Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System

Bose‐Brill, Seuli; Feeney, Michelle; Prater, Laura; Corbett, Angela; Koesters, Stephen

doi:10.2196/jmir.9203

Cited by 34 publications

(31 citation statements)

References 27 publications

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“…For developing better messaging, however, there is a need for more implementation studies identifying effective practices for using the patient portal as a means to bolster patient-physician communication during visits. There have been successful examples of this, including collecting and displaying patient-reported outcomes through the portal, and using the portal to facilitate advanced care planning discussions [ 12 , 38 , 51 - 53 ]. These strategies should be replicated in additional settings.…”

Section: Discussionmentioning

confidence: 99%

Patient Portal Barriers and Group Differences: Cross-Sectional National Survey Study

et al. 2020

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Background Past studies examining barriers to patient portal adoption have been conducted with a small number of patients and health care settings, limiting generalizability. Objective This study had the following two objectives: (1) to assess the prevalence of barriers to patient portal adoption among nonadopters and (2) to examine the association between nonadopter characteristics and reported barriers in a nationally representative sample. Methods Data from this study were obtained from the 2019 Health Information National Trends Survey. We calculated descriptive statistics to determine the most prevalent barriers and conducted multiple variable logistic regression analysis to examine which characteristics were associated with the reported barriers. Results The sample included 4815 individuals. Among these, 2828 individuals (58.73%) had not adopted a patient portal. Among the nonadopters (n=2828), the most prevalent barriers were patient preference for in-person communication (1810/2828, 64.00%), no perceived need for the patient portal (1385/2828, 48.97%), and lack of comfort and experience with computers (735/2828, 25.99%). Less commonly, individuals reported having no patient portal (650/2828, 22.98%), no internet access (650/2828, 22.98%), privacy concerns (594/2828, 21.00%), difficulty logging on (537/2828, 18.99%), and multiple patient portals (255/2828, 9.02%) as barriers. Men had significantly lower odds of indicating a preference for speaking directly to a provider compared with women (odds ratio [OR] 0.75, 95% CI 0.60-0.94; P=.01). Older age (OR 1.01, 95% CI 1.00-1.02; P<.001), having a chronic condition (OR 1.83, 95% CI 1.44-2.33; P<.001), and having an income lower than US $20,000 (OR 1.61, 95% CI 1.11-2.34; P=.01) were positively associated with indicating a preference for speaking directly to a provider. Hispanic individuals had significantly higher odds of indicating that they had no need for a patient portal (OR 1.59, 95% CI 1.24-2.05; P<.001) compared with non-Hispanic individuals. Older individuals (OR 1.05, 95% CI 1.04-1.06; P<.001), individuals with less than a high school diploma (OR 3.15, 95% CI 1.79-5.53; P<.001), and individuals with a household income of less than US $20,000 (OR 2.78, 95% CI 1.88-4.11; P<.001) had significantly higher odds of indicating that they were uncomfortable with a computer. Conclusions The most common barriers to patient portal adoption are preference for in-person communication, not having a need for the patient portal, and feeling uncomfortable with computers, which are barriers that are modifiable and can be intervened upon. Patient characteristics can help predict which patients are most likely to experience certain barriers to patient portal adoption. Further research is needed to tailor implementation approaches based on patients’ needs and preferences.

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Section: Discussionmentioning

confidence: 99%

Patient Portal Barriers and Group Differences: Cross-Sectional National Survey Study

et al. 2020

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“…This read rate exceeds rates of similar ACP interventions with younger cohorts. 14,16 Despite the high read rate, the relatively lower use of the portal for ACP compared with article-based AD completion and in-person ACP discussions highlights the need for further evaluation of how and why older adults choose to engage in ACP, including through the patient portal. 20 Our early work described perspectives of early adopters of the ACP tools.…”

Section: Discussionmentioning

confidence: 99%

“…Use of patient portals has resulted in increased advance directives (ADs) in the EHR in a few studies. [13][14][15] For example, Tieu et al 16 conducted a study among primary care patients to test whether a motivational electronic message linked to an external ACP workbook, AD, and letter from the primary care provider (PCP), increased ADs in the EHR. The intervention group completed an AD 5.5% of the time compared with 2% in standard care.…”

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confidence: 99%

Use of an Ambulatory Patient Portal for Advance Care Planning Engagement

et al. 2019

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Background: Primary care clinics need sustainable, population-based approaches to engage patients in advance care planning (ACP). Patient portal-based ACP tools may provide an option for patient engagement. Objective: To increase ACP outcomes by engaging older adults through portal-based ACP tools, including an electronic Medical Durable Power of Attorney (MDPOA) form. Methods: Geriatric clinic pilot of a multi-modal population-based outreach strategy for portal-based ACP tools. Outreach was to patients (n ‫؍‬ 105) who were 65 years and older with an active portal account, no cognitive impairment, and no MDPOA on file. Patients received a motivational message via the portal and, if not read within 2 weeks, a mailed postcard about the portal-based ACP tools. Primary outcome was composite of any ACP action at 1-year including 1) new advance directive (AD) in the electronic health record, 2) use of portal-based ACP tools, or 3) documented ACP discussion with a provider. Results: Sixty-five older adults read the electronic message at 12 months. Seventeen (16%) engaged in at least 1 ACP action. Fourteen of 17 engaged by adding an AD to their record. More patients completed an AD on article or brought a previously completed AD to clinic, compared with choosing to complete an electronic MDPOA via the portal. Conclusions: Brief motivational messages about ACP via a patient portal is feasible and may increase ACP outcomes for older adults in primary care. Future studies should evaluate population-based portal outreach strategies in combination with team-based workflows to enhance patient engagement in ACP.

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“…Portals thus offer a particularly accessible platform for patients and care partners to learn about COVID-19 treatment options and communicate goals of care with their providers. Over the last 5 years, our research team has partnered with health care system information technology experts, patients, caregivers, and providers to develop, test, and implement patient portal advance care planning strategies [ 20 - 24 ]. Specifically, the UCHealth patient portal offers patients the ability to learn more about advance care planning through web-based resources and provides the ability to create an electronically signed MDPOA form to choose a medical decision maker.…”

Section: Introductionmentioning

confidence: 99%

Advance Care Planning Among Users of a Patient Portal During the COVID-19 Pandemic: Retrospective Observational Study

Portz¹,

Brungardt²,

Shanbhag³

et al. 2020

J Med Internet Res

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Background Advance care planning is the process of discussing health care treatment preferences based on patients’ personal values, and it often involves the completion of advance directives. In the first months of 2020, a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), began circulating widely in the American state of Colorado, leading to widespread diagnosis of coronavirus disease (COVID-19), hospitalizations, and deaths. In this context, the importance of technology-based, non–face-to-face methods to conduct advance care planning via patient portals has increased. Objective The aim of this study was to determine the rates of use of a web-based advance care planning tool through a health system–based electronic patient portal both before and in the early months of the COVID-19 pandemic. Methods In 2017, we implemented web-based tools through the patient portal of UCHealth’s electronic health record (EHR) for patients to learn about advance care planning and complete an electronically signed medical durable power of attorney (MDPOA) to legally appoint a medical decision maker. Patients accessing the portal can complete and submit a legally valid MDPOA, which becomes part of their medical record. We collected data on the patients’ date of MDPOA completion, use of advance care planning messaging, age, sex, and geographic location during the early phase of the COVID-19 pandemic (December 29, 2019, to May 30, 2020). Results Over a 5-month period that includes the early phase of the COVID-19 pandemic in Colorado, total monthly use of the advance care planning portal tool increased from 418 users in January to 1037 users in April and then decreased slightly to 815 users in May. The number of MDPOA forms submitted per week increased 2.4-fold after the stay-at-home order was issued in Colorado on March 26, 2020 (P<.001). The mean age of the advance care planning portal users was 47.7 years (SD 16.1), and 2206/3292 (67.0%) were female. Women were more likely than men to complete an MDPOA, particularly in younger age groups (P<.001). The primary use of the advance care planning portal tools was the completion of an MDPOA (3138/3292, 95.3%), compared to sending an electronic message (148/3292, 4.5%). Over 50% of patients who completed an MDPOA did not have a prior agent in the EHR. Conclusions Use of a web-based patient portal to complete an MDPOA increased substantially during the first months of the COVID-19 pandemic in Colorado. There was an increase in advance care planning that corresponded with state government shelter-in-place orders as well as public health reports of increased numbers of COVID-19 cases and deaths. Patient portals are an important tool for providing advance care planning resources and documenting medical decision makers during the pandemic to ensure that medical treatment aligns with patient goals and values.

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Validation of a Novel Electronic Health Record Patient Portal Advance Care Planning Delivery System

Cited by 34 publications

References 27 publications

Patient Portal Barriers and Group Differences: Cross-Sectional National Survey Study

Patient Portal Barriers and Group Differences: Cross-Sectional National Survey Study

Use of an Ambulatory Patient Portal for Advance Care Planning Engagement

Advance Care Planning Among Users of a Patient Portal During the COVID-19 Pandemic: Retrospective Observational Study

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