Implementation of acute care patient portals: recommendations on utility and use from six early adopters

Abstract

We summarize the experiences of 6 organizations that have implemented acute care portals, representing a variety of settings and technologies. We discuss the considerations for and challenges of incorporating various features into an acute care patient portal, and extract the lessons learned from each institution's experience. We recommend that stakeholders in acute care patient portals should: (1) consider the benefits and challenges of generic and structured electronic care team messaging; (2) examine strategies to provide rich care plan information, such as daily schedule, problem list, care goals, discharge criteria, and post-hospitalization care plan; (3) offer increasingly comprehensive access to clinical data and medical record information; (4) develop alternative strategies for patient education that go beyond infobuttons; (5) focus on improving patient safety through explicit safety-oriented features; (6) consider strategies to engage patient caregivers through portals while remaining cognizant of potential Health Insurance Portability and Accountability Act (HIPAA) violations; (7) consider offering amenities to patients through acute care portals, such as information about navigating the hospital or electronic food ordering.

Technology Access, Technical Assistance, and Disparities in Inpatient Portal Use

“…12,13 The increasing popularity of portals and their potential utility to hospitalized patients has motivated some organizations to adopt inpatient portals, or patient portals accessed in the hospital setting. [14][15][16][17][18][19] Vendors now offer portals intended specifically for in-hospital use, such as MyChart Bedside from Epic Systems Corporation. 20 Institutions use inpatient portals to address patients' information needs, engage patients in decision making, facilitate patient-provider communication, improve transparency, provide health education, increase patient safety, and enable transitions of care.…”

“…20 Institutions use inpatient portals to address patients' information needs, engage patients in decision making, facilitate patient-provider communication, improve transparency, provide health education, increase patient safety, and enable transitions of care. 14,15 Research suggests that inpatient portals may improve patient safety and satisfaction. [21][22][23][24][25][26] Inpatient portals empower patients to report safety concerns, facilitate patient recognition of errors, improve patients' perceptions of safety and quality, and fulfill patients' information needs.…”

A systematic review of patient access to medical records in the acute setting: practicalities, perspectives and ethical consequences

“…Two studies used questionnaires [17,18]; four used interviews or focus groups [19][20][21][22][23][24]; two used mixed methods [25,26]. One note analysis, [27] one portal analysis [28] and one clinical trial [29,30] was conducted, and six analysis articles were identified [31][32][33][34][35][36]. One empirical study came from each of Israel [19], Norway [20,21] and Canada [18]; the rest originated from the USA.…”

“…Sharing notes was seen to empower patients by improving trust and knowledge [30], facilitating patients to work with doctors [28]. Communication of written information was considered superior to verbal explanations; one patient was reported as saying "Yeah, they come and update me but..I mean I can't keep track of it all.…”

“…Patients and doctors had discordant perceptions of how accessing the medical record might affect care: whilst doctors were concerned access to notes will overwhelm or unnecessarily worry patients, [17,24] patients were reassured by the shared information [37]. Grossman et al suggested that 'it may be prudent to omit or explain potentially alarming information that carries a low degree of certainty such as a cancer on a differential diagnosis list" [28]. A reoccurring conflict was the release of lab (and other) results in real timepatients strongly supported this whereas doctors preferred a delay, [24,29,31] in part so they could interpret them appropriately, offer support and create a future healthcare plan.…”