingly, clinicians have expressed concern that patients often experience great difficulty in comprehending, interpreting, and correctly responding to personalized health information, partly due to inappropriate presentation of the information in patient portals [ 13 , 14 ]. In particular, misunderstanding test results leads to confusion, frustration, and disruptions in healthcare processes, including delays in seeking care, overutilization of services, medication errors, and inappropriate healthcare decision-making [ 5 , 7 , 14 ].…”

“…The present research is also motivated by the fact that despite growing interest in laypersons’ comprehension and use of medical knowledge to reach appropriate medical decisions, little is still known of the extent to which different visual displays help people discriminate between test results that do or do not require urgent action [ 7 , 13 , 14 , 26 ]. Zikmund-Fisher et al [ 13 ] asked their participants to imagine that they were viewing the results of a set of blood tests on an online patient portal.…”