Using the Electronic Patient Portal to Engage Patients with Multiple Chronic Conditions

Three in four Americans aged 65 and older is living with multiple chronic conditions. These patients have complex care needs and stand to benefit from tools facilitating engagement in their healthcare. Little is known regarding use of the electronic patient portal as a tool to support self-care in patients with multiple chronic conditions. The purpose of this multiple-methods study was to (1) explore characteristics and patterns of portal use by patients with multiple chronic conditions and (2) to understand the perceived usefulness of this tool to improve self-care. In phase 1, the quantitative phase, data from electronic health records and web server log files were analyzed. Patients (n=500) who were 45 years or older, registered portal users, and diagnosed with at least two chronic conditions were included in the analysis. No significant differences in portal use were found according to demographic characteristics, distance separating the patient from their primary care provider, and practice size and location. There was a significant difference between patients who accessed the portal to send a message to the provider and patient entered data in regards to logins (p\u3c .001 and p=.03). In phase 2, the qualitative phase, semi-structured interviews with patients (n=9) and providers (n=7) were conducted to understand how patients learn about the portal and their perceptions of usefulness for improving self-care in patients with multiple chronic conditions. Twelve categories related to four broad themes: 1) how patients are introduced to the EPP, 2) perceived benefits of the EPP, 3) perceived barriers to using the EPP, and 4) perceptions of using EPP for self-management of chronic illness were revealed. Implications for further research, policy, and practice are presented

Su salud a la mano (your health at hand): patient perceptions about a bilingual patient portal in the Los Angeles safety net.

ObjectivesDriven by beneficial patient-centered outcomes associated with patient portal use and the Affordable Care Act, portal implementation has expanded into safety nets-health systems that offer access to care to a large share of uninsured, Medicaid, and other vulnerable populations. However, little attention has been paid to the factors that affect portal accessibility by the vulnerable patients served by these health systems-including those who are limited English proficient (LEP).Materials and methodsThe Los Angeles County Department of Health Services (LAC DHS), the second-largest safety net system in the nation, launched its first patient portal, and one of the few bilingual English-Spanish interfaces in existence, in March of 2015. To explore portal awareness and perceptions, we conducted focus groups with LAC DHS patients, in English and Spanish (LEP). The Technology Acceptance Model was used to guide thematic analysis of focus group data.ResultsOf the 46 participants, 37 were patients and 9 were caretakers; 23 were English-speaking and 23 Spanish-speaking LEP. All patients had diabetes or hypertension. Over half had an annual household income <$10 000, yet 78% of English-speaking and 65% of Spanish-speaking LEP participants reported at-home Internet access. Participants' discussion centered around 3 major thematic narratives: (1) participants' awareness or attitudes about the LAC DHS portal; (2) role of culture, language, or community with regard to portal accessibility and utility; and (3) perceived needs for successful portal implementation.ConclusionsSafety net participants identified concrete benefits to the portal and emphasized the need for portal engagement that offered accessible education, support, and resources in clinical and community settings. The portal offers an additional opportunity to engage the patient and family with trusted and validated health information, and should be further developed in this capacity. This study provides a better understanding of preferred improvements of patient portal engagement that guide broader health technology efforts to address electronic health disparities

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

Patient access to complex chronic disease records on the internet

Background: Access to medical records on the Internet has been reported to be acceptable and popular with patients, although most published evaluations have been of primary care or office-based practice. We tested the feasibility and acceptability of making unscreened results and data from a complex chronic disease pathway (renal medicine) available to patients over the Internet in a project involving more than half of renal units in the UK. Methods: Content and presentation of the Renal PatientView (RPV) system was developed with patient groups. It was designed to receive information from multiple local information systems and to require minimal extra work in units. After piloting in 4 centres in 2005 it was made available more widely. Opinions were sought from both patients who enrolled and from those who did not in a paper survey, and from staff in an electronic survey. Anonymous data on enrolments and usage were extracted from the webserver. Results: By mid 2011 over 17,000 patients from 47 of the 75 renal units in the UK had registered. Users had a wide age range (<10 to >90 yrs) but were younger and had more years of education than non-users. They were enthusiastic about the concept, found it easy to use, and 80% felt it gave them a better understanding of their disease. The most common reason for not enrolling was being unaware of the system. A minority of patients had security concerns, and these were reduced after enrolling. Staff responses were also strongly positive. They reported that it aided patient concordance and disease management, and increased the quality of consultations with a neutral effect on consultation length. Neither patient nor staff responses suggested that RPV led to an overall increase in patient anxiety or to an increased burden on renal units beyond the time required to enrol each patient. Conclusions: Patient Internet access to secondary care records concerning a complex chronic disease is feasible and popular, providing an increased sense of empowerment and understanding, with no serious identified negative consequences. Security concerns were present but rarely prevented participation. These are powerful reasons to make this type of access more widely available

PATIENTS’ DIRECT ACCESS TO THEIR ELECTRONIC MEDICAL RECORD USING THE INTERNET: A LITERATURE REVIEW

Patient-accessible medical record is an important element of evolution in the patient-physician relationship: patients want to become more active in their health care process. We want to highlight the results of studies that analyse the impact of patients having access to their electronic medical record using the Internet on patients, on physicians and on their relationship. The studies were identified using “Pub Med” and “Web of Knowledge”. The search was limited to articles published between 2000 and October 2012. We focused on articles about patients accessing, through Internet, their electronic medical record that are created and filled in by physicians. 26 studies were selected and analysed. Quantitative data were obtained through questionnaires, analysis of the log-ins and analysis of the records, while qualitative data were obtained through interviews and focus groups. The specificity of our review refers to the electronic means through which patients access their electronic medical (and particularly Internet)

Perceived Usefulness and Perceived Ease of Use Impact on Patient Portal Use

Patient portals are web-based tools that provide patients with access to their health records and enhance communication with providers. Despite the efforts in expanding their use and patients interest in using them, patient portal usage remains low. Higher use of portals is associated with greater patient engagement and better healthcare quality and outcomes. This study investigated the impact of perceived usefulness (PU) and perceived ease of use (PEU) on patient portal usage. The conceptual framework was based on the Technology Acceptance Model, which suggests that PU and PEU of a system affect attitude and behavioral intention toward using the system, and ultimately the use of the system. The research questions focused on whether PU and PEU significantly affect portal usage. Participants included a convenience sample of 432 patients of Abington Health, located in Abington, PA, who had access to Abington\u27s eClinicalWorks patient portal. Cross-sectional data collected from the completed online surveys included responses to Davis\u27 PU and PEU measurement scale, self-reported portal login frequency and login duration, and some patient demographics. Data was analyzed by using chi-square test of independence and multinomial logistic regression. The study found that a significant relationship exists between PU and login frequency, PU and login duration, and PEU and login duration; however, the impact of PU and PEU on portal usage was not significant. The study could be repeated among a different population using a different patient portal. This study helps understand the relationship between PU/PEU and portal usage, something healthcare providers can capitalize upon when promoting portal use, and ultimately, encouraging greater patient engagement in their own health

A Quality Improvement Project to Improve Patients\u27 Satisfaction with Telemedicine Use in the General Hematology-Oncology Setting

Abstract The COVID-19 pandemic has accelerated the use of synchronous telemedicine in oncology. While telemedicine can increase access to care, decrease care costs, and reduce hospitalizations, patients’ satisfaction with telemedicine is critical to telemedicine’s sustainability. However, limited research exists on telemedicine use and patients\u27 satisfaction in oncology. The scholarly project had a quality improvement design that determined the factors affecting patients\u27 satisfaction using secondary data from patients\u27 satisfaction surveys. Using the Donabedian Structure, Process, Outcomes Model as a framework, the project involved three general hematology-oncology clinics at a large urban, academic medical center. Three-hundred ninety-four patient satisfaction surveys with at least one comment from April 2020 to September 2021 were analyzed, which yielded 665 comments to provide context. Surveys with no comments were excluded from the analysis. The independent variables were age, race, and gender. The dependent variables were ease of scheduling, therapeutic communication by the care providers, audio/video quality, and the overall assessment of telemedicine use. One-way analysis of variance (ANOVA) evaluated the differences in the mean scores with age and race. An independent t-test assessed the mean scores for gender. A statistical difference existed between age groups in the satisfaction scores regarding ease of scheduling and audio/video quality of telemedicine. In race or gender, neither the one-way ANOVA nor the independent t-test demonstrated any statistical significance in satisfaction scores. The analysis of the comments guided the quality improvement recommendations. The recommendations to positively impact patient satisfaction with the oncology clinic telemedicine workflow were: Build adequate systems capabilities and clinic infrastructure; establish workflow and evaluate staff resources; provide resources for patients and providers by creating a telemedicine champion; leverage community resources and partnerships; assess the patient population; evaluate rules and regulations. The sustainability of synchronous telemedicine will depend on many factors, including patient satisfaction. Because patient satisfaction is crucial to clinical outcomes and reimbursements, it will continue to play a vital role in the sustainability of many initiatives in healthcare in today’s healthcare landscape. Keywords: telemedicine, synchronous telemedicine, patient satisfaction

Is Telemedicine The Future Primary Care Physician? An Analysis Of Past, Current, And Future Trends

This thesis offers a new method of analyzing the trends of telemedicine in the past, current, and future states, particularly in relation to primary healthcare settings. This thesis consists of a literature review of various studies, an analysis of current legislation, and suggestions for future improvements of the healthcare system in the United States. The terms surrounding telemedicine will be defined and the history of telemedicine will be explained in order to convey an understanding of the topic and to allow the reader to deduce general conclusions from the thesis. The thesis will focus on the patient perspective, the healthcare provider perspective, and the challenges that these two respective groups of people face in relation to successful implementation of telemedicine. Conclusions from this thesis are applicable in the current age due to the rising cost of healthcare, the healthcare shortage in certain geographic areas, and the increasingly technological presence in the United States and in the world

Telehealth in the Context of COVID-19: Changing Perspectives in Australia, the United Kingdom, and the United States

Background: On the 12th March 2020, the World Health Organization (WHO) announced the COVID-19 virus outbreak as a pandemic. On that date there were 134,576 reported cases and 4,981 deaths worldwide. By 26th March, just two weeks later, reported cases had increased fourfold to 531,865 and deaths fivefold to 24,073. Older people are both major users of telehealth services and are more likely to die as a result of COVID-19. Objectives: This paper examines the extent to which Australia, the United Kingdom (UK) and the United States (US) during the two weeks following the pandemic announcement, sought to promote telehealth as a tool that could help identify COVID-19 among older people who may live alone, be frail and/or be self-isolating; and give support or facilitate the treatment of people who are or maybe infected. Methods: The paper reports, for the two-week period or immediately prior, on activities and initiatives in the three countries taken by governments or their agencies (at national or state levels); together with publications of or guidance issued by professional, trade and charitable bodies. Different sources of information are drawn upon that point to the perceived likely benefits of telehealth in fighting the pandemic. It is not the purpose of this paper to draw together or analyse information that reflects growing knowledge about COVID-19, except where telehealth is seen as a component. Results: The picture that emerges for the three countries, based on the sources identified, shows a number of differences. These differences centre on the nature of their health services; the extent of attention given to older people (and the circumstances that can relate to them); the different geographies (notably concerned with rurality) and the changes to funding frameworks that impact on these. Common to all three countries is the value attributed to maintaining quality safeguards in the wider context of their health services but where such services are noted as sometimes having precluded significant telehealth use. Conclusion: The COVID-19 pandemic is forcing changes and may help to establish telehealth more firmly in its aftermath. Some of the changes may not be long-lasting. However, the momentum is such that telehealth will almost certainly find a stronger place within health service frameworks for each of the three countries and is likely to have increased acceptance among both patients and healthcare providers

An analysis of the effects of certified electronic health records on organizations and patients.

The growing technological advancement of electronic health records can become an issue with quality and electronic patient information exchange if hospitals do not adhere to federal guidelines. It is recommended that hospitals utilize certified electronic health records (EHRs) to receive financial incentives. This certification is supposedly also associated with the quality of the EHR itself. The certification process is criticized for allowing EHR vendors to meet a set of limited functions known in advance. EHRs can affect healthcare quality and electronic health information exchange. This dissertation explored what is known about the effects of certified EHRs on length of stay (LOS) and patient generated health data (PGHD), the relationship between hospital utilization of certified EHRs and LOS, and the relationship between hospital utilization of certified EHRs with hospital capability of allowing the function of PGHD. The first analysis was a scoping review guided by the PRISMA protocol to explore what is known of the effects of certified EHRs on LOS and PGHD. The second analysis used datasets from the American Hospital Association Survey and Information Technology Supplement and Kentucky Cabinet for Health and Family Services, Office of Health Policy from 2015 to 2019 to understand the relationship between hospital utilization of certified EHRs and LOS through a fixed effects regression model. The final paper analysis used datasets from the American Hospital Association Survey and Information Technology Supplement from 2016 to 2020 to understand the relationship between hospital utilization of certified EHRs and the function of enabling PGHD through a binary logistic regression. There is support amongst researchers on EHRs improving quality, such as, LOS and the function of PGHD improving technology efficiency and others supporting EHRs with more customization and open architecture. There is less known about whether an EHR, certified or non-certified, are different from one another with providing advantages for hospitals. Hospitals with certified EHRs have a longer LOS compared to hospitals with non-certified EHRs. Most hospitals experienced barriers with receiving, sending, or other electronic information exchange. Most hospitals with certified EHRs were more likely to not enable the function for PGHD compared to hospitals with non-certified EHRs. EHRs can be problematic while hospitals are providing hospital care. Although most hospitals possess certified EHRs, most do not enable the function of PGHD. Secondary sources from the survey were completed by the Chief Technology Officer or Chief Information Officer. Further research could be continued with understanding different groups’ health effects with health information technology. Hospitals may be satisfied with their EHRs but not as abreast on how functional the EHR is and how the EHR can benefit patients