The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente.

BackgroundPatient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited.MethodsThis paper uses qualitative methods to advance our understanding of the organizational dynamics that influence the impact of a patient portal on organizational performance and patient health. The study setting is Kaiser Permanente, the world's largest not-for-profit integrated delivery system, which has been using a portal for over ten years. We interviewed eighteen physician leaders and executives particularly knowledgeable about the portal to learn about how they believe the patient portal works and what organizational factors affect its workings. Our analytical framework centered on two research questions. (1) How does the patient portal impact care delivery to produce the documented effects?; and (2) What are the important organizational factors that influence the patient portal's development?ResultsWe identify five ways in which the patient portal may impact care delivery to produce reported effects. First, the portal's ability to ease access to services improves some patients' satisfaction as well as changes the way patients seek care. Second, the transparency and activation of information enable some patients to better manage their care. Third, care management may also be improved through augmented patient-physician interaction. This augmented interaction may also increase the 'stickiness' of some patients to their providers. Forth, a similar effect may be triggered by a closer connection between Kaiser Permanente and patients, which may reduce the likelihood that patients will switch health plans. Finally, the portal may induce efficiencies in physician workflow and administrative tasks, stimulating certain operational savings and deeper involvement of patients in medical decisions. Moreover, our analysis illuminated seven organizational factors of particular importance to the portal's development--and thereby ability to impact care delivery: alignment with financial incentives, synergy with existing IT infrastructure and operations, physician-led governance, inclusive decision making and knowledge sharing, regional flexibility to implementation, continuous innovation, and emphasis on patient-centered design.ConclusionsThese findings show how organizational dynamics enable the patient portal to affect care delivery by summoning organization-wide support for and use of a portal that meets patient needs

A Process Improvement Project: Demonstrating a Patient Portal to Increase Enrollment and Use in an Underserved Population with Chronic Illness

High risk, high cost chronic conditions such as diabetes, asthma, and congestive heart failure are prevalent in the United States. Nearly half of all Americans have at least one chronic condition (Centers for Disease Control and Prevention, 2009). Almost four-fifths of total health care spending in the U.S. is related to high risk, chronic conditions (Baker, Johnson, Macaulay, & Birnbaum, 2011). The use of patient portals in ambulatory care may be an avenue toward improving chronic disease management. Portals can be used by patients to schedule appointments, send secure messages to their providers, request medication refills, review lab and test results, make payments, and other activities. The purpose of this quality improvement project was to evaluate whether combining portal demonstration to patients during clinic visits with immediate enrollment would increase the use of a portal in a safety-net primary care clinic. Most of the participants (N = 51) were Caucasian aged 38 to 47 years, high school graduates, and diabetic with no comorbid conditions. Over half were daily internet users. Participants’ use of the portal was recorded over three months. The use rate improved from none prior to portal demonstration to 39.2%. The demonstration was timed and a cost analysis was performed to present a sustainability plan for demonstration adoption in the primary care clinic. Increased portal use rates may over time equate to improved patient-provider communication and increased patient self-care, leading to improved chronic condition management

Telemedicine: An Augmentation Strategy to Mitigate the Primary Care Shortage

According to the Association of American Medical Colleges, the primary care workforce shortage in 2025 will exceed 46,000 primary care physicians. Healthcare business leaders in Gwinnett County, Georgia have not evaluated the advantages and disadvantages of telemedicine (TM) to mitigate the workforce shortage. The purpose of this qualitative descriptive study was to determine factors primary care physician administrators consider when deciding to implement TM as a potential solution for the growing physician shortage. A purposive sample of 20 primary care physician administrators located in Gwinnett County, Georgia was drawn. The theory of disruptive technology was the conceptual framework. Data collected stemmed from semistructured interviews with each participant and review of organizational plans and workflow documents. Data were recorded, transcribed, and coded to develop themes. Three themes morphed from the study: TM awareness and education, TM cost and reimbursement, and TM implementation and utilization. Results indicated that awareness and education of leaders toward TM requires improvement, costs, and reimbursement were variables for deciding to implement or not implement TM, and TM implementation requires knowing the appropriate use of TM. The implications for positive social change include the potential for primary care physician administrators to positively influence the healthcare workforce shortage by adding flexibility to manage patient workflow with TM. Additionally, the potential for physician administrators to utilize TM for healthcare access, creating savings in transportation, energy consumption, and resource optimization, may provide better access to hard-to-reach populations

Decreasing No-Show Rates in an Outpatient Specialty Clinic

Decreasing Patient No-Show Rates in an Outpatient Specialty Clinic Abstract Problem: Non-attendance or no-shows of patients in an outpatient clinic is a prevalent occurrence that impacts the quality of patient care and cost utilization in the clinic. Context: A collaborative effort was undertaken with the clinic nurse manager to implement a quality improvement intervention to reduce patient no-shows in the optometry and otolaryngology clinics. The electronic health record EPIC data analysis revealed language variability in the occurrence of no-shows, indicating the need for improvements. Interventions: Tools were employed to gather comprehensive information regarding the factors contributing to patient no-shows and identify potential strategies for enhancing communication within the clinic, thereby reducing instances of missed appointments. In addition, patients who did not attend their appointments offered suggestions on communication strategies that could effectively reduce the number of missed appointments in the future. Measures: The data collection encompassed the patient reasons for no-shows. Individuals who failed to attend their appointments provided recommendations regarding communication strategies that could effectively discourage future instances of missed appointments. Results: The data analysis indicated that the most common reason for no-shows was the patients\u27 failure to recall their scheduled appointments. To minimize the occurrence of missed appointments, patients commonly recommended receiving text messages one to two days before their scheduled appointment. A positive correlation was identified between patients who did not have access to MyChart, a platform that enables the transmission of appointment reminders via text messaging, and an increased frequency of missed appointments. Conclusion: The optimal approach for reducing patient no-show rates entails providing patients with comprehensive education on the utilization of MyChart, a platform that offers text messaging in advance of their scheduled appointments. Empowering patients by equipping them with the necessary tools to access MyChart ensures they can effectively manage their healthcare. Keywords: no-show rates, outpatient clinic, patient perceptio

Population-level management of Type 1 diabetes via continuous glucose monitoring and algorithm-enabled patient prioritization: Precision health meets population health

OBJECTIVE: To develop and scale algorithm-enabled patient prioritization to improve population-level management of type 1 diabetes (T1D) in a pediatric clinic with fixed resources, using telemedicine and remote monitoring of patients via continuous glucose monitor (CGM) data review. RESEARCH DESIGN AND METHODS: We adapted consensus glucose targets for T1D patients using CGM to identify interpretable clinical criteria to prioritize patients for weekly provider review. The criteria were constructed to manage the number of patients reviewed weekly and identify patients who most needed provider contact. We developed an interactive dashboard to display CGM data relevant for the patients prioritized for review. RESULTS: The introduction of the new criteria and interactive dashboard was associated with a 60% reduction in the mean time spent by diabetes team members who remotely and asynchronously reviewed patient data and contacted patients, from 3.2 ± 0.20 to 1.3 ± 0.24 min per patient per week. Given fixed resources for review, this corresponded to an estimated 147% increase in weekly clinic capacity. Patients who qualified for and received remote review (n = 58) have associated 8.8 percentage points (pp) (95% CI = 0.6–16.9 pp) greater time-in-range (70–180 mg/dl) glucoses compared to 25 control patients who did not qualify at 12 months after T1D onset. CONCLUSIONS: An algorithm-enabled prioritization of T1D patients with CGM for asynchronous remote review reduced provider time spent per patient and was associated with improved time-in-range

Explainable Retinal Screening with Self-Management Support to Improve Eye-Health of Diabetic Population via Telemedicine

Diabetic Retinopathy (DR) is one major complication of diabetes and is the leading cause of blindness worldwide. Progression of DR and complete vision loss can be prevented by keeping diabetes in control and by early diagnosis through annual eye screenings. However, cost, healthcare disparities, cultural limitations, lack of motivation, etc., are the main barriers against regular screening, especially for a few ethnically and racially minority communities. On the other hand, to well-manage and control diabetes, the diabetic population needs to be physically active and keep their weight healthy. From the perspective of Behavioral Science, Some self-management techniques based on motivational interviewing can be utilized to motivate people to take preventive and mandatory measures to control diabetes. However, technical solutions based on `Motivational Interviewing\u27 are still not sufficiently available to healthcare providers who work with the diabetic population. Thus, collaborative teamwork of Computer Science and Behavioral Science is contemporary to improve eye health and the overall health of the diabetic population. In this dissertation, a community telemedicine framework has been proposed and designed which can connect clinicians with community partners to organize retinal screenings in community settings rather than traditional clinical settings. Secondly, automating the initial retinal screenings utilizing Deep Learning models, particularly Convolutional Neural Network (CNN), can reduce ophthalmologists\u27 workload and cost of screening. However, such Machine Learning models lack transparency and cannot explain how these models make particular decisions. Thus, an explainable retinal screening model has been developed to facilitate the recommended annual screening to overcome this limitation. Finally, a Computer-guided Action Planning (CAP) tool has been designed and developed to motivate the diabetic population to adopt healthier behaviors through Brief Action Planning, a self-management support technique. Through several feasibility studies, it is evident that the contribution of this dissertation could be combined to help prevent vision loss from diabetes

Influence of mhealth interventions on gender relations in developing countries: a systematic literature review

INTRODUCTION: Research has shown that mHealth initiatives, or health programs enhanced by mobile phone technologies, can foster women’s empowerment. Yet, there is growing concern that mobile-based programs geared towards women may exacerbate gender inequalities. METHODS: A systematic literature review was conducted to examine the empirical evidence of changes in men and women’s interactions as a result of mHealth interventions. To be eligible, studies had to have been published in English from 2002 to 2012, conducted in a developing country, included an evaluation of a mobile health intervention, and presented findings on resultant dynamics between women and men. The search strategy comprised four electronic bibliographic databases in addition to a manual review of the reference lists of relevant articles and a review of organizational websites and journals with recent mHealth publications. The methodological rigor of selected studies was appraised by two independent reviewers who also abstracted data on the study’s characteristics. Iterative thematic analyses were used to synthesize findings relating to gender-transformative and non-transformative experiences. RESULTS: Out of the 173 articles retrieved for review, seven articles met the inclusion criteria and were retained in the final analysis. Most mHealth interventions were SMS-based and conducted in sub-Saharan Africa on topics relating to HIV/AIDS, sexual and reproductive health, health-based microenterprise, and non-communicable diseases. Several methodological limitations were identified among eligible quantitative and qualitative studies. The current literature suggests that mobile phone programs can influence gender relations in meaningfully positive ways by providing new modes for couple’s health communication and cooperation and by enabling greater male participation in health areas typically targeted towards women. MHealth initiatives also increased women’s decision-making, social status, and access to health resources. However, programmatic experiences by design may inadvertently reinforce the digital divide, and perpetuate existing gender-based power imbalances. Domestic disputes and lack of spousal approval additionally hampered women’s participation. CONCLUSION: Efforts to scale-up health interventions enhanced by mobile technologies should consider the implementation and evaluation imperative of ensuring that mHealth programs transform rather than reinforce gender inequalities. The evidence base on the effect of mHealth interventions on gender relations is weak, and rigorous research is urgently needed

Socially Accountable Medical Education: An Innovative Approach at Florida International University Herbert Wertheim College of Medicine

PROBLEM: Despite medical advances, health disparities persist, resulting in medicine\u27s renewed emphasis on the social determinants of health and calls for reform in medical education. APPROACH: The Green Family Foundation Neighborhood Health Education Learning Program (NeighborhoodHELP) at Herbert Wertheim College of Medicine provides a platform for the school\u27s community-focused mission. NeighborhoodHELP emphasizes social accountability and interprofessional education while providing evidence-based, patient- and household-centered care. NeighborhoodHELP is a required, longitudinal service-learning outreach program in which each medical student is assigned a household in a medically underserved community. Students, teamed with learners from other professional schools, provide social and clinical services to their household for three years. Here the authors describe the program\u27s engagement approach, logistics, and educational goals and structure. OUTCOMES: During the first six years of NeighborhoodHELP (September 2010-August 2016), 1,470 interprofessional students conducted 7,452 visits to 848 households with, collectively, 2,252 members. From August 2012, when mobile health centers were added to the program, through August 2016, students saw a total of 1,021 household members through 7,207 mobile health center visits. Throughout this time, households received a variety of free health and social services (e.g., legal aid, tutoring). Compared with peers from other schools, graduating medical students reported more experience with clinical interprofessional education and health disparities. Surveyed residency program directors rated graduates highly for their cultural sensitivity, teamwork, and accountability. NEXT STEPS: Faculty and administrators are focusing on social accountability curriculum integration, systems for assessing and tracking relevant educational and household outcomes, and policy analysis

Assessment of Veteran Satisfaction With Telehealth Services During the COVID-19 Pandemic

Abstract With the advent of the COVID-19 public health emergency in the United States, many U.S. veterans were unable to maintain their usual office visits due to safe access concerns. Patients were strongly encouraged to maintain their healthcare needs at home by utilizing online technology resources like telehealth services with their healthcare providers. Providing excellent healthcare services for veterans during COVID-19 became a challenge for primary care providers at many veteran healthcare organizations. Since little was known about the satisfaction of veteran clients with healthcare management using virtual care during the pandemic, this formative program evaluation was designed to survey and assess veteran clients’ satisfaction using a veteran telehealth survey tool. This study found that approximately 88% of participating veterans agreed that telehealth made positive changes in their life, 89% agreed telehealth led to positive health changes, and 90% would recommend telehealth to others. Of these participants, nearly 70% were 60 years and older, with 40% of all participants being 70–79-year-olds, primarily representing an older veteran population. Some 99% of veteran participants perceived improved health management as validating the importance of providing continued telehealth care services. This formative evaluation on telehealth care will serve to provide healthcare leaders with information on improving healthcare using telehealth services, reinforce data of the positively perceived healthcare outcomes, and support a trend of the evolving need for continued healthcare access to the veteran during challenging conditions. Keywords: veteran, telehealth, COVID-19, primary care provider

The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: A qualitative study of Kaiser Permanente

Background: Patient portals may lead to enhanced disease management, health plan retention, changes in channel utilization, and lower environmental waste. However, despite growing research on patient portals and their effects, our understanding of the organizational dynamics that explain how effects come about is limited. Methods