Meaningful use and the patient portal: patient enrollment, use, and satisfaction with patient portals at a later-adopting center.
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ABSTRACT:
SUBMITTER: Neuner J
PROVIDER: S-EPMC4141030 | biostudies-literature | 2015 Mar-Apr
REPOSITORIES: biostudies-literature
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Meaningful use and the patient portal: patient enrollment, use, and satisfaction with patient portals at a later-adopting center.
Neuner Joan J Fedders Megan M Caravella Mary M Bradford Lisa L Schapira Marilyn M
American journal of medical quality : the official journal of the American College of Medical Quality 20140221 2
Many physicians are adopting patient portals in response to governmental incentives for meaningful use (MU), but the stage 2 requirements for portal use may be particularly challenging for newer electronic health record (EHR) users. This study examined enrollment, use based on MU requirements, and satisfaction in a recently adopting fee-for-service multispecialty system. Between 2010 and 2012, overall portal enrollment increased from 13.2% to 23.1% but varied substantially by physician specialty ...[more]
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Project description:BACKGROUND:Theoretical models help to explain or predict the adoption of electronic health (eHealth) technology and illustrate the complexity of the adoption process. These models provide insights into general factors that influence the use of eHealth technology. However, they do not give hospitals much actionable knowledge on how to facilitate the adoption process. OBJECTIVE:Our study aims to provide insights into patient portal adoption processes among patients and hospital staff, including health care professionals (HCPs), managers, and administrative clerks. Studying the experiences and views of stakeholders answers the following question: How can hospitals encourage patients and HCPs to adopt a patient portal? METHODS:We conducted 22 semistructured individual and group interviews (n=69) in 12 hospitals and four focus groups with members of national and seminational organizations and patient portal suppliers (n=53). RESULTS:The effort hospitals put into adopting patient portals can be split into three themes. First, inform patients and HCPs about the portal. This communication strategy has four objectives: users should (1) know about the portal, (2) know how the portal works, (3) know that action on the portal is required, and (4) know where to find help with the portal. Second, embed the patient portal in the daily routine of HCPs and management. This involves three forms of support: (1) hospital policy, (2) management by monitoring the numbers, and (3) a structured implementation strategy that includes all staff of one department. Third, try to adjust the portal to meet patients' needs to optimize user-friendliness in two ways: (1) use patients' feedback and (2) focus on optimizing for patients with special needs (eg, low literacy and low digital skills). CONCLUSIONS:Asking stakeholders what they have learned from their efforts to stimulate patient portal use in hospitals elicited rich insights into the adoption process. These insights are missing in the theoretical models. Therefore, our findings help to translate the relatively abstract factors one finds in theoretical models to the everyday pragmatics of eHealth projects in hospitals.
| S-EPMC7268003 | biostudies-literature
Project description:ObjectivePatient portal functionalities, such as patient-physician e-communication, can benefit patients by improving clinical outcomes. Utilization has historically been low but may have increased in recent years due to the implementation of Stage 2 Meaningful Use for electronic health records. This study has 2 objectives: 1) to compare patient portal utilization rates before Stage 2 (2011-2013) and after Stage 2 (2014-2017), and 2) to examine whether disparities in patient portal utilization attenuate after Stage 2.Materials and methodsWe conducted an observational study using a pooled cross-sectional analysis of 2011-2017 National Health Interview Survey data (n = 254 183).ResultsThe mean percent use of patient portals significantly increased from the pre-Stage 2 to the post-Stage 2 period (6.9%, 95% CI, 6.2-7.5; P < .001). Non-Hispanic Black individuals (OR 0.81, 95% CI, 0.76-0.86; P < .0001) and Hispanic individuals (OR 0.79, 95% CI, 0.74-0.84; P < .0001) have lower odds of using patient portals compared to non-Hispanic White individuals. Although we found independent effects of race/ethnicity, we did not find a statistically significant interaction between race/ethnicity and time. We found a similar level of increase in patient portal utilization from the pre- to postperiod across racial and ethnic groups.DiscussionHealth care policies such as Stage 2 Meaningful Use are likely contributing to increased patient portal utilization across all patients and helping to attenuate disparities in utilization between subgroups of patients.ConclusionFurther research is needed to explore which patient portal functionalities are perceived as most beneficial to patients and whether patients have access to those functionalities.
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Project description:BackgroundWith digital delivery of health care services gaining prominence, patient portals have become a mainstay of many health care organizations. Despite the importance of patient portals, inconclusive data exist regarding the effect of patient portal use on patient satisfaction.ObjectiveThe aim of this study is to understand the relationship between the postadoptive use of patient portals and patient satisfaction outcomes.MethodsPostadoptive use of patient portals has a positive relationship with the 3 dimensions of patient satisfaction, mediated by gratification, health self-awareness, and health perceptions. A total of 504 valid patient portal user responses were collected, and partial least squares analysis was performed to analyze the data.ResultsPatient satisfaction was captured using three dimensions: care team interaction, atmosphere, and instruction effectiveness. The results show that postadoptive use of patient portals has a positive influence on all 3 dimensions of patient satisfaction through the mediating variables of gratification, health self-awareness, and health perceptions. Specifically, postadoptive use had significant positive influence on gratification, health self-awareness, and health perceptions. Each of the 3 patient perceptions had significant positive influence on all 3 dimensions of patient satisfaction: care team interaction, atmosphere, and instruction effectiveness. Specifically, our model explained 31.8% of the care team interaction, 40.6% of the atmosphere, and 39.1% of the instruction effectiveness.ConclusionsOur model shows that patient portal use can influence patient satisfaction through the mediating effects of gratification, health self-awareness, and health perception. Patient satisfaction is an important outcome for health care organizations. Therefore, by promoting effective patient portal use and fostering patient perceptions, health care organizations can improve patient satisfaction.
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Project description:BackgroundPatient portals have been introduced in several countries in the last few decades. Despite worldwide objectives of introducing patient portals, nationwide portals are rare, and studies about their use are limited. Finland is one of the forerunners in developing nationwide health data systems. A nationwide patient portal, My Kanta, for viewing electronic prescriptions and health data has been phased in, starting in 2010.ObjectiveThe aim of this study was to investigate what functions Finnish pharmacy customers use in My Kanta, their perceptions of the service's usability, and how satisfied users are with My Kanta overall.MethodsIn spring 2019, questionnaires (N=2866) were distributed from 18 pharmacies of varying size across mainland Finland to adult pharmacy customers purchasing prescription medications for themselves or for their child under 18 years of age. Questions were asked about the use and usability of the patient portal by means of structured and Likert-scale questions. Statistical analyses included frequencies, means, medians, chi-square tests, Fisher exact tests, and Kruskal-Wallis tests.ResultsIn total, 994 completed questionnaires of 2866 delivered questionnaires (34.68%) were returned. The most-used My Kanta functions were browsing prescription information (781/802, 97.4%), records of health care visits (772/802, 96.3%), and results of laboratory tests and x-ray examinations (722/804, 89.8%). Most users (558/793, 70.4%) had also requested a prescription renewal using the service. My Kanta was perceived as easy to log into (772/816, 94.6%) and clear to view (709/808, 87.7%). Most users considered the service useful for monitoring their health information (753/813, 92.6%) and felt that it provides a good overall picture of the medications prescribed to them (711/813, 87.5%). The majority of users found the information recorded about them easy to understand (684/800, 85.5%). Of the users, 16.7% (135/807) disagreed with the statement that the information they were looking for was easy to find. Approximately two-thirds (501/814, 61.5%) of users did not know whether it is easy to view in which pharmacies and health care units their prescription information has been viewed, and over one-third (306/805, 38.0%) did not know whether it is easy to view in which health care units their health information has been processed. Approximately one-fifth of participants (181/805, 22.5%) feared that unauthorized persons might view their information and that their electronically saved prescription and health information might disappear (180/810, 22.2%). In addition, 16.1% (129/799) expressed interest in receiving guidance on My Kanta use. The vast majority of users (719/804, 89.4%) were satisfied with the service overall.ConclusionsPharmacy customers were satisfied with the nationwide patient portal. It was mostly used for browsing e-prescriptions and medical records. Overall, the usability of the service was good. However, users need to be better informed about data privacy and security issues, and guidance on using the portal needs to be improved.
| S-EPMC8325076 | biostudies-literature
Project description:BackgroundPatient-facing health information technology (HIT) tools, such as patient portals, are recognized as a potential mechanism to facilitate patient engagement and patient-centered care, yet the use of these tools remains limited in the hospital setting. Although research in this area is growing, it is unclear how the use of acute care patient portals might affect outcomes, such as patient activation.ObjectiveThe aim of this study was to describe the use of an acute care patient portal and investigate its association with patient and care partner activation in the hospital setting.MethodsWe implemented an acute care patient portal on 6 acute care units over an 18-month period. We investigated the characteristics of the users (patients and their care partners) of the patient portal, as well as their use of the portal. This included the number of visits to each page, the number of days used, the length of the user's access period, and the average percent of days used during the access period. Patient and care partner activation was assessed using the short form of the patient activation measure (PAM-13) and the caregiver patient activation measure (CG-PAM). Comparisons of the activation scores were performed using propensity weighting and robust weighted linear regression.ResultsOf the 2974 randomly sampled patients, 59.01% (1755/2974) agreed to use the acute care patient portal. Acute care patient portal enrollees were younger, less sick, less likely to have Medicare as their insurer, and more likely to use the Partners Healthcare enterprise ambulatory patient portal (Patient Gateway). The most used features of the acute care patient portal were the laboratory test results, care team information, and medication list. Most users accessed the portal between 1 to 4 days during their hospitalization, and the average number of days used (logged in at least once per day) was 1.8 days. On average, users accessed the portal 42.69% of the hospital days during which it was available. There was significant association with patient activation on the neurology service (P<.001) and medicine service (P=.01), after the introduction of HIT tools and the acute care patient portal, but not on the oncology service.ConclusionsPortal users most often accessed the portal to view their clinical information, though portal usage was limited to only the first few days of enrollment. We found an association between the use of the portal and HIT tools with improved levels of patient activation. These tools may help facilitate patient engagement and improve outcomes when fully utilized by patients and care partners. Future study should leverage usage metrics to describe portal use and assess the impact of HIT tools on specific outcome measures in the hospital setting.
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Project description:ObjectiveWe sought to measure patient portal satisfaction with patient portals and characterize its relationship to attitude towards computers, health literacy, portal usage, and patient demographics.Materials and methodsWe invited 13 040 patients from an academic medical center to complete a survey measuring satisfaction, perceived control over computers, and health literacy using validated instruments (End User Computing Satisfaction, Computer Attitude Measure, and Brief Health Literacy Screen). We extracted portal usage and demographic information from the medical center data warehouse.ResultsA total of 6026 (46.2%) patients completed the survey. The median (IQR) scores for satisfaction, computer control, and health literacy were 87% (20%), 86% (22%), and 95% (15%), respectively. The normalized mean (SD) usage of messaging, lab, appointment, medication, and immunization functions were 6.6 (2.6), 4.6 (2.4), 3.1 (1.7), 1.5 (1.2), and 0.88 (0.91) times, respectively. Logistic regression yielded significant odds ratios [99% CI] for computer control (3.6 [2.5-5.2]), health literacy (12 [6.9-23]), and immunization function usage (0.84 [0.73-0.96]).DiscussionRespondents were highly satisfied and had high degrees of computer control and health literacy. Statistical analysis revealed that higher computer control and health literacy predicted higher satisfaction, whereas usage of the immunization function predicted lower satisfaction. Overall, the analytical model had low predictive capability, suggesting that we failed to capture the main drivers of satisfaction, or there was inadequate variation in satisfaction to delineate its contributing factors.ConclusionThis study provides insight into patient satisfaction with and usage of a patient portal. These data can guide the development of the patient portal, with the ultimate goal of increasing functionality and usability to enhance the patient experience.
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Project description:ObjectiveUS health care institutions are implementing secure websites (patient portals) to achieve federal Meaningful Use (MU) certification. We sought to understand efforts to implement portals in "safety net" health care systems that provide services for low-income populations.Materials and methodsOur rapid ethnography involved visits at 4 California safety net health systems and in-depth interviews at a fifth. Visits included interviews with clinicians and executives ( n = 12), informal focus groups with front-line staff ( n = 35), observations of patient portal sign-up procedures and clinic work, review of marketing materials and portal use data, and a brief survey ( n = 45).ResultsOur findings demonstrate that the health systems devoted considerable effort to enlisting staff support for portal adoption and integrating portal-related work into clinic routines. Although all health systems had achieved, or were close to achieving, MU benchmarks, patients faced numerous barriers to portal use and our participants were uncertain how to achieve and sustain "meaningful use" as defined by and for their patients.DiscussionHealth systems' efforts to achieve MU certification united clinic staff under a shared ethos of improved quality of care. However, MU's assumptions about patients' demand for electronic access to health information and ability to make use of it directed clinics' attention to enrollment and message routing rather than to the relevance and usability of a tool that is minimally adaptable to the safety net context.ConclusionWe found a mismatch between MU-based metrics of patient engagement and the priorities and needs of safety net patient populations.
| S-EPMC6080844 | biostudies-literature
Project description:BackgroundWhile a number of studies have explored patient- and provider-related factors contributing to quality of care, few studies have explored the role of technology in improving quality and optimizing patient-provider communication. This study explores the use of an interactive patient-provider software platform (IPSP) at a single institution. Specifically, we compared: (1) patient satisfaction scores, (2) complication rates, and (3) readmission rates before and after the use of an IPSP on patients undergoing total hip arthroplasty and total knee arthroplasty.Material and methodsA retrospective review was performed on all total hip arthroplasty and total knee arthroplasty patients who completed a Press Ganey survey at a single institution between the years 2014 and 2017. Primary outcomes included Press Ganey patient satisfaction scores and 90-day complication and readmission rates. Mann-Whitney U testing and chi-squared analyses were conducted to assess continuous and categorical variables, respectively.ResultsAnalysis revealed an improvement in median Clinician and Group Consumer Assessment of Healthcare Providers and Systems (89 vs 97) and Hospital for Consumer Assessment of Healthcare Providers and Systems scores (9 vs 10; P < .001) between pre-IPSP and post-IPSP. There was a decrease in 90-day complication rates (17.3 vs 11.2%; P = .035) but no decrease in readmission rates (0.30 vs 0.18%, P = .322) between the 2 time points.ConclusionsThe use of an IPSP proved instrumental in improving patient satisfaction and lowering 90-day complication rates at a single institution. The implementation of an IPSP may prove beneficial to arthroplasty surgeons and health-care institutions alike seeking to optimize the quality of care. Larger multicenter studies are necessary to validate the results of the present study.
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Project description:BackgroundPatient portals provide patients and their caregivers online access to limited health results. Health care employees with electronic health record (EHR) access may be able to view their health information not available in the patient portal by looking in the EHR.ObjectiveIn this study, we examine how employees use the patient portal when they also have access to the tethered EHR.MethodsWe obtained patient portal and EHR usage logs corresponding to all employees who viewed their health data at our institution between January 1, 2013 and November 1, 2017. We formed three cohorts based on the systems that employees used to view their health data: employees who used the patient portal only, employees who viewed health data in the EHR only, and employees who used both systems. We compared system accesses and usage patterns for each employee cohort.ResultsDuring the study period, 35,172 employees accessed the EHR as part of patients' treatment and 28,631 employees accessed their health data: 25,193 of them used the patient portal and 13,318 accessed their clinical data in EHR. All employees who accessed their records in the EHR viewed their clinical notes at least once. Among EHR accesses, clinical note accesses comprised more than 42% of all EHR accesses. Provider messaging and appointment scheduling were the most commonly used functions in the patient portal. Employees who had access to their health data in both systems were more likely to engage with providers through portal messages.ConclusionEmployees at a large medical center accessed clinical notes in the EHR to obtain information about their health. Employees also viewed other health data not readily available in the patient portal.
| S-EPMC7299683 | biostudies-literature
Project description:IntroductionPatient portal enrollment following pediatric emergency department (ED) visits allows access to critical results, physician documentation, and telehealth follow-up options. Despite these advantages, there are many challenges to portal invitation and enrollment. Our primary objective was to improve patient portal enrollment rates for discharged pediatric ED patients.MethodsA multidisciplinary team of staff from two ED sites developed successful portal enrollment interventions through sequential Plan-Do-Study-Act cycles from October 2020 to October 2021. Interventions included a new invitation process, changes to patient paperwork on ED arrival, staff portal education, and changes to discharge paperwork and the portal website. The team utilized statistical process control charts to track the percentage of eligible discharged patients who received a portal invitation (process measure) and enrolled in the patient portal.ResultsBefore the study's initiation, less than 1% of eligible patients received patient portal invites or enrolled in the patient portal. Statistical process control charts revealed significant changes in enrollment and baseline shift at both a large academic ED campus and a satellite ED site by May 2021. Improvements in invitation rates were also observed at both campuses. Changes were sustained for over 6 months at both locations.ConclusionsHigh-reliability interventions and a multidisciplinary approach allowed for significant and sustained improvement in patient portal invitation and enrollment rates in eligible pediatric ED patients. Future study will examine enrollment patterns across patient demographics and further high-reliability interventions.
| S-EPMC10990375 | biostudies-literature