Growth of Secure Messaging Through a Patient Portal as a Form of Outpatient Interaction across Clinical Specialties

Cronin, Robert M.; Davis, Sharon E.; Shenson, Jared A.; Chen, Q.; Rosenbloom, S. Trent; Jackson, Gretchen Purcell

doi:10.4338/aci-2014-12-ra-0117

Cited by 86 publications

(41 citation statements)

References 52 publications

(88 reference statements)

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“…Reducing the frequency of in-person visits could be accomplished by using computer technologies, such as secure messaging (email) or telehealth systems, for non-essential office visits. Many medical systems are already using secure messaging systems to share the results from routine medical tests with patients [26, 27]. Reducing costs associated with prescription drugs is perhaps more difficult to address.…”

Section: Discussionmentioning

confidence: 99%

Assessing key cost drivers associated with caring for chronic kidney disease patients

Damien

Lanham

Parthasarathy³

et al. 2016

BMC Health Serv Res

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BackgroundTo examine key factors influencing chronic kidney disease (CKD) patients’ total expenditure and offer recommendations on how to reduce total cost of CKD care without compromising quality.MethodsUsing the 2002–2011 Medical Expenditure Panel Survey (MEPS) data, our cross-sectional study analyzed 197 patient records—79 patients with one record and 59 with two entries per patient (138 unique patients). We used three patient groups, based on international statistical classification of diseases version 9 code for condition (ICD9CODX) classification, to focus inference from the analysis: (a) non-dialysis dependent CKD, (b) dialysis and (c) transplant. Covariate information included region, demographic, co-morbid conditions and types of services. We used descriptive methods and multivariate generalized linear models to understand the impact of cost drivers. We compared actual and predicted CKD cost of care data using a hold-out sample of nine, randomly selected patients to validate the models.ResultsTotal costs were significantly affected by treatment type, with dialysis being significantly higher than non-dialysis and transplant groups. Costs were highest in the West region of the U.S. Average costs for patients with public insurance were significantly higher than patients with private insurance (p < .0743), and likewise, for patients with co-morbid conditions over those without co-morbid conditions (p < .001).ConclusionsManaging CKD patients both before and after the onset of dialysis treatment and managing co-morbid conditions in individuals with CKD are potential sources of substantial cost savings in the care of CKD patients. Comparing total costs pre and post the United States Affordable Care Act could provide invaluable insights into managing the cost-quality tradeoff in CKD care.

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Section: Discussionmentioning

confidence: 99%

Assessing key cost drivers associated with caring for chronic kidney disease patients

Damien

Lanham

Parthasarathy³

et al. 2016

BMC Health Serv Res

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“…A prior study of a random sample of 3253 MHAV messages found that approximately 72% involved medical needs or communications, but this study only analyzed individual patient-initiated messages, not the entire threads, and involved all clinical specialties, not just those messages sent to surgeons. [13, 14] We know that the majority of patient-initiated MHAV messages are received by primary care or medicine specialty providers [17], so it is not clear whether the higher percentage involving medical care found in this study was due to differences in portal messaging use across specialties or the richness of the full message threads. However, in both studies, a critical finding was that substantial medical care was being delivered through patient portal messages.…”

Section: Discussionmentioning

confidence: 98%

“…[17] In 2007, accounts for pediatric patients and their parents or guardians were made available. MHAV provides a collection of common patient portal functions including access to selected portions of the electronic medical record, appointment scheduling, secure messaging with healthcare providers, account and bill management, and delivery of personalized health information.…”

Section: Methodsmentioning

confidence: 99%

“…[15] Further, messaging adoption by surgical patients and providers grew rapidly across surgical subspecialties. [16] Although providers conduct growing numbers of online encounters by exchanging messages with patients through such portals, the nature of such communications has not been analyzed for surgery.…”

Section: Introductionmentioning

confidence: 99%

“…[16] Although providers conduct growing numbers of online encounters by exchanging messages with patients through such portals, the nature of such communications has not been analyzed for surgery. [16, 17]…”

Section: Introductionmentioning

confidence: 99%

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Complexity of medical decision-making in care provided by surgeons through patient portals

Robinson

Valentine

Carney

et al. 2017

Journal of Surgical Research

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Introduction Patient portals are online applications that allow patients to interact with healthcare organizations and information. Portal messages exchanged between patients and providers contain diverse types of communications, including delivery of medical care. The types of communications and complexity of medical decision-making in portal messages sent to surgeons has not been studied. Materials and Methods We obtained all message threads initiated by patients and exchanged with surgical providers through the Vanderbilt University Medical Center patient portal from June 1 to December 31, 2014. Five hundred randomly selected messages were manually analyzed by two research team members to determine the types of communication (i.e., informational, medical, logistical, or social), whether medical care was delivered, and complexity of medical decision-making as defined for outpatient billing in each message thread. Results 9,408 message threads were sent to 401 surgical providers during the study period. In the 500 threads selected for detailed analysis, 1,293 distinct issues were communicated, with an average of 2.6 issues per thread. Medical care was delivered in 453 message threads (90.6%). Of these, 339 (67.8%) of message threads contained medical decision-making. Overall complexity of medical decision-making was straightforward in 210 messages (62%), low in 102 messages (30%), and moderate in 27 messages (8%). No highly complex decisions were made over portal messaging. Conclusions Through patient portal messages, surgeons deliver substantial medical care with varied levels of medical complexity. Models for compensation of online care must be developed as consumer and surgeon adoption of these technologies increases.

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Determinants of mobile technology use and smartphone application interest in cancer patients

Raghunathan

Korenstein

et al. 2018

Cancer Medicine

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BackgroundSupportive care is a critical component of the treatment of cancer patients that is underutilized; patient lack of information about these services is an important barrier. Mobile technologies may be useful tools for delivering information, but cancer patient use of and interest in using them to learn about supportive care services have not been described. This study evaluates factors associated with cancer patient use of mobile technologies and interest in smartphone applications for information delivery about supportive care.MethodsWe conducted a cross‐sectional survey among cancer patients from one urban academic hospital and 11 community hospitals. Patients self‐reported use of mobile technologies and interest in smartphone applications. Multivariate logistic analysis was used to identify determinants of mobile technology use and smartphone interest.ResultsAmong 631 participants, 466 (74%) reported regular use of mobile devices and 242 (39%) expressed an interest in supportive care information via smartphone applications. Patients under 45 were more likely to use a mobile device (Adjusted Odds Ratio [AOR] 6.8, 2.8‐16.9 95% CI, P < 0.001) and were interested in smartphone applications for delivery of information (AOR 3.2, 1.8‐5.9 95% CI, P < 0.001). Non‐white patients had similar use of mobile technology compared to whites but reported greater interest in smartphone application‐based information (AOR 3.4, 2.1‐5.5 95% CI, P < 0.001).ConclusionMany patients expressed interest in smartphone application‐based information about supportive care services, especially those who are younger and non‐white. Future studies should investigate the characteristics of patients and smartphones applications that will optimize information delivery through a mobile technology platform.

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Growth of Secure Messaging Through a Patient Portal as a Form of Outpatient Interaction across Clinical Specialties

Cited by 86 publications

References 52 publications

Assessing key cost drivers associated with caring for chronic kidney disease patients

Assessing key cost drivers associated with caring for chronic kidney disease patients

Complexity of medical decision-making in care provided by surgeons through patient portals

Determinants of mobile technology use and smartphone application interest in cancer patients

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