Examining the Impact of Design Features of Electronic Health Records Patient Portals on the Usability and Information Communication for Shared Decision Making

The use of the Electronic Health Records (EHR) patient portal has been shown to be effective in generating positive outcomes in patients’ healthcare, improving patient engagement and patient-provider communication. Government legislation also required proof of its meaningful use among patients by healthcare providers. Typical patient portals also include features such as health information and patient education materials. However, little research has examined the specific use of patient portals related to individuals with specific diseases such as inflammatory bowel diseases (IBDs). IBDs are life-long, not curable, chronic diseases that can impact the whole population. Individuals with IBDs may have higher needs to acquire health information from their EHR portals to properly self-manage their health conditions. The research aims of the present dissertation are to understand the online health information-seeking behaviors of a target group (IBDs) of patients, the use of EHR patient portals, and the impact of design features of EHR patient portals on the usability and information communication for shared decision making. Through this dissertation, I conducted four studies to address the above research aims. First, I identified how individuals with inflammatory bowel disease (IBD) used the internet for health information seeking, the factors impacting their use of the internet to obtain health information, and how they used the internet for health-related tasks. The purpose of this study is to get a general understanding of the online health information-seeking behaviors and to guide the study of health information presentation of EHR portals in the following research. Second, I examined what factors influenced an EHR patient portal user to believe that the portal is a valuable part of their health care. This part of the dissertation aimed to reveal the critical design factors that help design an EHR portal perceived as valuable in managing health. Third, I looked at how patients used EHR patient portals, what features of the portals facilitated their use and encouraged Shared Decision Making (SDM) and engagement in health management and what features acted as barriers to SDM and their engagement in health management. This part of my dissertation focused on a broad understanding of EHR portals usage by introducing more specific factors such as features of EHR portals. Fourth, I conducted an eye-tracking study to examine how information presentation methods and chatbots impact the use and effect of patient portals. This part of my dissertation built on the other studies within my dissertation and deepened the understanding of the influence of different EHR portal designs on their effectiveness and people’s willingness to participate in SDM. The results of this dissertation contribute to the literature of understanding the information-seeking behaviors of IBD patients and the use of portals, as well as the design considerations of how to make a suitable EHR portal to support the information-seeking needs of IBD patients. The results of this dissertation can be used to guide building proper patient education materials to support their health information needs of their specific health condition, especially for individuals with chronic diseases that require a certain amount of self-management. Meanwhile, examining artificial intelligence (AI) based chatbots use in EHR portals reveals a potential path of AI use in healthcare, such as information acquisition and patient education. Designing good usable EHR may also facilitate the process of informing patients of the advantages and disadvantages of treatment plans for their disease and, therefore, may increase their willingness to participate in SDM

Increasing Patient Engagement in the African American Community through Personal Health Record Use

Personal Health records have many potential benefits to patients, caregivers and institutions. In order to meet meaningful use standards EHR systems must allow patients to be able to access and easily download their healthcare records and images for their own use. Previous studies have shown that African Americans are less likely to enroll in a personal health record than other ethnic populations. This study was done to research and identify possible barriers the have limited the utilization of personal health record use in the African American community. A preliminary survey and focus group were convened to discuss issues affecting PHR utilization

The Promise of the Affordable Care Act, the Practical Realities of Implementation: Maintaining Health Coverage During Life Transitions

Recommends policy options for outreach, education, and automatic application to ensure that all Americans can maintain coverage in the event of unemployment, divorce, early retirement, or other life transitions through health insurance exchanges

The Factors That Impact Patient Portal Utilization

Spawned by legislative mandates, such as the American Recovery and Reinvestment Act of 2009’s Health Information Technology for Economic and Clinical Health Act, and individuals desiring to have more personal accountability for their health and healthcare, the introduction and use of electronic personal health information (ePHI) has grown substantially. Given that most ePHI is maintained within the healthcare delivery system, an information portal is required for individuals to have access to the ePHI. As a result, the legislation required the introduction and use of patient portals to grant such access. Despite substantial financial incentives and disincentives for healthcare organizations to provide and promote the use of patient portals, actual utilization of patient portals has fallen significantly short of expectations and desires. It has been posited that limited patient portal utilization may have been related to multiple factors, with no definitive set of factors empirically established as the root cause. While patient age and gender exhibit some relation to patient portal utilization, those factors are not able to be modified, thereby limiting any potential to change utilization. Therefore, there is an interest to identify other variables that can be modified to have an impact on patient portal utilization. The study sought to contribute to the body of knowledge concerning factors that impact the utilization of patient portals, specifically, how patient literacies, i.e., computer/Internet, health, and numeracy impact patient portal utilization. These literacies for 400 University of Maryland Medical System patients were assessed via self-administered surveys, with the results compared to their actual patient portal utilization. The goal was to identify related correlations between literacy scores and utilization, using the correlations to construct a portal use index capable of accurately predicting utilization based on these literacies. However, Kendall tau-b correlation coefficients indicated an absence of significant correlations between patient literacies and patient portal use

The Effect of Education on Portal Personal Health Record Use

Abstract The purpose of this study was to assess the computer-use attitudes among chronically ill adult primary care practice (PCP) patients. The goal was to examine the rate of portal personal health record (PHR) use of middle-aged and older adults, to evaluate the effectiveness of an educational intervention in improving PHR adoption, and to identify patients’ thoughts about the PHR. The quasi-experimental, pre-test/post-test design with a paired matched set was performed with a convenience sample of 50 subjects from a primary care group practice in Central Florida. Participants were recruited on the day of their provider appointment. After participant’s consent was obtained, the Background and Computer Questionnaire was administered and the educational intervention completed. A four-week follow-up phone survey followed the educational intervention. To evaluate the effectiveness of the educational intervention, the participants were pair matched, a technique that uses knowledge of participants’ characteristics such as age, gender, and ethnicity to form a comparison, or non-participant control group (Polit & Beck, 2012). Participants’ computer use comfort level increased significantly four weeks after the PHR educational intervention (Z = -1.668, p \u3c .005). In addition, the amount of PHR use by the participant group (M = 1.08) was significantly higher as compared to the pair matched control group (M = 0.16), U = 735.5, p = .001. Analysis of the qualitative component indicated that patients are willing to use the PHR if their laboratory results are up-to-date and available for review. Hands-on computer instructions are an effective method to increase PHR use among chronically ill adult PCP patients. Computer training and education promote and improve the overall computer use comfort level. Patients feel that the PHR is a valuable tool if their data are current and accessible. Keywords: personal health record, patient portal, PHR adoption, computer educatio

Trends in U.S. Consumers’ Use of E-Health Services: Fine-Grained Results from a Longitudinal, Demographic Survey

Although growth in U.S. consumers’ overall use of e-health is strong, it is being driven by only a portion of the e-health services that are offered through online health portals. Fine-grained, longitudinal analysis of three representative e-health services shows that, while online communication with medical personnel has grown consistently between 2003 and 2012, the purchase of health supplies online plateaued by 2007, and participation in online support groups has been flat since 2003. Socio-economic factors of income and education level continue to have an impact on consumers’ use of e-health; however, differences based on age, sex, and race/ethnicity are trending lower during this period. The findings caution against the common practice of studying e-health adoption principally at the level of online health portals, which can mask substantial variation in adoption trends among the underlying e-health services, and suggest that it is important to update trend studies on a regular basis to maintain currency

A Lazy User Perspective to the Voluntary Adoption of Electronic Personal Health Records (PHRs)

Personal Health Records (PHRs) have been imbued with the potential to improve health outcomes for individual healthcare consumers, providers, and the broader healthcare system. With Meaningful Use Stage 2 now mandating the implementation of tethered PHRs, tethered to provider electronic health records (patient portals), will healthcare consumers voluntarily use PHRs and contribute to safety, quality, efficiency and reduced health disparities through engagement? Or will PHR use remain low? In this qualitative study, using grounded theory, we asked users how they currently managed their personal health information (PHI) and why. Using the lazy user model, we found that letting physicians manage healthcare consumers PHI is the least effort-based solution and thus the predominant and preferred solution. Providers as guardians of patient PHI suggests the low use rates may persist yet. We should do more to make these technologies usable and accessible to those with irregular contact with a primary care physician

Telemedicine Perception: An Identification and Evaluation of Factors Contributing To The Use of Telemedicine Services

A morbidity and mortality report made by the Centers for Disease Control (CDC) on the impact of telehealth services during the COVID-19 pandemic throughout 2020 noted several instances in which telemedicine tools had contributed to improved patient outcomes, including: increasing the availability of care to patients otherwise left with little access to health care, decreasing unnecessary patient visits, and reduced disease exposure to patients and staff directly at risk (CDC, 2020). As the utilization of telemedicine becomes more important and prevalent in U.S. health care systems, it is important to recognize factors that inhibit patient usage. Factors such as inadequate access to electronic tools, the internet, education on telemedicine program use, and personal preference in health care management can affect how patients participate in telemedicine. The purpose of this DNP project was to identify and analyze the different factors that affect telemedicine use among adult participants utilizing a questionnaire created by the researcher. The questionnaire was made available to two locations for convenience sampling: The University of Southern Mississippi (USM) Nursing College student email list via direct online hyperlink, and a specialty clinic in Hattiesburg, Mississippi via paper copies and QR code signage linked to the questionnaire online. Improving health care systems such as patient telemedicine use can positively impact patient health outcomes through improved health care access. Providers, health care organizations, and other interested parties can improve patient participation through individualized promotion and education on the use and benefits of telemedicine by recognizing factors that impact telemedicine use. Providing a self-completed questionnaire for patients evaluating telemedicine perception, access, and use can provide adequate data to improve patient-centered approaches to telemedicine participation

Perspective on the Utilization and the Outcome of Digital Tools to Manage Chronic Diseases

The increasing aging population and the prevalence of chronic diseases among lower socioeconomic groups have led to higher healthcare spending on chronic care management. In this paper, the study revolves around the utilization of Information and Communication Technology (ICT) for the management of chronic diseases, with a particular focus on the elderly population. The study examines various digital health interventions, including eHealth, mHealth, electronic health records, remote monitoring, wearable devices, clinical decision support systems, telehealth, and telemedicine, in the context of chronic disease management. The opportunities, strengths, and weaknesses of digital technology are discussed, highlighting the potential benefits of ICT in improving healthcare outcomes and reducing the severity of chronic conditions. The paper also addresses the barriers to the adoption of digital health interventions, such as lack of skills, privacy concerns, limited access to high-quality healthcare, and disparities in internet connectivity. Despite these barriers, the integration of ICT in healthcare has shown promising results, empowering patients, enhancing self-management, reducing relapse, and increasing patient participation. The study concludes by emphasizing the significance of digital health technology in addressing the challenges posed by the aging population and chronic diseases, while also acknowledging the need for further research and policy considerations for effective implementation