Optimizing the User Experience: Identifying Opportunities to Improve Use of an Inpatient Portal

Walker, Daniel M.; Menser, Terri; Yen, Po Yin; McAlearney, Ann Scheck

doi:10.1055/s-0037-1621732

Cited by 30 publications

(33 citation statements)

References 34 publications

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“…New approaches to improving usability may help reduce training needs. 68,69 Despite the well-documented evidence for disparities in outpatient portal use, [27][28][29][30][31][32][33] fewer studies have investigated potential disparities in inpatient portal use. [34][35][36] However, this study and the existing literature indicate that disparities in use occur with inpatient portals as with outpatient ones.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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Background Disadvantaged populations, including minorities and the elderly, use patient portals less often than relatively more advantaged populations. Limited access to and experience with technology contribute to these disparities. Free access to devices, the Internet, and technical assistance may eliminate disparities in portal use. Objective To examine predictors of frequent versus infrequent portal use among hospitalized patients who received free access to an iPad, the Internet, and technical assistance. Materials and Methods This subgroup analysis includes 146 intervention-arm participants from a pragmatic randomized controlled trial of an inpatient portal. The participants received free access to an iPad and inpatient portal while hospitalized on medical and surgical cardiac units, together with hands-on help using them. We used logistic regression to identify characteristics predictive of frequent use. Results More technology experience (adjusted odds ratio [OR] = 5.39, p = 0.049), less severe illness (adjusted OR = 2.07, p = 0.077), and private insurance (adjusted OR = 2.25, p = 0.043) predicted frequent use, with a predictive performance (area under the curve) of 65.6%. No significant differences in age, gender, race, ethnicity, level of education, employment status, or patient activation existed between the frequent and infrequent users in bivariate analyses. Significantly more frequent users noticed medical errors during their hospital stay. Discussion and Conclusion Portal use was not associated with several sociodemographic characteristics previously found to limit use in the inpatient setting. However, limited technology experience and high illness severity were still barriers to frequent use. Future work should explore additional strategies, such as enrolling health care proxies and improving usability, to reduce potential disparities in portal use.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…9,12,[15][16][17][18] In recent years, health care systems have been trying to engage patients by offering online access to their health records via patient portals, and reported experiences regarding implementation of patient portals for acute care are now starting to emerge. 15,[19][20][21][22][23][24][25][26][27] Still, few studies have demonstrated meaningful impact on key outcomes, 20,[28][29][30] and to our knowledge, none have demonstrated the potential for using patient portals to improve concordance about the care plan, including recovery goals, among patients and clinicians in the acute care setting. 23,31,32 Improving patient-clinician communication through the meaningful use of patient portals represents a promising strategy to enhance mutual understanding about the plan and facilitate goal-concordant care for seriously ill patients during hospitalization and the transition back to the ambulatory setting.…”

Section: Background and Significancementioning

confidence: 99%

Potential of an Electronic Health Record-Integrated Patient Portal for Improving Care Plan Concordance during Acute Care

et al. 2019

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Background Care plan concordance among patients and clinicians during hospitalization is suboptimal. Objective This article determines whether an electronic health record (EHR)-integrated patient portal was associated with increased understanding of the care plan, including the key recovery goal, among patients and clinicians in acute care setting. Methods The intervention included (1) a patient portal configured to solicit a single patient-designated recovery goal and display the care plan from the EHR for participating patients; and (2) an electronic care plan for all unit-based nurses that displays patient-inputted information, accessible to all clinicians via the EHR. Patients admitted to an oncology unit, including their nurses and physicians, were enrolled before and after implementation. Main outcomes included mean concordance scores for the overall care plan and individual care plan elements. Results Of 457 and 283 eligible patients approached during pre- and postintervention periods, 55 and 46 participated in interviews, respectively, including their clinicians. Of 46 postintervention patients, 27 (58.7%) enrolled in the patient portal. The intention-to-treat analysis demonstrated a nonsignificant increase in the mean concordance score for the overall care plan (62.0–67.1, adjusted p = 0.13), and significant increases in mean concordance scores for the recovery goal (30.3–57.7, adjusted p < 0.01) and main reason for hospitalization (58.6–79.2, adjusted p < 0.01). The on-treatment analysis of patient portal enrollees demonstrated significant increases in mean concordance scores for the overall care plan (61.9–70.0, adjusted p < 0.01), the recovery goal (30.4–66.8, adjusted p < 0.01), and main reason for hospitalization (58.3–81.7, adjusted p < 0.01), comparable to the intention-to-treat analysis. Conclusion Implementation of an EHR-integrated patient portal was associated with increased concordance for key care plan components. Future efforts should be directed at improving concordance for other care plan components and conducting larger, randomized studies to evaluate the impact on key outcomes during transitions of care. Clinical Trials Identifier NCT02258594.

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“…They included other applications such as games, music, and video streaming; but did not include access to the Internet. For a more detailed description of the inpatient portal, see Kelly et al 17 and Walker et al 24 Over 1 year, a multidisciplinary implementation team met monthly to plan inpatient portal implementation. This 31-member team included a project manager and representatives from stakeholder groups, including: bedside nursing (2), nurse management (2), support staff (2), physicians, trainees, patient/family advisors, inpatient informatics, learning and development, patient experience, quality and safety, hospital administration, ambulatory patient portal, security, and legal.…”

Section: Inpatient Portal and Implementation Processmentioning

confidence: 99%

Nurses' Expectations of an Inpatient Portal for Hospitalized Patients and Caregivers

et al. 2019

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Background Patient portals are intended to engage patients and enhance patient-centered care. Recent studies suggest that the information within portals could provide benefits to patients and their caregivers during hospitalization; however, few studies have examined nurse and staff expectations of portals when used in the hospital setting. Objective This article examines inpatient nurse and support staff expectations of a commercially available inpatient portal prior to its hospital-wide implementation. Methods In this cross-sectional study, nurses and support staff were surveyed 1 month prior to the implementation of an inpatient portal for patients. Items included respondent characteristics, satisfaction with online inpatient portal training, expectations of the effects of portal use on patients, caregivers, and staff, overall acceptance, and barriers to its implementation. Results Of 881 respondents, 73.0% were staff nurses, 18.4% nurse assistants, 4.3% unit coordinators, and 1.2% nurse managers. Respondents were generally satisfied with the portal information they received from online training. A majority liked the portal to some extent prior to its use (66.7%); however, they noted multiple implementation barriers, including: tablets would get lost/damaged (66.2% of respondents), patients and/or caregivers would have too many questions (48.5%), and staff would have problems integrating it into their workflow (44.7%). Respondents working on medical units had higher expectations (p < 0.001) and acceptance (p < 0.01) of the portal than those on surgical and intensive care units. Nurse managers were more positive than respondents with other job roles were (all p < 0.001). Conclusion Overall, nurse and support staff had high expectations of the effects of inpatient portal use prior to its hospital-wide implementation. They thought it would benefit patients and/or their caregivers; however, they also perceived several barriers to its implementation. These results will be used in conjunction with patient and caregiver perspectives to inform future efforts to evaluate and improve upon inpatient portal implementation and dissemination across health systems.

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Optimizing the User Experience: Identifying Opportunities to Improve Use of an Inpatient Portal

Cited by 30 publications

References 34 publications

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

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

Potential of an Electronic Health Record-Integrated Patient Portal for Improving Care Plan Concordance during Acute Care

Nurses' Expectations of an Inpatient Portal for Hospitalized Patients and Caregivers

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