Analysis & Visualization of EHR Patient Portal Clickstream Data

The purpose of this paper is the analysis of EHR clickstream data of patient portal to determine patient usage behavior. We present our analysis of patterns found in patient clickstream data. Using directed and undirected data mining approach, data can be explored to examine whether different patient groups appear to use the portal differently. We examine changes in usage over time, and also explore difference in usage, average number of clicks per session and time spent per page based on age and gender. We then use clustering to create groups that discriminate patients by their portal usage behavior. Knowledge of these usage patterns can help service providers understand the demographics and behavioral aspects of their patients, which in turn can help them develop, enhance and improve their systems to make the best use of these portals

Explaining the Effect of Health Status on Patient Portal Use and Health System Utilization

Since the inception of patient portals, it has been widely assumed that portals would empower patients by increasing their participation in health decisions and subsequently reducing the burden on healthcare organizations. To investigate whether this assumption holds, we analyzed the relationship between frequency of portal use and frequency of patient clinical encounters. We found that patient portal usage is proportional to patient clinical encounters, contrary to the assumption that portal use would decrease patient encounters. Patients with poorer health tended to have more encounters and subsequently more portal usage than those with better health, who had fewer encounters, indicating a possible common factor of patients’ health status. Significant differences between patients with poorer and better health status were observed for patient encounter types and portal feature usage. In addition, some portal features such as appointment scheduling, flowsheet report, medical advice, encounter details and prescription renewal were associated with fewer encounters

A Theory of Organization-EHR Affordance Actualization

While organizations implement information technology (IT) to effect change, current theories of IT-associated organizational change pay insufficient attention to the change goals, the role of IT in organizational change, and the multilevel nature of change processes. We take a fresh look at IT-associated organizational change using grounded theory methods. Our longitudinal study of an electronic health record (EHR) system implementation in a multi-site medical group found user behaviors that did not fit well with existing theories. Instead, we found that they fit better with the concept of affordances from ecological psychology. In developing our affordance-based theory of IT-associated organizational change from our field data, we discovered three gaps in the affordance literature; namely, the lack of theory for (1) the process of actualizing an affordance’s potential, (2) affordances in an organizational context, and (3) bundles of interrelated affordances. This paper extends the theory of affordances to handle these three gaps and, in doing so, develops a mid-range theory for EHR-associated organizational change in a healthcare organization. While the resulting theory is specific to EHR implementations, it offers a template for other mid-range affordance-actualization theories and a more general affordance-actualization lens. Our affordance-actualization lens considers the materiality of the IT artifact, the non-deterministic process by which IT leads to organizational effects, the multilevel nature of IT-associated change processes, and the intentionality of managers and users as agents of change, and thus addresses important criteria for theories of IT effects in organizations. The paper also provides practical guidance for implementing EHR systems and other organizational systems

Learning how to coach: the different learning situations reported by coaches

This chapter aims to identify and describe the different learning situations reported by coaches, and to gain some insight into their preferred sources of knowledge. It starts by outlining the background to classifying sources of coach learning as formal, non-formal and informal (Nelson et al.,2006). The chapter then moves onto the main section which identifies the range of learning situations experienced by coaches. This section of the chapter draws heavily on a study that used 35 interviews of community youth ice hockey coaches in Canada (Wright et al., 2007); the main issues identified in the Canadian study are transferable to other sports and settings. Quotes have been used from Wright et al.'s (2007) interviews for coaches to explain, in their own words, how they perceive their learning; in addition, edited sections of their explanatory text have been utilised and referenced throughout. The chapter concludes by considering the learning preferences of coaches from a variety of sports (Erickson et al., 2009)

Understanding the Link between Patient Portal Use and Health System Utilization

Identifying the effects of patient portal use on patient engagement with the healthcare delivery system is an active research area. This study aims to understand the link between overall patient portal use (portal activity) and overall health system utilization (encounters) through the analyses of data logs from the patient portal and Electronic Health Record (EHR) system in a large multi-specialty group practice. Analyses of our data revealed correlations between the level of specific portal activity and encounter type. They also show portal use is clustered around other health system utilization activities. Furthermore, total encounters in a given month are predictive of future patient portal activity. Understanding such links can help health care managers plan resources to support patient needs and engagement

Explaining the Effect of Age on Patient Activation, Portal Use and Health System Utilization

Since the launch of patient portals, it is widely assumed that the portals should empower patients by increasing their participation in health decisions and subsequently reduce the burden on healthcare organizations. It is necessary to examine patient portals as a form of patient activation and how it varies with age. In this research, we analyzed two years of patient portal clickstream and clinical encounter activities. We then analyzed how age could explain the relationship between the variations in frequencies of use in patient portal and clinical encounters. Results suggest that aging has positive association with encounters but it does not significantly explain the variations in portal usage by itself. There is positive association between portal usage and clinical encounters and it is stronger for younger patient segments. Making use of some portal features that vary for each patient age segments can help in reducing face-to-face encounters and subsequently healthcare costs

Patient Portals: An Underused Resource for Improving Patient Engagement

The potential of patient portals to improve patient engagement and health outcomes has been discussed for more than a decade. The slow growth in patient portal adoption rates among patients and providers in the United States, despite external incentives, indicates that this is a complex issue. We examined evidence of patient portal use and effects with a focus on the pulmonary domain. We found a paucity of studies of patient portal use in pulmonary practice, and highlight gaps for future research. We also report on the experience of a pulmonary department using a patient portal to highlight the potential of these systems. Inc