A Web-Based Patient Portal for Mental Health Care: Benefits Evaluation

Abstract

BackgroundTreatment for mental illness has shifted from focusing purely on treatment of symptoms to focusing on personal recovery. Patient activation is an important component of the recovery journey. Patient portals have shown promise to increase activation in primary and acute care settings, but the benefits to tertiary level mental health care remain unknown.ObjectiveTo conduct a benefits evaluation of a Web-based portal for patients undergoing treatment for serious or persistent mental illness in order to examine the effects on (1) patient activation, (2) recovery, (3) productivity, and (4) administrative efficiencies.MethodsAll registered inpatients and outpatients at a tertiary level mental health care facility were offered the opportunity to enroll and utilize the patient portal. Those who chose to use the portal and those who did not were designated as “users” and “nonusers,” respectively. All patients received usual treatment. Users had Web-based access to view parts of their electronic medical record, view upcoming appointments, and communicate with their health care provider. Users could attend portal training or support sessions led by either the engagement coordinator or peer support specialists. A subset of patients who created and utilized their portal account completed 2 Web-based surveys at baseline (just after enrollment; n=91) and at follow-up (6 and 10 months; n=65). The total score of the Mental Health Recovery Measure (MHRM) was a proxy for patient activation and the individual domains measured recovery. The System and Use Survey Tool (SUS) examined the use of functions and general feedback about the portal. Organizational efficiencies were evaluated by examining the odds of portal users and nonusers missing appointments (productivity) or requesting information from health information management (administrative efficiencies) in the year before (2014) and the year after (2015) portal implementation.ResultsA total of 461 patients (44.0% male, n=203) registered for the portal, which was used 4761 times over the 1-year follow-up period. The majority of uses (95.34%, 4539/4761) were for e-views. The overall MHRM score increased from 70.4 (SD 23.6) at baseline to 81.7 (SD 25.1) at combined follow-up (P=.01). Of the 8 recovery domains, 7 were increased at follow-up (all P<.05). The odds of a portal user attending an appointment were 67% (CI 56%-79%) greater than that of nonusers over the follow-up period. Compared with 2014, over 2015 there was an 86% and 57% decrease in requests for information in users and nonusers, respectively. The SUS revealed that users felt an increased sense of autonomy and found the portal to be user-friendly, helpful, and efficient but felt that more information should be accessible.ConclusionsThe benefits evaluation suggested that access to personal health records via patient portals may improve patient activation, recovery scores, and organizational efficiencies in a tertiary level mental health care facility.

How Do Patients with Mental Health Diagnoses Use Online Patient Portals? An Observational Analysis from the Veterans Health Administration

“…We found that the odds of using the My HealtheVet appointment view feature are greater for Veterans with MST, PTSD and depression, and lower for those with bipolar, substance use, and psychotic disorders. A recent study by Kipping et al (2016) found that patient portal use among individuals with "serious or persistent mental illness" resulted in decreased missed appointments and increased patient activation (Kipping et al 2016). Taken together, these findings support the importance of future research to better understand and increase use of this feature in those with bipolar, substance use and psychotic disorders.…”

The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study

“…It promoted patient activation by enabling patients to access their personal health information. A full benefits evaluation of the portal was previously reported [20] that showed improvements in patient activation and recovery over the year following implementation. Notably, a subset of patients who responded to a survey reported an increased sense of autonomy [20], which is an important component to mental health recovery [11-13].…”

“…A full benefits evaluation of the portal was previously reported [20] that showed improvements in patient activation and recovery over the year following implementation. Notably, a subset of patients who responded to a survey reported an increased sense of autonomy [20], which is an important component to mental health recovery [11-13]. Indeed, the EMR has played an important role in the incorporation of recovery-oriented services into practice and will remain a central component of future initiatives to promote patient-centered recovery.…”

“…A benefits evaluation of the patient portal showed improved administrative efficiencies and productivity in the year following compared to the year prior to portal implementation [20]. Internally, the EMR data were presented to highlight trends, providing information for clinicians to support informed clinical decision making at the direct care level.…”

“…The portal was a built-in function of the EMR that was customized to Ontario Shores’ needs. Full details have previously been reported [20]. Briefly, upon portal enrollment, patients were able to access parts of their medical record, view upcoming appointments, and communicate with their clinician from any device with Internet connectivity.…”