High Touch and High Tech (HT2) Proposal: Transforming Patient Engagement Throughout the Continuum of Care by Engaging Patients with Portal Technology at the Bedside

Abstract

BackgroundFor patients with complex care needs, engagement in disease management activities is critical. Chronic illnesses touch almost every person in the United States. The costs are real, personal, and pervasive. In response, patients often seek tools to help them manage their health. Patient portals, personal health records tethered to an electronic health record, show promise as tools that patients value and that can improve health. Although patient portals currently focus on the outpatient experience, the Ohio State University Wexner Medical Center (OSUWMC) has deployed a portal designed specifically for the inpatient experience that is connected to the ambulatory patient portal available after discharge. While this inpatient technology is in active use at only one other hospital in the United States, health care facilities are currently investing in infrastructure necessary to support large-scale deployment. Times of acute crisis such as hospitalization may increase a patient’s focus on his/her health. During this time, patients may be more engaged with their care and especially interested in using tools to manage their health after discharge. Evidence shows that enhanced patient self-management can lead to better control of chronic illness. Patient portals may serve as a mechanism to facilitate increased engagement.ObjectiveThe specific aims of our study are (1) to investigate the independent effects of providing both High Tech and High Touch interventions on patient-reported outcomes at discharge, including patients’ self-efficacy for managing chronic conditions and satisfaction with care; and (2) to conduct a mixed-methods analysis to determine how providing patients with access to MyChart Bedside (MCB, High Tech) and training/education on patient portals, and MyChart Ambulatory (MCA, High Touch) will influence engagement with the patient portal and relate to longer-term outcomes.MethodsOur proposed 4-year study uses a mixed-methods research (MMR) approach to evaluate a randomized controlled trial studying the effectiveness of a High Tech intervention (MCB, the inpatient portal), and an accompanying High Touch intervention (training patients to use the portal to manage their care and conditions) in a sample of hospitalized patients with two or more chronic conditions. This study measures how access to a patient portal tailored to the inpatient stay can improve patient experience and increase patient engagement by (1) improving patients’ perceptions of the process of care while in the hospital; (2) increasing patients’ self-efficacy for managing chronic conditions; and (3) facilitating continued use of a patient portal for care management after discharge. In addition, we aim to enhance patients’ use of the portal available to outpatients (MCA) once they are discharged.ResultsThis study has been funded by the Agency for Healthcare Research and Quality (AHRQ). Research is ongoing and expected to conclude in August 2019.ConclusionsProviding patients real-time access to health information can be a positive f...

What are the Gaps in Mobile Patient Portal? Mining Users Feedback Using Topic Modeling

“…While previous studies reported positive findings, including patient reports of enhanced engagement in the care process and satisfaction with care, none included patient-centered functionality such as the ability to send messages to the care team, allowing patients to input information or record noteselements that have been demonstrated to further enhance patients' engagement [10]. This is especially true with the proliferation of wearable devices, where data about an individual's health state can be collected by real-time sampling and analysis of a few parameters using noninvasive, inexpensive, and portable devices [26].…”

“…Providing patients real-time access to health information has been demonstrated as a positive force for change in the way care is provided [10]. In this regard, Lu, et al [25] develop an App to inspect controlled substances in patient care units.…”

“…Patient Health Records (PHR) technology, often known as patient portal, provides patients with online access to their health records which in turn enables better disease management through tracking of comprehensive health indicators and lower the cost of care [6,7]. Through the potential to provide continuity of service and better care, and the potential to change the physician-patient relationship and enable chronic disease self-management, patient portals are positioned as a central component of patient engagement [10].…”

Patient Engagement as Measured by Inpatient Portal Use: Methodology for Log File Analysis (Preprint)

“…An IPP provides a hospitalized patient with similar functions to those found in outpatient portals, including the ability to view vital signs, laboratory results, medication information, schedule appointments and communicate with their provider. However, IPPs may offer additional functions such as meal planning, real-time messaging with the inpatient care team, daily schedules, and access to educational materials relevant to their specific conditions [11,12]. In practice, IPPs have been developed as websites and tablet apps, with hospitals providing the required technology as a component of care during the patient's stay.…”

“…One of the first such implementations occurred in 2013 at The Ohio State University Wexner Medical Center (OSU) with Epic Systems' MyChart Bedside (MCB) product. As the first academic medical center to implement an IPP system-wide, OSU sought to use its unique position to document its journey and provide guidance on IPP adoption [11,12,16]. However, only recently has enough usage data been available upon which to explore outcomes through a "big data" approachspecifically through the analysis of audit log files.…”