eHealth Literacy: Patient Engagement in Identifying Strategies to Encourage Use of Patient Portals Among Older Adults

Abstract

Innovations in chronic disease management are growing rapidly as advancements in technology broaden the scope of tools. Older adults are less likely to be willing or able to use patient portals or smartphone apps for health-related tasks. The authors conducted a cross-sectional survey of older adults (ages ≥50) with hypertension or diabetes to examine relationships between portal usage, interest in health-tracking tools, and eHealth literacy, and to solicit practical solutions to encourage technology adoption. Among 247 patients surveyed in a large integrated delivery health system between August 2015 and January 2016, eHealth literacy was positively associated with portal usage (OR [95% CI]: 1.3 [1.2-1.5]) and interest in health-tracking tools (1.2 [1.1-1.3]). Portal users compared to nonusers (N = 137 vs.110) had higher rates of interest in using websites/smartphone apps to track blood pressure (55% vs. 36%), weight (53% vs. 35%), exercise (53% vs. 32%), or medication (46% vs 33%, all P < 0.05). Portal users noted cumbersome processes for accessing portals and variations in provider availability for online scheduling and response times to messages. Portal nonusers expressed concerns about data security, lack of personalization, and limited perceived value of using portals. Both groups noted the importance of computer literacy and technical support. Patient stakeholders recommended marketing initiatives that capture patient stories demonstrating real-life applications of what patients can do with digital technology, how to use it, and why it may be useful. Health systems also must screen for eHealth literacy, provide training, promote proxy users, and institute quality assurance that ensures patients' experiences will not vary across the system.

Barriers to patient, provider, and caregiver adoption and use of electronic personal health records in chronic care: a systematic review

“…Due to its impacts on physician's time management and workload, "physician resistance" was mentioned as "the greatest barrier to PHR implementation" (12). There were also concerns about the impacts on providers' available time for care, lack of reimbursement, or professional liability issues (36,65,69). Physicians voiced their concerns about excess time and efforts to handle issues related to the PHRs due to lack of integration with EHRs (80, 81).…”

“…Tangible incentives and cost compensations, or otherwise lack thereof, were also an important factor (12,55,65,66). For example, it was important to be certain on how PHR-related services would be paid for, who would pay and under what circumstances (41).…”

“…Moreover, patients reported frustration at a number of instances in which their profile, medication list, lab results or medical history were incorrect or missing in the PHR but they were unable to correct them (46,51,65)…”

“…The degree to which a PHR was perceived as being consistent with the existing values, past experiences, and needs of its potential adopters i.e., chronic patients and their caregivers and providers was mentioned as an important factor for adoption in a number of studies (36,40,44,65,91). When comparing with the traditional chronic care, users asked for much easier navigation through PHRs, access to additional information (e.g., progress notes, outside test results, personalized medication information, and a structure to track the course of treatment) or a customized PHR based on their specific chronic illness (36,39,41,44,46,51,61,63,79,81).…”

Secure Messaging with Physicians by Proxies for Patients with Diabetes: Findings from the ECLIPPSE Study

“…Yet, information is lacking regarding the mechanisms through which portals may influence patient outcomes. 14 Despite growing Internet access, older adults and those with communication barriers face challenges using patient portals that proxies might mitigate. [15][16][17][18][19] Describing the prevalence of proxy SM use and determining which patients rely on proxies is important for understanding how to leverage proxies and health IT to improve patient and caregiver outcomes.…”