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

Etingen, Bella; Hogan, Timothy P.; Martínez, Rachael N.; Shimada, Stephanie L.; Stroupe, Kevin T.; Nazi, Kim M.; Connolly, Samantha L.; Lipschitz, Jessica M.; Weaver, Frances M.; Smith, Bridget

doi:10.1007/s10488-019-00938-x

Cited by 21 publications

(19 citation statements)

References 50 publications

(38 reference statements)

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“…Data were collected in a more extensive study examining the role of patient portals in diabetes management, described previously [ 15 ]. Briefly, from November 2017 to January 2018, 1200 patients living with diabetes were invited to participate in a mailed survey about their diabetes self-management and use of the United States Department of Veterans Affairs (VA) online patient portal, My Health e Vet [ 16 ]. The My Health e Vet portal offers several features to help patients manage their care.…”

Section: Methodsmentioning

confidence: 99%

The Promise of Patient Portals for Individuals Living With Chronic Illness: Qualitative Study Identifying Pathways of Patient Engagement

Stewart¹,

Hogan²,

Nicklas³

et al. 2020

J Med Internet Res

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Background Patients play a critical role in managing their health, especially in the context of chronic conditions like diabetes. Electronic patient portals have been identified as a potential means to improve patient engagement; that is, patients’ involvement in their care. However, little is known about the pathways through which portals may help patients engage in their care. Objective Our objective is to understand how an electronic patient portal facilitates patient engagement among individuals with diabetes. Methods This qualitative study employed semistructured telephone interviews of 40 patients living with diabetes since at least 2011, who had experienced uncontrolled diabetes, and had used secure messaging through a portal at least 4 times over 18 months. The interviews were recorded, transcribed, coded, and analyzed using primarily an inductive approach to identify how patients living with diabetes use an online health portal to support diabetes self-management. Results Overall, patients who used the portal reported feeling engaged in their health care. We identified four pathways by which the portal facilitates patient engagement and some challenges. The portal provides a platform that patients use to (1) better understand their health by asking questions about new symptoms, notes, or labs, (2) prepare for medical appointments by reviewing labs and notes, (3) coordinate care between VA (Veterans Affairs) and non-VA health care teams, and (4) reach out to providers to request help between visits. Several patients reported that the portal helped improve the patient-provider relationship; however, aspects of the portal design may hinder engagement for others. Patients reported challenges with both secure messaging and access to medical records that had negative impacts on their engagement. Benefits for patient engagement were described by many types of portal users with varying degrees of diabetes control. Conclusions Patient portals support engagement by facilitating patient access to their health information and by facilitating patient-provider communication. Portals can help a wide range of users engage with their care.

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Section: Methodsmentioning

confidence: 99%

The Promise of Patient Portals for Individuals Living With Chronic Illness: Qualitative Study Identifying Pathways of Patient Engagement

Stewart¹,

Hogan²,

Nicklas³

et al. 2020

J Med Internet Res

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“…The research team developed a standardized template to extract and chart relevant data from the included studies [5,[12][13][14][15][16][17][18][19][20][21][22][23][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56]. The following parameters were recorded in detail: reference ID, authors, year, country, design, sample, participants, treatment setting and medical specialty, study purpose, and a summary of the results.…”

Section: Data Extraction and Managementmentioning

confidence: 99%

Sharing Clinical Notes and Electronic Health Records With People Affected by Mental Health Conditions: Scoping Review

Schwarz¹,

Bärkås²,

Blease³

et al. 2021

JMIR Ment Health

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Background Electronic health records (EHRs) are increasingly implemented internationally, whereas digital sharing of EHRs with service users (SUs) is a relatively new practice. Studies of patient-accessible EHRs (PAEHRs)—often referred to as open notes—have revealed promising results within general medicine settings. However, studies carried out in mental health care (MHC) settings highlight several ethical and practical challenges that require further exploration. Objective This scoping review aims to map available evidence on PAEHRs in MHC. We seek to relate findings with research from other health contexts, to compare different stakeholders’ perspectives, expectations, actual experiences with PAEHRs, and identify potential research gaps. Methods A systematic scoping review was performed using 6 electronic databases. Studies that focused on the digital sharing of clinical notes or EHRs with people affected by mental health conditions up to September 2021 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews guided narrative synthesis and reporting of findings. Results Of the 1034 papers screened, 31 were included in this review. The studies used mostly qualitative methods or surveys and were predominantly published after 2018 in the United States. PAEHRs were examined in outpatient (n=29) and inpatient settings (n=11), and a third of all research was conducted in Veterans Affairs Mental Health. Narrative synthesis allowed the integration of findings according to the different stakeholders. First, SUs reported mainly positive experiences with PAEHRs, such as increased trust in their clinician, health literacy, and empowerment. Negative experiences were related to inaccurate notes, disrespectful language use, or uncovering of undiscussed diagnoses. Second, for health care professionals, concerns outweigh the benefits of sharing EHRs, including an increased clinical burden owing to more documentation efforts and possible harm triggered by reading the notes. Third, care partners gained a better understanding of their family members’ mental problems and were able to better support them when they had access to their EHR. Finally, policy stakeholders and experts addressed ethical challenges and recommended the development of guidelines and trainings to better prepare both clinicians and SUs on how to write and read notes. Conclusions PAEHRs in MHC may strengthen user involvement, patients’ autonomy, and shift medical treatment to a coproduced process. Acceptance issues among health care professionals align with the findings from general health settings. However, the corpus of evidence on digital sharing of EHRs with people affected by mental health conditions is limited. Above all, further research is needed to examine the clinical effectiveness, efficiency, and implementation of this sociotechnical intervention.

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“…Data were collected in a more extensive study examining the role of patient portals in diabetes management, described previously [15]. Briefly, from November 2017 to January 2018, 1200 patients living with diabetes were invited to participate in a mailed survey about their diabetes self-management and use of the United States Department of Veterans Affairs (VA) online patient portal, My HealtheVet [16]. The My HealtheVet portal offers several features to help patients manage their care.…”

Section: Methodsmentioning

confidence: 99%

The Promise of Patient Portals for Individuals Living With Chronic Illness: Qualitative Study Identifying Pathways of Patient Engagement (Preprint)

Stewart¹,

Hogan²,

Nicklas³

et al. 2020

Preprint

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BACKGROUND Patients play a critical role in managing their health, especially in the context of chronic conditions like diabetes. Electronic patient portals have been identified as a potential means to improve patient engagement; that is, patients’ involvement in their care. However, little is known about the pathways through which portals may help patients engage in their care. OBJECTIVE Our objective is to understand how an electronic patient portal facilitates patient engagement among individuals with diabetes. METHODS This qualitative study employed semistructured telephone interviews of 40 patients living with diabetes since at least 2011, who had experienced uncontrolled diabetes, and had used secure messaging through a portal at least 4 times over 18 months. The interviews were recorded, transcribed, coded, and analyzed using primarily an inductive approach to identify how patients living with diabetes use an online health portal to support diabetes self-management. RESULTS Overall, patients who used the portal reported feeling engaged in their health care. We identified four pathways by which the portal facilitates patient engagement and some challenges. The portal provides a platform that patients use to (1) better understand their health by asking questions about new symptoms, notes, or labs, (2) prepare for medical appointments by reviewing labs and notes, (3) coordinate care between VA (Veterans Affairs) and non-VA health care teams, and (4) reach out to providers to request help between visits. Several patients reported that the portal helped improve the patient-provider relationship; however, aspects of the portal design may hinder engagement for others. Patients reported challenges with both secure messaging and access to medical records that had negative impacts on their engagement. Benefits for patient engagement were described by many types of portal users with varying degrees of diabetes control. CONCLUSIONS Patient portals support engagement by facilitating patient access to their health information and by facilitating patient-provider communication. Portals can help a wide range of users engage with their care. CLINICALTRIAL

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

Cited by 21 publications

References 50 publications

The Promise of Patient Portals for Individuals Living With Chronic Illness: Qualitative Study Identifying Pathways of Patient Engagement

The Promise of Patient Portals for Individuals Living With Chronic Illness: Qualitative Study Identifying Pathways of Patient Engagement

Sharing Clinical Notes and Electronic Health Records With People Affected by Mental Health Conditions: Scoping Review

The Promise of Patient Portals for Individuals Living With Chronic Illness: Qualitative Study Identifying Pathways of Patient Engagement (Preprint)

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