Interest in the Use of Computerized Patient Portals: Role of the Provider–Patient Relationship

Abstract

BACKGROUND: Bioinformatics experts are developing interactive patient portals to help those living with diabetes and other chronic diseases to better manage their conditions. However, little is known about what influences patients' desires to use this technology. OBJECTIVE:To discern the impact of the providerpatient relationship on interest in using a web-based patient portal. DESIGN: Qualitative analysis of focus groups.PARTICIPANTS: Ten focus groups involving 39 patients (range 2-7) recruited from four primary care practices.APPROACH: A qualitative approach was used, which involved reading transcribed texts until a consensus was reached on data interpretation. An intercoder reliability kappa score (0.89) was determined by comparing the provider-patient relationship talk selected by the two coders. A conceptual framework was developed, which involved the development and refinement of a codebook and the application of it to the transcripts. RESULTS:Interest in the portal was linked to dissatisfaction with the provider-patient relationship, including dissatisfaction with provider communication/ responsiveness, the inability to obtain medical information, and logistical problems with the office. Disinterest in the portal was linked to satisfaction with the provider-patient relationship, including provider communication/responsiveness, difficulty in using the portal, and fear of losing relationships and e-mail contact with the provider. No patient identified encrypted e-mail communication through the portal as an advantage.CONCLUSIONS: Promoting the use of computerized portals requires patient-based adaptations. These should include ease of use, direct provider e-mail, and reassurances that access and interpersonal relationships will not be lost. Education is needed about privacy concerns regarding traditional e-mail communication.

Clinician Perspectives about Molecular Genetic Testing for Heritable Conditions and Development of a Clinician-Friendly Laboratory Report

“…29 A concern was raised that genetic test results appearing in the medical record in the absence of a carefully constructed interpretation have the potential for being misinterpreted resulting in undue alarm to and/or faulty decision-making by patients and their families. To minimize the potential for misunderstanding and promote patient understanding, workgroup participants suggested that patients or patient groups be consulted in developing or improving the format and wording of the result report and its presentation in the medical record.…”

Use of an Electronic Patient Portal Among Disadvantaged Populations

“…On the other hand, some qualitative research has linked patient interest in portals with dissatisfaction with the patient-provider relationship. 18 In either case, provider attitude and behavior are likely to be key factors for future research.…”

Patient Accessible Electronic Health Records for the Chronically Ill: A Review of the Literature

“…Zickmund et al reported on a connection between patient dissatisfaction with the patient-provider relationship and increased interest in the use of PAEHR [23] . Two studies reported that users who logged in more frequently were of superior health status [18,27] , while a third reported contrary findings as the users in their study experienced more symptoms and had more visits with providers [15] .…”

“…[15,20,36,31] . Several groups advocated for an edited version of the electronic medical record that provides explanatory information [15,23,29] or a glossary of medical terms [31] and is easier to understand for use by patients [15,24] .…”

“…Two citations indicated that issues regarding confidentiality and privacy were not major concerns among the patient populations studied [15,23] . Zickmund et al noted that the diabetic patients in their study failed to observe the improved security provided by the portal in the form of encrypted e-mail [23] .…”