Patient Portals

Tulu, Bengisu; Trudel, John D.; Strong, Diane M.; Johnson, Sharon A.; Sundaresan, Devi; Garber, Lawrence

doi:10.1378/chest.14-2559

Cited by 39 publications

(16 citation statements)

References 21 publications

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“…A recent systematic review of 170 studies found technology-based health interventions had positive effects on patient engagement, health behaviours and health outcomes among patients across a range of conditions [7]. Reviews have synthesised evidence around the effectiveness of HIT interventions such as patient portals [8, 9], decision support aids [10] or multiple technologies [7, 11, 12] for patient engagement in health care in the primary care setting. Together these reviews suggest great potential for HITs to engage patients in care, but overall highlight a lack of high quality evidence on their effectiveness in terms of health outcomes and cost-effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Using technology to engage hospitalised patients in their care: a realist review

Roberts

Chaboyer

González

et al. 2017

BMC Health Serv Res

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BackgroundPatient participation in health care is associated with improved outcomes for patients and hospitals. New technologies are creating vast potential for patients to participate in care at the bedside. Several studies have explored patient use, satisfaction and perceptions of health information technology (HIT) interventions in hospital. Understanding what works for whom, under what conditions, is important when considering interventions successfully engaging patients in care. This realist review aimed to determine key features of interventions using bedside technology to engage hospital patients in their care and analyse these in terms of context, mechanisms and outcomes.MethodsA realist review was chosen to explain how and why complex HIT interventions work or fail within certain contexts. The review was guided by Pawson’s realist review methodology, involving: clarifying review scope; searching for evidence; data extraction and evidence appraisal; synthesising evidence and drawing conclusions. Author experience and an initial literature scope provided insight and review questions and theories (propositions) around why interventions worked were developed and iteratively refined. A purposive search was conducted to find evidence to support, refute or identify further propositions, which formed an explanatory model. Each study was ‘mined’ for evidence to further develop the propositions and model.ResultsInteractive learning was the overarching theme of studies using technology to engage patients in their care. Several propositions underpinned this, which were labelled: information sharing; self-assessment and feedback; tailored education; user-centred design; and support in use of HIT. As studies were mostly feasibility or usability studies, they reported patient-centred outcomes including patient acceptability, satisfaction and actual use of HIT interventions. For each proposition, outcomes were proposed to come about by mechanisms including improved communication, shared decision-making, empowerment and self-efficacy; which acted as facilitators to patient participation in care. Overall, there was a stronger representation of health than IT disciplines in studies reviewed, with a lack of IT input in terms of theoretical underpinning, methodological design and reporting of outcomes.ConclusionHIT interventions have great potential for engaging hospitalised patients in their care. However, stronger interdisciplinary collaboration between health and IT researchers is needed for effective design and evaluation of HIT interventions.

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Section: Introductionmentioning

confidence: 99%

Using technology to engage hospitalised patients in their care: a realist review

Roberts

Chaboyer

González

et al. 2017

BMC Health Serv Res

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“…Patient access to their health information via portals proposes to increase patient engagement in the clinical decision-making process and thus improve quality and safety of care [2]. By providing direct access to health information, patient portals have improved patient engagement [3] and empowered patients to take control of their care by giving them a more informed perspective of their health [4]. …”

Section: Background and Significancementioning

confidence: 99%

Methods for Patient-Centered Interface Design of Test Result Display in Online Portals

Nyström

Singh

Baldwin

et al. 2018

eGEMs

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Objectives:Patients have unique information needs to help them interpret and make decisions about laboratory test results they receive on web-based portals. However, current portals are not designed in a patient-centered way and little is known on how best to harness patients’ information needs to inform user-centered interface design of portals. We designed a patient-facing laboratory test result interface prototype based on requirement elicitation research and used a mixed-methods approach to evaluate this interface.Methods:After designing an initial test result display prototype, we used multiple evaluation methods, including focus group review sessions, expert consultation, and user testing, to make iterative design changes. For the user testing component, we recruited 14 patient-users to collect and analyze three types of data: comments made during testing sessions, responses to post-session questionnaires, and system usability scores.Results:Our initial patient-centered interface design included visual ranges of laboratory values, nontechnical descriptions of the test and result, and access to features to help patients interpret and make decisions about their results. Findings from our evaluation resulted in 6 design iterations of the interface. Results from user testing indicate that the later versions of the interface fulfilled patient’s information needs, were perceived as usable, and provided access to information and techniques that facilitated patient’s ability to derive meaning from each test result.Conclusions:Requirement elicitation studies can inform the design of a patient-facing test result interface, but considerable user-centered design efforts are necessary to create an interface that patients find useful. To promote patient engagement, health information technology designers and developers can use similar approaches to enhance user-centered software design in patient portals.

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“…Our study also has implications for the design of patient portals and the display of patients’ health data. By giving patients direct access to their health data, patient portals can improve patient engagement [ 63 ] and empower patients to actively participate in their care [ 64 ]. However, research suggests that patients struggle to understand health data communicated to them via patient portals [ 65 ].…”

Section: Discussionmentioning

confidence: 99%

A Patient-Facing Diabetes Dashboard Embedded in a Patient Web Portal: Design Sprint and Usability Testing

Martínez¹,

Threatt²,

Rosenbloom³

et al. 2018

JMIR Hum Factors

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BackgroundHealth apps and Web-based interventions designed for patients with diabetes offer novel and scalable approaches to engage patients and improve outcomes. However, careful attention to the design and usability of these apps and Web-based interventions is essential to reduce the barriers to engagement and maximize use.ObjectiveThe aim of this study was to apply design sprint methodology paired with mixed-methods, task-based usability testing to design and evaluate an innovative, patient-facing diabetes dashboard embedded in an existing patient portal and integrated into an electronic health record.MethodsWe applied a 5-day design sprint methodology developed by Google Ventures (Alphabet Inc, Mountain View, CA) to create our initial dashboard prototype. We identified recommended strategies from the literature for using patient-facing technologies to enhance patient activation and designed a dashboard functionality to match each strategy. We then conducted a mixed-methods, task-based usability assessment of dashboard prototypes with individual patients. Measures included validated metrics of task performance on 5 common and standardized tasks, semistructured interviews, and a validated usability satisfaction questionnaire. After each round of usability testing, we revised the dashboard prototype in response to usability findings before the next round of testing until the majority of participants successfully completed tasks, expressed high satisfaction, and identified no new usability concerns (ie, stop criterion was met).ResultsThe sample (N=14) comprised 5 patients in round 1, 3 patients in round 2, and 6 patients in round 3, at which point we reached our stop criterion. The participants’ mean age was 63 years (range 45-78 years), 57% (8/14) were female, and 50% (7/14) were white. Our design sprint yielded an initial patient-facing diabetes dashboard prototype that displayed and summarized 5 measures of patients’ diabetes health status (eg, hemoglobin A1c). The dashboard used graphics to visualize and summarize health data and reinforce understanding, incorporated motivational strategies (eg, social comparisons and gamification), and provided educational resources and secure-messaging capability. More than 80% of participants were able to successfully complete all 5 tasks using the final prototype. Interviews revealed usability concerns with design, the efficiency of use, and content and terminology, which led to improvements. Overall satisfaction (0=worst and 7=best) improved from the initial to the final prototype (mean 5.8, SD 0.4 vs mean 6.7, SD 0.5).ConclusionsOur results demonstrate the utility of the design sprint methodology paired with mixed-methods, task-based usability testing to efficiently and effectively design a patient-facing, Web-based diabetes dashboard that is satisfying for patients to use.

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Patient Portals

Cited by 39 publications

References 21 publications

Using technology to engage hospitalised patients in their care: a realist review

Using technology to engage hospitalised patients in their care: a realist review

Methods for Patient-Centered Interface Design of Test Result Display in Online Portals

A Patient-Facing Diabetes Dashboard Embedded in a Patient Web Portal: Design Sprint and Usability Testing

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