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

Abstract

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.

Effects of Electronic Health Record Implementation and Barriers to Adoption and Use: A Scoping Review and Qualitative Analysis of the Content

“…Better communication between patients and providers was reported as a benefit following the implementation of EHRs/PHRs [32,34,38,42,44,69,86,87,102,134,146,147,153]. Physicians recognized the value of being able to share patient-centered information with patients using EHRs [34,143], while clinicians perceived that new communication channels such as messaging through EHRs should improve communication between patients and providers [45].…”

Preferred Functions of Personal Health Records in Rural Primary Health Clinics in Canada: Health Care Team Perspectives

“…29,30 Providers also may underestimate the utility of patient portals 31 ; many patients are keen to have access and believe portals can improve many aspects of their care, 30 with viewing laboratory results being the most frequently accessed activity on the portal. 32 Portals may increase patient understanding of the care plan 33 ; yet ways to visualize such data provided in portals needs further work to result in more meaningful use. 34 Concerns about data management (security, privacy, and reliability of data), which was a key issue in the 2013 study, 20 was not identified as a major barrier in our study.…”

Capturing the Impact of Patient Portals Based on the Quadruple Aim and Benefits Evaluation Frameworks: Scoping Review

“…Many of the studies [ 47 , 68 , 77 , 80 , 82 , 100 , 101 , 109 - 112 , 114 ] have explored patient experiences with access to patient portals and subsequently access to their own medical information. All of the studies reported that users were highly satisfied with the access, and in one study, 97% of survey respondents stated that they would definitely or probably recommend the portal to other clients and families [ 110 ].…”