The impact of digital patient portals on health outcomes, system efficiency, and patient attitudes: Updated systematic literature review

Background: Patient portals are becoming increasingly popular worldwide even though their impact on individual health and health system efficiency is still unclear. Objective: The aim of this systematic review was to summarize evidence on the impact of patient portals on health outcomes and health care efficiency, and to examine user characteristics, attitudes, and satisfaction. Methods: We searched the PubMed and Web of Science databases for articles published from January 1, 2013, to October 31, 2019. Eligible studies were primary studies reporting on the impact of patient portal adoption in relation to health outcomes, health care efficiency, and patient attitudes and satisfaction. We excluded studies where portals were not accessible for patients and pilot studies, with the exception of articles evaluating patient attitudes. Results: Overall, 3456 records were screened, and 47 articles were included. Among them, 11 studies addressed health outcomes reporting positive results, such as better monitoring of health status, improved patient-doctor interaction, and improved quality of care. Fifteen studies evaluated the impact of digital patient portals on the utilization of health services with mixed results. Patient characteristics were described in 32 studies, and it was reported that the utilization rate usually increases with age and female gender. Finally, 30 studies described attitudes and defined the main barriers (concerns about privacy and data security, and lack of time) and facilitators (access to clinical data and laboratory results) to the use of a portal. Conclusions: Evidence regarding health outcomes is generally favorable, and patient portals have the potential to enhance the doctor-patient relationship, improve health status awareness, and increase adherence to therapy. It is still unclear whether the use of patient portals improves health service utilization and efficiency

Sharing Clinical Notes and Electronic Health Records With People Affected by Mental Health Conditions: Scoping Review

Background: Electronic health records (EHRs) are increasingly implemented internationally, whereas digital sharing of EHRs with service users (SUs) is a relatively new practice. Studies of patient-accessible EHRs (PAEHRs)—often referred to as open notes—have revealed promising results within general medicine settings. However, studies carried out in mental health care (MHC) settings highlight several ethical and practical challenges that require further exploration. Objective: This scoping review aims to map available evidence on PAEHRs in MHC. We seek to relate findings with research from other health contexts, to compare different stakeholders’ perspectives, expectations, actual experiences with PAEHRs, and identify potential research gaps. Methods: A systematic scoping review was performed using 6 electronic databases. Studies that focused on the digital sharing of clinical notes or EHRs with people affected by mental health conditions up to September 2021 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews guided narrative synthesis and reporting of findings. Results: Of the 1034 papers screened, 31 were included in this review. The studies used mostly qualitative methods or surveys and were predominantly published after 2018 in the United States. PAEHRs were examined in outpatient (n=29) and inpatient settings (n=11), and a third of all research was conducted in Veterans Affairs Mental Health. Narrative synthesis allowed the integration of findings according to the different stakeholders. First, SUs reported mainly positive experiences with PAEHRs, such as increased trust in their clinician, health literacy, and empowerment. Negative experiences were related to inaccurate notes, disrespectful language use, or uncovering of undiscussed diagnoses. Second, for health care professionals, concerns outweigh the benefits of sharing EHRs, including an increased clinical burden owing to more documentation efforts and possible harm triggered by reading the notes. Third, care partners gained a better understanding of their family members’ mental problems and were able to better support them when they had access to their EHR. Finally, policy stakeholders and experts addressed ethical challenges and recommended the development of guidelines and trainings to better prepare both clinicians and SUs on how to write and read notes. Conclusions: PAEHRs in MHC may strengthen user involvement, patients’ autonomy, and shift medical treatment to a coproduced process. Acceptance issues among health care professionals align with the findings from general health settings. However, the corpus of evidence on digital sharing of EHRs with people affected by mental health conditions is limited. Above all, further research is needed to examine the clinical effectiveness, efficiency, and implementation of this sociotechnical intervention

Views of healthcare professionals to linkage of routinely collected healthcare data : a systematic review

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Credibility of Health Information and Digital Media: New Perspectives and Implications for Youth

Part of the Volume on Digital Media, Youth, and Credibility. This chapter considers the role of Web technologies on the availability and consumption of health information. It argues that young people are largely unfamiliar with trusted health sources online, making credibility particularly germane when considering this type of information. The author suggests that networked digital media allow for humans and technologies act as "apomediaries" that can be used to steer consumers to high quality health information, thereby empowering health information seekers of all ages

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

Electronic health record portals adoption by health care consumers

A thesis submitted in partial fulfillment of the requirements for the degree of Doctor in Information Management Specialization in Information and Decision SystemsElectronic Health Record (EHR) portals, also called EHR patient portals, have received great attention and investment at the government level worldwide, like the multi-billion dollar US initiative, named meaningful use program. According to the literature review, there is still a lack of studies that address the topic of understanding why people adopt and use EHR Portals, making this a field of knowledge that requires more research. According to the findings in the literature review the complexity of EHR portals requires having a patient-centred model that should be able to cover additional dimensions related with health behaviour, confidentiality concerns, and innovation drivers. Potential adoption differences between countries with different regulations in their health care systems should also be tested. With this dissertation, we contribute to a better understanding of the factors that lead health care consumers to use and adopt EHR portals. To this end we develop four empirical studies. In the first empirical study (Chapter 3) we tested the Extended Unified Theory of Acceptance and Use of Technology (UTAUT2) in Portugal. Being a consumer- centred model, it was important to evaluate its feasibility to study the EHR portals adoption determinants by the health care consumers. Several constructs in the model helped explain the adoption of EHR portals: performance expectancy, effort expectancy, social influence and habit. With habit a consumer specific construct from UTAUT2 having the most relevant impact in both behavioural intention and use. UTAUT2 showed its importance as a consumer-focused model identifying the factors that drive health care consumers to use EHR portals. In the second empirical study (Chapter 4) -also tested in Portugal- we extended the UTAUT2 model by adding a health specific construct, self-perception. This construct showed its relevance by being a statistically significant predictor of behavioural intention, demonstrating the usefulness of including a construct derived from the Health Belief Model (HBM), in a technology applied in the field of health care. In the third empirical study (Chapter 5) we performed a cross-country analysis between US and Portugal combining UTAUT2 with the Concern for Information Privacy (CFIP) framework. We made an assessment of the potential differences between the determinants of adoption between the two countries with different health care regulations and health care models. In the US there is no national health system (NHS) coverage and the patients need to have an expensive private insurance or pay directly to the health care provider to have health care support, while in Portugal there is universal health coverage. It was hypothesized and confirmed via the price value construct that the value that the US health care consumers give to a tool like EHR portals is statistically significantly greater than the Portuguese health care consumers. It was also expected that confidentiality concerns in US are greater than in Portugal, due to the less strict regulation in US regarding patient data confidentiality. This was measured by the CFIP framework, but confidentiality concerns were not an issue in either US or Portugal. Social influence, hedonic motivation, and price value were predictors only in the US group. With this study we verified the importance to perform cross-country evaluations when studying EHR portals adoption. In the fourth empirical study (Chapter 6) we used the evidence from the previous empirical studies plus the literature review to propose a new research model that integrates constructs from UTAUT2, HBM, and the Diffusion of Innovation (DOI) theory. In this study, we performed a national survey based on randomly generated mobile phone numbers, when in the previous empirical research, we targeted our sample to educational institutions. We used a two-phase sampling approach. In the first phase, we asked potential respondents if they were users of EHR portals and if yes, if she/he was interested in replying to our main survey (second phase). From this sample regarding the question to identify the users of EHR portals, we obtained 8.6% EHR portals usage in the adult Portuguese population. A relevant contribution from our study to understand the usage of this type of technology at country level. All three theories contributed with constructs that help to understand EHR portals adoption. The final research model obtained the best results from the all of the empirical studies executed in this dissertation with 76.0% of variance explained in behavioural intention and 61.8% of variance explained in use behaviour. In this dissertation’s conclusions (Chapter 7), we provide more detailed insights about the overall contributions of this dissertation, managerial implications to develop and implement better EHR portals, limitations and avenues for future research about EHR portals.Os Portais de Registo de Saúde Eletrónicos (PRSE), também denominados portais do doente, têm recebido bastante atenção e investimentos a nível governamental em todo o Mundo, tendo como exemplo a iniciativa multibilionária “meaningful use program” nos Estados Unidos da América. De acordo com a revisão da literatura, ainda existe uma lacuna no estudo das razões pelas quais as pessoas adotam e usam os PRSE, fazendo desta uma área de conhecimento que necessita de mais investigação. De acordo com a revisão da literatura, a complexidade dos PRSE, requere um modelo centrado no doente e que seja capaz de cobrir dimensões adicionais relacionadas com o comportamento na saúde, preocupações de confidencialidade e inovação. Potenciais diferenças na adoção entre países com diferentes regulamentações nos sistemas de saúde também deverão ser testadas. Com esta dissertação procuramos contribuir para um melhor conhecimento dos fatores que levam os consumidores na saúde a usar e adotar PRSE. Com este propósito desenvolvemos quatro estudos empíricos. No primeiro estudo empírico (Capítulo 3), testamos em Portugal o modelo de “Extended Unified Theory of Acceptance and Use of Technology” (UTAUT2). Sendo um modelo centrado no consumidor, era importante avaliar a sua adequação para estudar os determinantes de adoção dos PRSE pelos consumidores na saúde. Vários fatores no modelo ajudaram a explicar a adoção dos PRSE: expectativa de desempenho, expectativa de esforço, influência social e hábito. Sendo o hábito um fator especifico da área do consumidor do UTAUT2, demonstrou este fator o impacto mais relevante tanto na intenção de uso como no uso efetivo. O UTAUT2 demonstrou a sua importância como um modelo centrado no consumidor, identificando os fatores que influenciam os consumidores na saúde a usarem PRSE. No segundo estudo empírico (Capítulo 4), também testado em Portugal, estendemos o modelo de UTAUT2, adicionando um fator especifico da saúde, auto- perceção. Este fator demonstrou a sua relevância, tendo uma influência estatisticamente significativa sobre a intenção de uso, demonstrando a utilidade de incluir um fator derivado do “Health Belief Model”(HBM), numa tecnologia aplicada à saúde. No terceiro estudo empírico (Capítulo 5), executamos uma análise entre os Estados Unidos da América e Portugal combinando o UTAUT2 e o “Concern For Information Privacy” (CFIP). Foi feita uma avaliação das potenciais diferenças entre os dois países, com diferentes regulamentações e modelos de saúde, no que diz respeito aos determinantes de adoção. Nos Estados Unidos não existe um sistema nacional de saúde e os doentes têm de ter um seguro privado de saúde bastante dispendioso ou pagarem diretamente as suas despesas ao prestador dos cuidados de saúde, por sua vez em Portugal existe uma cobertura universal dos cuidados de saúde. Foi testada e confirmada a hipótese através do fator preço-valor, que nos Estados Unidos da América, o valor que os consumidores na saúde dão aos PRSE é maior do que em Portugal, sendo esta diferença estatisticamente significativa. Também seria esperado que as preocupações com a confidencialidade fossem maiores nos Estados Unidos da América do que em Portugal, devido a uma regulamentação menos restritiva nos Estados Unidos da América relativamente à confidencialidade dos dados clínicos dos doentes. Utilizamos o CFIP para este propósito, no entanto as preocupações relativamente à confidencialidade, não demonstraram ser um problema tanto nos Estados Unidos da América como em Portugal. A influência social, motivação hedónica e preço-valor, foram fatores relevantes apenas nos Estados Unidos da América. Com este estudo, verificamos que é importante fazer comparações entre países para estudar a adoção de PRSE. No quarto estudo empírico (Capítulo 6), utilizamos a evidência dos estudos empíricos anteriores e da revisão da literatura para propor um novo modelo que integra fatores do UTAUT2, HBM e “Diffusion of Innovation” (DOI). Neste estudo foi feita uma sondagem nacional, utilizando uma amostra aleatória de números de telemóvel, enquanto que nos estudos empíricos anteriores, utilizamos amostras obtidas em instituições com fins educacionais. No processo de amostragem utilizamos duas fases. Na primeira fase perguntamos aos inquiridos se eram utilizadores de PRSE e só depois se a reposta fosse afirmativa se estariam interessados em responder ao inquérito principal do estudo (segunda fase). Desta amostragem e relativamente à questão utilizada para identificar utilizadores de PRSE obtivemos 8.6% de uso na população adulta portuguesa. Uma contribuição importante do nosso estudo para o entendimento da utilização deste tipo de tecnologia ao nível de um país. As três teorias contribuíram com fatores que ajudam a compreender a adoção de PRSE. O modelo final obteve os melhores resultados de todos os estudos empíricos desta dissertação com 76.0% da variância explicada em intenção de uso e 61.8% da variância no uso. Nas conclusões desta dissertação (Capítulo 7), é descrito em maior detalhe todas as contribuições desta dissertação, implicações para decisões de gestão relativamente ao desenvolvimento e implementação de melhores PRSE e limitações e novos caminhos de investigação a ser seguidos para os PRSE

Patient Engagement: The Impact of Electronic Patient Portal Use on Missed Appointments in Patients with Diabetes, a Retrospective Study

Background: This retrospective observational chart review evaluated the use of the MyChart® patient portal as a viable tool for engaging patients. Engagement was measured as fewer missed appointments (no-shows and same-day cancellations). Objectives: To determine who uses the MyChart® patient portal in a chronically ill population of adult patients with diabetes and assess the association of portal use with missed appointments. Methods: The medical records of adult patients (18-80) with a diagnosis of Type 1 and/or Type 2 Diabetes Mellitus (DM) were reviewed (N=7,795). The efficacy of the MyChart® patient portal at reducing missed appointments was assessed by comparing patients who use the portal (evidenced by two or more log-ins during the study period) to those who do not. Results: In this study, 43.7% of adult patients with diabetes used a portal account. Portal users were predominantly female, non-Black, married, non-smokers, and had at least one of the comorbidities often associated with diabetes (hypertension, hyperlipidemia, and/or obesity). Portal users were on average 58.8 years old. Use of the MyChart® patient portal was independently associated with a reduced no-show rate (4.7% for portal users compared to 12.4% for nonusers). However, when patients who activated a portal account during the study period were subjected to a within-subjects analysis, the mean missed appointment percentage was not statistically significantly different when patients had an activated portal account compared to when they did not. Thus, the portal may be a useful tool for engaging chronically ill patients but it is only one component to appointment arrivals. Conclusion: Conclusions from this study are limited given the retrospective design. Nonetheless, the findings suggest that the patient portal is effective at engaging chronically ill patients and thus warrants greater merit. The portal may also be a useful tool for reducing missed appointments in patients with chronic illness who would greatly benefit from appointment adherence. Future research should focus on testing the hypotheses generated in a prospective manner

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

Factors that influence public engagement with eHealth: a literature review

Purpose: Public engagement with eHealth is generally viewed as beneficial. However, despite the potential benefits, public engagement with eHealth services remains variable. This article explores reasons for this variability through a review of published international literature. Methods: A focused search, conducted in January 2009, of three bibliographic databases, MEDLINE, CINAHL and EMBASE, returned 2622 unique abstracts. Results: Fifty articles met the inclusion criteria for the review. Four main types of eHealth service were identified: health information on the Internet; custom-made online health information; online support; and telehealth. Public engagement with these services appears to depend on a number of factors: characteristics of users; technological issues; characteristics of eHealth services; social aspects of use; and eHealth services in use. Conclusions: Recommendations for policy makers, developers, users and health professionals, include: targeting efforts towards those underserved by eHealth; improving access; tailoring services to meet the needs of a broader range of users; exploiting opportunities for social computing; and clarifying of the role of health professionals in endorsement, promotion and facilitation