Getting results for hematology patients through access to the electronic health record

Wiljer, David; Bogomilsky, Sima; Catton, Pamela; Murray, Cindy; Stewart, Janice; Minden, Mark D.

doi:10.5737/1181912x163154158

Cited by 21 publications

(19 citation statements)

References 16 publications

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“…Approximately 1300 patients attend 4500 appointments each month under the service of 77 pediatric-focused physicians, 6 physician assistants, and 5 nurse practitioners. We also included one specialty clinic focused on hematology/oncology, as anecdotal evidence in the literature suggests that this group of patients is particularly interested in monitoring their clinical information online [15]. This clinic diagnoses, treats, and helps patients manage solid tumors, lymphomas, and a variety of complex bleeding and clotting disorders.…”

Section: Methodsmentioning

confidence: 99%

Impact of Health Portal Enrollment With Email Reminders on Adherence to Clinic Appointments: A Pilot Study

Horvath¹,

Levy²,

L'Engle³

et al. 2011

J Med Internet Res

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BackgroundInternet portal technologies that provide access to portions of electronic health records have the potential to revolutionize patients’ involvement in their care. However, relatively few descriptions of the demographic characteristics of portal enrollees or of the effects of portal technology on quality outcomes exist. This study examined data from patients who attended one of seven Duke Medicine clinics and who were offered the option of enrolling in and using the Duke Medicine HealthView portal (HVP). The HVP allows patients to manage details of their appointment scheduling and provides automated email appointment reminders in addition to the telephone and mail reminders that all patients receive.ObjectiveOur objective was to test whether portal enrollment with an email reminder functionality is significantly related to decreases in rates of appointment “no-shows,” which are known to impair clinic operational efficiency.MethodsAppointment activity during a 1-year period was examined for all patients attending one of seven Duke Medicine clinics. Patients were categorized as portal enrollees or as nonusers either by their status at time of appointment or at the end of the 1-year period. Demographic characteristics and no-show rates among these groups were compared. A binomial logistic regression model was constructed to measure the adjusted impact of HVP enrollment on no-show rates, given confounding factors. To demonstrate the effect of HVP use over time, monthly no-show rates were calculated for patient appointment keeping and contrasted between preportal and postportal deployment periods.ResultsAcross seven clinics, 58,942 patients, 15.7% (9239/58,942) of whom were portal enrollees, scheduled 198,199 appointments with an overall no-show rate of 9.9% (19,668/198,199). We found that HVP enrollees were significantly more likely to be female, white, and privately insured compared with nonusers. Bivariate no-show rate differences between portal enrollment groups varied widely according to patient- and appointment-level attributes. Large reductions in no-show rates were seen among historically disadvantaged groups: Medicaid holders (OR = 2.04 for nonuser/enrollee, 5.6% difference, P < .001), uninsured patients (OR = 2.60, 12.8% difference, P < .001), and black patients (OR = 2.13, 8.0% difference, P < .001). After fitting a binomial logistic regression model for the outcome of appointment arrival, the adjusted odds of arrival increased 39.0% for portal enrollees relative to nonusers (OR = 1.39, 95% CI 1.22 - 1.57, P < .001). Analysis of monthly no-show rates over 2 years demonstrated that patients who registered for portal access and received three reminders of upcoming appointments (email, phone, and mail) had a 2.0% no-show rate reduction (P < .001), whereas patients who did not enroll and only received traditional phone and mail reminders saw no such reduction (P < .09).ConclusionsMonthly no-show rates across all seven Duke Medicine clinics were significantly reduced among patients who registered for po...

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Section: Methodsmentioning

confidence: 99%

Impact of Health Portal Enrollment With Email Reminders on Adherence to Clinic Appointments: A Pilot Study

Horvath¹,

Levy²,

L'Engle³

et al. 2011

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…For instance, in a cohort of patients with hematologic malignancies, 89% expressed interest in accessing electronic health records. 10 Additionally, disease burden and complexity in medical oncology may lead to greater health care need, which in turn has been associated with increased portal use. 11 To our knowledge, this is the first study to examine PHR portal use in a large, contemporary oncology cohort.…”

Section: Discussionmentioning

confidence: 99%

Predictors and Intensity of Online Access to Electronic Medical Records Among Patients With Cancer

Gerber

Laccetti

Chen

et al. 2014

JOP

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“…As patients express interests in reading their own EHR data [5], health care institutions have also begun to open up access to the EHR records [6]. However, EHRs are written by physicians to communicate with other health care professionals [7].…”

Section: Introductionmentioning

confidence: 99%

Readability Formulas and User Perceptions of Electronic Health Records Difficulty: A Corpus Study

Zheng¹,

Yu²

2017

J Med Internet Res

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BackgroundElectronic health records (EHRs) are a rich resource for developing applications to engage patients and foster patient activation, thus holding a strong potential to enhance patient-centered care. Studies have shown that providing patients with access to their own EHR notes may improve the understanding of their own clinical conditions and treatments, leading to improved health care outcomes. However, the highly technical language in EHR notes impedes patients’ comprehension. Numerous studies have evaluated the difficulty of health-related text using readability formulas such as Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning-Fog Index (GFI). They conclude that the materials are often written at a grade level higher than common recommendations.ObjectiveThe objective of our study was to explore the relationship between the aforementioned readability formulas and the laypeople’s perceived difficulty on 2 genres of text: general health information and EHR notes. We also validated the formulas’ appropriateness and generalizability on predicting difficulty levels of highly complex technical documents.MethodsWe collected 140 Wikipedia articles on diabetes and 242 EHR notes with diabetes International Classification of Diseases, Ninth Revision code. We recruited 15 Amazon Mechanical Turk (AMT) users to rate difficulty levels of the documents. Correlations between laypeople’s perceived difficulty levels and readability formula scores were measured, and their difference was tested. We also compared word usage and the impact of medical concepts of the 2 genres of text.ResultsThe distributions of both readability formulas’ scores (P<.001) and laypeople’s perceptions (P=.002) on the 2 genres were different. Correlations of readability predictions and laypeople’s perceptions were weak. Furthermore, despite being graded at similar levels, documents of different genres were still perceived with different difficulty (P<.001). Word usage in the 2 related genres still differed significantly (P<.001).ConclusionsOur findings suggested that the readability formulas’ predictions did not align with perceived difficulty in either text genre. The widely used readability formulas were highly correlated with each other but did not show adequate correlation with readers’ perceived difficulty. Therefore, they were not appropriate to assess the readability of EHR notes.

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Getting results for hematology patients through access to the electronic health record

Cited by 21 publications

References 16 publications

Impact of Health Portal Enrollment With Email Reminders on Adherence to Clinic Appointments: A Pilot Study

Impact of Health Portal Enrollment With Email Reminders on Adherence to Clinic Appointments: A Pilot Study

Predictors and Intensity of Online Access to Electronic Medical Records Among Patients With Cancer

Readability Formulas and User Perceptions of Electronic Health Records Difficulty: A Corpus Study

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