Improving the informational continuity of care in diabetes mellitus treatment with a nationwide Shared EHR system: Estimates from Austrian claims data

PurposeShared Electronic Health Record (EHR) systems, which provide a health information exchange (HIE) within a community of care, were found to be a key enabler of informational continuity of diabetes mellitus (DM) care. Quantitative analyses of the actual contribution of Shared EHR systems to informational continuity of care are rare. The goal of this study was to quantitatively analyze (i) the degree of fragmentation of DM care in Austria as an indicator for the need for HIE, and (ii) the quantity of information (i.e. number of documents) from Austrian DM patients that would be made available by a nationwide Shared EHR system for HIE.MethodsOur analyses are based on social security claims data of 7.9 million Austrians from 2006 and 2007. DM patients were identified through medication data and inpatient diagnoses. The degree of fragmentation was determined by the number of different healthcare providers per patient. The amount of information that would be made available by a nationwide Shared EHR system was estimated by the number of documents that would have been available to a healthcare provider if he had access to information on the patient’s visits to any of the other healthcare providers. As a reference value we determined the number of locally available documents that would have originated from the patient’s visits to the healthcare provider himself. We performed our analysis for two types of systems: (i) a “comprehensive” Shared EHR system (SEHRS), where each visit of a patient results in a single document (progress note), and (ii) the Austrian ELGA system, which allows four specific document types to be shared.Results391,630 DM patients were identified, corresponding to 4.7% of the Austrian population. More than 90% of the patients received health services from more than one healthcare provider in one year. Both, the SEHRS as well as ELGA would have multiplied the available information during a patient visit in comparison to an isolated local EHR system; the median ratio of external to local medical documents was between 1:1 for a typical visit at a primary care provider (SEHRS as well as ELGA) and 39:1 (SEHRS) respectively 28:1 (ELGA) for a typical visit at a hospital.ConclusionsDue to the high degree of care fragmentation, there is an obvious need for HIE for Austrian DM patients. Both, the SEHRS as well as ELGA could provide a substantial contribution to informational continuity of care in Austrian DM treatment. Hospitals and specialists would have gained the most amount of external information, primary care providers and pharmacies would have at least doubled their available information. Despite being the most important potential feeders of a national Shared EHR system according to our analysis, primary care providers will not tap their full corresponding potential under the current implementation scenario of ELGA.     

Electronic health records implementation: An evaluation of information system impact and contingency factors

ObjectiveThis paper provides a review of EHR (electronic health record) implementations around the world and reports on findings including benefits and issues associated with EHR implementation.Materials and methodsA systematic literature review was conducted from peer-reviewed scholarly journal publications from the last 10 years (2001–2011). The search was conducted using various publication collections including: Scopus, Embase, Informit, Medline, Proquest Health and Medical Complete. This paper reports on our analysis of previous empirical studies of EHR implementations. We analysed data based on an extension of DeLone and McLean's information system (IS) evaluation framework. The extended framework integrates DeLone and McLean's dimensions, including information quality, system quality, service quality, intention of use and usage, user satisfaction and net benefits, together with contingent dimensions, including systems development, implementation attributes and organisational aspects, as identified by Van der Meijden and colleagues.ResultsA mix of evidence-based positive and negative impacts of EHR was found across different evaluation dimensions. In addition, a number of contingent factors were found to contribute to successful implementation of EHR.LimitationsThis review does not include white papers or industry surveys, non-English papers, or those published outside the review time period.ConclusionThis review confirms the potential of this technology to aid patient care and clinical documentation; for example, in improved documentation quality, increased administration efficiency, as well as better quality, safety and coordination of care. Common negative impacts include changes to workflow and work disruption. Mixed observations were found on EHR quality, adoption and satisfaction. The review warns future implementers of EHR to carefully undertake the technology implementation exercise. The review also informs healthcare providers of contingent factors that potentially affect EHR development and implementation in an organisational setting. Our findings suggest a lack of socio-technical connectives between the clinician, the patient and the technology in developing and implementing EHR and future developments in patient-accessible EHR. In addition, a synthesis of DeLone and McLean's framework and Van der Meijden and colleagues’ contingent factors has been found useful in comprehensively understanding and evaluating EHR implementations.     

The EHR-ARCHE project: Satisfying clinical information needs in a Shared Electronic Health Record System based on IHE XDS and Archetypes

PurposeWhile contributing to an improved continuity of care, Shared Electronic Health Record (EHR) systems may also lead to information overload of healthcare providers. Document-oriented architectures, such as the commonly employed IHE XDS profile, which only support information retrieval at the level of documents, are particularly susceptible for this problem. The objective of the EHR-ARCHE project was to develop a methodology and a prototype to efficiently satisfy healthcare providers’ information needs when accessing a patient's Shared EHR during a treatment situation. We especially aimed to investigate whether this objective can be reached by integrating EHR Archetypes into an IHE XDS environment.MethodsUsing methodical triangulation, we first analysed the information needs of healthcare providers, focusing on the treatment of diabetes patients as an exemplary application domain. We then designed ISO/EN 13606 Archetypes covering the identified information needs. To support a content-based search for fine-grained information items within EHR documents, we extended the IHE XDS environment with two additional actors. Finally, we conducted a formative and summative evaluation of our approach within a controlled study.ResultsWe identified 446 frequently needed diabetes-specific information items, representing typical information needs of healthcare providers. We then created 128 Archetypes and 120 EHR documents for two fictive patients. All seven diabetes experts, who evaluated our approach, preferred the content-based search to a conventional XDS search. Success rates of finding relevant information was higher for the content-based search (100% versus 80%) and the latter was also more time-efficient (8–14 min versus 20 min or more).ConclusionsOur results show that for an efficient satisfaction of health care providers’ information needs, a content-based search that rests upon the integration of Archetypes into an IHE XDS-based Shared EHR system is superior to a conventional metadata-based XDS search.     

Impact of the mental health and dynamic referral for oncology (MHADRO) program on oncology patient outcomes,health care utilization,and health provider behaviors: A multi-site randomized control trial

ObjectiveThe MHADRO assesses psychosocial and medical needs, provides tailored feedback reports, and connects patients to mental health providers. This study examined the MHADRO’s effect on patient outcomes, health care utilization, and oncology provider documentation and behaviors.Methods836 patients were part of a multi-site RCT and assessments were conducted at baseline, 2, 6 and 12 months.ResultsThe intervention group engaged in less emergency calls to providers. There were no differences in psychosocial outcomes at follow up assessments. Providers of patients in the intervention group were more likely to: document psychosocial symptoms and history; refer to psychosocial services; encourage support groups; seek psychological evaluations during visits. Patients who agreed to a mental health referral had decreased hospitalizations, increased mental health care interactions, and stronger ratings of counseling potential benefits. This group also reported increased psychosocial distress at all follow-up assessments.ConclusionThe MHADRO may increase access to mental health care, lessen utilization, and improve providers’ management of psychosocial needs, but does not appear to impact overall functioning over time.Practice ImplicationsProviders are encouraged to consider incorporating programs, like the MHADRO, into patient care as they may have the potential to impact screening and management of patients’ psychosocial needs.     

Provider and patient perspectives regarding health care for war-related health concerns

OBJECTIVE: To gain insight about Department of Defense providers' and health care beneficiaries' opinions regarding provider-patient communication of health care for post-deployment health concerns. METHODS: Thirty-five Department of Defense primary care providers and 14 military beneficiaries participated in focus groups at five military medical treatment facilities. We audiotaped, transcribed, and qualitatively analyzed semi-structured focus group interviews to determine attitudes and beliefs about war-related health concerns, symptoms, and health care quality. RESULTS: Focus groups revealed important insights about provider and patient perspectives of communication and care in four general areas: physician-patient trust, validity of symptoms and concerns, exchange of health information, and barriers to care. CONCLUSION: Provider-patient communication contributes to patient satisfaction with medical care; poor communication may contribute to decreased patient satisfaction and provider effectiveness. The military health care system poses several challenges to provider-patient communication: the dual nature of the provider's role, the occupational relationship between illness and health care, pre- and post-deployment issues, and continuity of care impact patient and provider perspectives. The prevalence of various beneficiary and provider concerns regarding health care communication requires further study, particularly for the severely wounded. PRACTICE IMPLICATIONS: The quality of information exchanged and of the interpersonal relationship impact medical decision making, particularly in occupational health settings such as the military. Attention to these issues may improve patient outcomes including satisfaction, adherence, trust, health status, and quality of life.     

The influence of mobile health applications on patient - healthcare provider relationships: A systematic,narrative review

ObjectiveTo explore the influence of mobile health applications on various dimensions of patient and healthcare provider relationships.MethodsA systematic, narrative review of English literature reporting experiences and outcomes of using mobile health applications was performed, evaluating communication and relationships between patients and healthcare professionals. Findings were framed thematically within the four dimensions of relationship-centred care. The methodological quality of included articles was appraised.ResultsThirty-seven articles were included, all of them meeting tenets of relationship-centred care. After adopting mobile health applications patients perceived an overall positive impact on their relationship with healthcare providers, indicating they are ready to transition from traditional clinical ecounters to a different modality. Use of the applications supported patients in assuming active roles in the management of their health in collaboration with health professionals. Reluctance of providers to using mobile health needs to be acknowledged and addressed when encouraging wider use of applications in clinical practice.ConclusionThe use of mobile health applications can influence communication and relationships between patients and providers positively, facilitating relationship-centered healthcare.Practice implicationImplementation of mobile health can support patients’ self-efficacy, improve access to healthcare services and improve relationships between patients and providers in ambulatory and hospital settings.     

Development and classification of a robust inventory of near real-time outcome measurements for assessing information technology interventions in health care

ObjectiveTo develop and classify an inventory of near real-time outcome measures for assessing information technology (IT) interventions in health care and assess their relevance as perceived by experts in the field.Materials and methodsTo verify the robustness and coverage of a previously published inventory of measures and taxonomy, we conducted semi-structured interviews with clinical and administrative leaders from a large care delivery system to collect suggestions of outcome measures that can be calculated with data available in electronic format for near real-time monitoring of EHR implementations. We combined these measures with the most commonly reported in the literature. We then conducted two online surveys with subject-matter experts to collect their perceptions of the relevance of the measures, and identify other potentially relevant measures.ResultsWith input from experienced health care leaders and informaticists, we developed an inventory of 102 outcome measures. These measures were classified into a taxonomy of commonly used measures around the categories of quality, productivity, and safety. Safety measures were rated as most relevant by subject-matter experts, especially those measuring medication processes. Clinician satisfaction and measures assessing mean time to complete tasks and time spent on electronic documentation were also rated as highly relevant.DiscussionBy expanding the coverage of our previously published inventory and taxonomy, we expect to help providers, health IT vendors and researchers to more effectively and consistently monitor the impact of EHR implementations in near real-time, and report more standardized outcomes in future studies. We identified several measures not commonly assessed by previous studies of IT implementations, especially those of safety and productivity, which deserve more attention from the broader informatics community.ConclusionOur inventory of measures and taxonomy will help researchers identify gaps in their measurement approaches and report more standardized measurements of IT interventions that could be shared among researchers, hopefully facilitating comparison across future studies and increasing our understanding of the impact of IT interventions in health care.     

Patient and provider perspectives on preterm birth risk assessment and communication

ObjectiveTo describe and compare how obstetric patients and care providers view preterm birth risk assessment and communication.MethodsWe conducted eight focus groups with obstetric patients (n = 35) and 16 qualitative interviews with obstetric providers. Grounded theory was used to identify and analyze themes.ResultsPatients' knowledge about preterm birth varied greatly. Similar benefits and risks of preterm birth risk counseling were discussed by patients and providers with notable exceptions: patients cited preparedness as a benefit and providers cited maternal blame, patient alienation, and estimate uncertainty as potential risks. Most patients expressed a desire to know their personalized preterm birth risk during pregnancy. Providers differed in whether they offer universal versus selective, and quantitative versus qualitative, preterm birth risk counseling. Many providers expressed concern about discussing social and structural risk factors for preterm birth.ConclusionWhile many patients desired knowing their personalized preterm birth risk, prenatal care providers’ disclosure practices vary because of uncertainty of estimates, concerns about negative consequences and challenges of addressing systemic inequities and social determinants of health.Practice implicationsGiven the existing asymmetry of information about preterm birth risk, providers should consider patient preferences regarding and potential benefits and risks of such disclosure in their practice.     

Evaluation of a comprehensive EHR based on the DeLone and McLean model for IS success: Approach,results, and success factors

ObjectiveThe article describes the methodological approach to, and results of an evaluation of a comprehensive electronic health record (EHR) in the shake down phase, shortly after its implementation at a regional hospital in Denmark.DesignA formative evaluation based on a mixed-methods case study, designed to be interactive and concurrent was conducted at two hospital departments based on the updated DeLone and McLean framework for evaluating information systems success.MethodsTo ascertain user assessments of the EHR, we distributed a questionnaire two months after implementation to four groups of staff (physicians, nurses, medical secretaries, and physiotherapists; n = 244), and at the same time we conducted thirteen individual, semi-structured interviews with representatives from these four groups. Subsequently, seven follow-up focus group interviews were conducted with the four above-mentioned groups, in order to go deeper into specific user assessments. Simultaneously, focus group interviews with two IT departments and the implementation team were conducted, to gain insight into system provider assessments of the implementation process and the EHR. Before, during, and after implementation, 88 h of ethnographic observation were carried out, to give the researchers an understanding of the daily routine of staff, and their use of health records. Finally, daily system performance data were obtained, to gather factual information on system response and downtime.ResultsOverall, staff had positive experiences with the EHR and its operational reliability, response time, login and support. Performance was acceptable. Medical secretaries found the use of the patient administration module cumbersome, and physicians found the establishment of the overview of professionally relevant data challenging. There were demands for improvements to these and other functionalities, and for the EHR to be integrated with other systems and databases.LimitationsEvaluations immediately following implementation are inherently difficult, but was required because a key role was to inform decision-making upon enrollment at other hospitals and systematically identify barriers in this respect. The strength of the evaluation is the mixed-methods approach. Further, the evaluation was based on assessments from staff in two departments that comprise around 50% of hospital staff. A weakness may be that staff assessment plays a major role in interviews and survey. These though are supplemented by performance data and observation. Also, the evaluation primarily reports upon the dimension ‘user satisfaction’, since use of the EHR is mandatory. Finally, generalizability may be low, since the evaluation was not based on a validated survey. All in all, however, the evaluation proposes an evaluation design in constrained circumstances.ConclusionsDespite inherent limitations, evaluation of a comprehensive EHR shortly after implementation may be necessary, can be conducted, and may inform political decision making. The updated DeLone and McLean framework was constructive in the overall design of the evaluation of the EHR implementation, and allowed the model to be adapted to the health care domain by being methodological flexible. The mixed-methods case study produced valid and reliable results, and was accepted by staff, system providers, and political decision makers. The successful implementation may be attributed to the configurability of the EHR and to factors such as an experienced, competent implementation organization at the hospital, upgraded soft- and hardware, and a high degree of user involvement.     

Characteristics of teach-back as practiced in a university health center,and its association with patient understanding,self-efficacy,and satisfaction

ObjectivesThe purpose of this research was to investigate the extent to which recommended characteristics of teach-back were employed by providers in a university Student Health Services department, and to evaluate its association with patient understanding, self-efficacy, and satisfaction.MethodThe study employed a causal comparative design. Audio recordings of 87 primary care interviews were transcribed and coded for presence and characteristics of teach-back. Patients and providers filled out post-encounter questionnaires.ResultsWhen teach-back was used, most recommended characteristics of teach-back were regularly employed. However, providers rarely placed the onus for understanding on themselves, and almost never “closed the loop” by asking patients to repeat back information until they got it correct. Teach-back was associated with higher patient self-efficacy, and high fidelity of implementation with better patient understanding of the reason for the treatment plan.ConclusionsFindings add to existing evidence regarding effectiveness of teach-back. Additional benefits may be realized when implementation is true to recommended characteristics. More research is needed into the necessity of closing the loop and placing onus on the provider.Practice implicationsGiven that neither patients nor providers accurately gauged the level of patient understanding in the medical encounter, teach-back may offer a simple, quick means of reinforcing provider health information and raising patient self-efficacy.     

Evaluating challenges for improving medically unexplained symptoms in US military veterans via provider communication

ObjectivesMedically unexplained symptoms (MUS) are common, with particularly high rates observed in military veterans. Effective patient-provider-communication is thought to be a key aspect of care; however there have been few empirical studies on the association between communication and outcomes for patients with MUS. We evaluate whether discussing veterans’ MUS-illness representations and good interpersonal skills have the potential to promote MUS-treatment adherence and improvement.MethodsVeterans experiencing MUS (n = 204) reported on their primary care providers’ communication about illness representations and interpersonal skills; correlation, regression, and bootstrap-mediation analyses were conducted to test hypotheses regarding veteran-reported outcomes. Main outcomes included satisfaction with the provider, MUS-treatment adherence, intentions to adhere, and expectations for MUS improvement.ResultsVeterans reported infrequent discussion of MUS illness representations but high degrees of provider interpersonal skills. Communication regarding patients’ illness representations and treatment expectations was significantly related to treatment adherence and adherence intentions; provider interpersonal skills were not. Both were related to veteran satisfaction.Conclusions and practice implicationsProviders’ interpersonal skills may be important in chronic illness contexts, such as MUS, by contributing to satisfaction with the provider. The current study suggests that providers may better promote MUS-treatment adherence through discussing MUS illness representations and treatment expectations.     

Service providers’ experiences of using a telehealth network 12 months after digitisation of a large Australian rural mental health service

BackgroundDespite evidence of benefits of telehealth networks in increasing access to, or providing, previously unavailable mental health services, care providers still prefer traditional approaches. For psychiatric assessment, digital technology can offer improvements over analog systems for the technical and, subsequently, the social quality of provider-client interaction. This is in turn expected to support greater provider uptake and enhanced patient benefits.ObjectiveWithin the framework of Innovation Diffusion Theory, to study service providers’ experiences of an existing regional telehealth network for mental health care practice twelve months after digitisation in order to identify the benefits of digital telehealth over an analog system for mental health care purposes in rural Australia.MethodsQualitative interviews and focus groups were conducted with over 40 service providers from June to September 2013 in South Australia, ranging from the metropolitan central operations to health providers located up to 600 km away in rural and remote areas of the same state. Participants included rural mental health teams, directors of nursing at rural hospitals, metropolitan-based psychiatrists and registrars, the metropolitan-based mental health team dedicated to rural provider support, rural GPs, administrative staff, and the executive group of the state rural health department. Fieldwork was conducted 12 months after the analog system was digitised. The interview and focus group data were analysed using thematic analysis, focusing on three key areas of innovation diffusion theory: relative advantage, technical complexity and technical compatibility.ResultsFive themes with 11 sub-themes were identified: (1) “Existing Uses”, with three sub-themes: current mental health use, use by GPs, and use for staff support; (2) “Relative Advantage”, with four sub-themes: improved technical quality, improved clinical practice, time and cost benefits for providers, and improved patient care; (3) “Technical Complexity”; (4) “Technical Compatibility” with two sub-themes: technical-clinical and technical-administrative; and (5) “Broader Organisational Culture”, with two sub-themes: organizational policy support and ‘digital telehealth' culture.ConclusionsThe digitised telehealth network was generally well received by providers and adopted into clinical practice. Compared with the previous analog system, staff found advantages in better visual and audio quality, more technical stability with less “drop-out”, less time delay to conversations and less confusion for clients. Despite these advantages, providers identified a range of challenges to starting or continuing use and they recommended improvements to increase uptake among mental health service providers and other providers (including GPs), and to clinical uses other than mental health. To further increase uptake and impact of telehealth-mediated mental health care in rural and remote areas, even with a high quality digital system, future research must design innovative care models, consider time and cost incentives for providers to use telehealth, and must focus not only on technical training but also how to best integrate technology with clinical practice and must develop an organization-wide digital telehealth culture.     

Cultural competency and microaggressions in the provision of care to LGBT patients in rural and appalachian Tennessee

PurposeLack of provider training in lesbian, gay, bisexual, and transgender (LGBT) cultural competence may diminish healthcare access. Culturally competent providers may enact microaggressions when providing LGBT patient care, especially in sociopolitically conservative areas. Our study examined LGBT cultural competence and microaggressions among healthcare providers in rural Tennessee.MethodsProviders (n = 85) completed a self-report survey on LGBT cultural competence. Post-survey, we invited respondents to provide an interview to contextualize quantitative findings and identify barriers to LGBT patient care (n = 6).ResultsMost quantitative respondents disagreed that they preferred not to care for LGBT patients (85.9%) or that they would refuse care to LGBT patients (92.9%). Only half felt competent to provide LGBT patient care (54.1%). Fewer oncology than primary care providers felt competent treating LGBT patients, and more physicians than nurses reported their training did not adequately address LGBT issues. Qualitatively, interviewees reported serving patients “equally”, yet described discomfort with LGBT patients and LGBT microaggressions in clinical practice.Principal conclusionsWhile many providers felt competent to provide LGBT patient care, they described behaviors and attitudes that may contribute to LGBT healthcare inequities.Practice ImplicationsProvider training must address how microaggressions negatively influence patient-provider interactions and LGBT patient care.     

Shared decision making for the allergist

ObjectiveShared decision making (SDM) is becoming more commonly appreciated and used in medical practice as a way to empower patients who are facing treatment preference-sensitive conditions, such as allergic rhinitis, atopic dermatitis, food allergy, and persistent asthma. The purpose of this review is to educate the allergy health care provider about how SDM works and provide practical advice and allergist-specific SDM resources.Data SourcesPubMed and online patient decision aid resources.Study SelectionsStudies and reviews relevant to SDM and patient decision aids relevant to the allergy health care provider were selected for discussion.ResultsThere are ethical, practical, economic, and psychological imperatives for the implementation of quality SDM, particularly for chronic diseases. Many benefits and barriers of SDM have been identified and models have been developed to encourage implementation of quality SDM. For the allergy health care provider, SDM for asthma has been shown to improve adherence, outcomes, and patient satisfaction with care. Patient decision aids are useful tools for SDM and have recently been developed for allergen immunotherapy, severe asthma, and atopic dermatitis.ConclusionEffective SDM has been shown to improve adherence and lead to better outcomes. SDM should be universally implemented as a key component of patient-centered health care. Allergy health care providers should work with their patients to reach treatment decisions that align with their values and preferences.     

How physicians document outpatient visit notes in an electronic health record

BackgroundClinical documentation, an essential process within electronic health records (EHRs), takes a significant amount of clinician time. How best to optimize documentation methods to deliver effective care remains unclear.ObjectiveWe evaluated whether EHR visit note documentation method was influenced by physician or practice characteristics, and the association of physician satisfaction with an EHR notes module.MeasurementsWe surveyed primary care physicians (PCPs) and specialists, and used EHR and provider data to perform a multinomial logistic regression of visit notes from 2008. We measured physician documentation method use and satisfaction with an EHR notes module and determined the relationship between method and physician and practice characteristics.ResultsOf 1088 physicians, 85% used a single method to document the majority of their visits. PCPs predominantly documented using templates (60%) compared to 34% of specialists, while 38% of specialists predominantly dictated. Physicians affiliated with academic medical centers (OR 1.96, CI (1.23, 3.12)), based at a hospital (OR 1.57, 95% CI (1.04, 2.36)) and using the EHR for longer (OR 1.13, 95% CI (1.03, 1.25)) were more likely to dictate than use templates. Most physicians of 383 survey responders were satisfied with the EHR notes module, regardless of their preferred documentation method.ConclusionsPhysicians predominantly utilized a single method of visit note documentation and were satisfied with their approach, but the approaches they chose varied. Demographic characteristics were associated with preferred documentation method. Further research should focus on why variation exists, and the quality of the documentation resulting from different methods used.     

Provider burnout and patient-provider communication in the context of hypertension care

ObjectiveBurnout is prevalent among healthcare providers and associated with poor patient-provider communication. Patient-provider communication is essential for effective care, particularly among patients with conditions such as hypertension. We examined the association between provider burnout and patient-provider communication in hypertension care.MethodsWe used cross-sectional data from 26 primary care providers and their 80 patients with hypertension. Patient-provider primary care visits were audiotaped and providers completed surveys. Patients were 65% Black/African American and 58% female. Providers were 54% white and 65% female. Patient-provider communication was coded using the Medical Interaction Process System (MIPS). We also assess provider-reported level of burnout and suboptimal patient care using validated surveys.ResultsOur findings show an inverse association between burnout and relationship building communication (e.g., displaying empathy) (b=-4.7 p < .05) and between relationship building communication and suboptimal patient care (b=-0.6 p < .05) in multivariate, adjusted models.ConclusionGiven the role of patient-provider communication, our work highlights provider burnout as a potentially significant hindrance to patient-provider relationship building in hypertension care.Practice implicationsFuture research should examine the factors that contribute to provider burnout in order to mitigate their negative effects on patient-provider communication and patient care.     

The Wired Patient: Patterns of Electronic Patient Portal Use Among Patients With Cardiac Disease or Diabetes

Background

As providers develop an electronic health record–based infrastructure, patients are increasingly using Web portals to access their health information and participate electronically in the health care process. Little is known about how such portals are actually used.

Objective

In this paper, our goal was to describe the types and patterns of portal users in an integrated delivery system.

Methods

We analyzed 12 months of data from Web server log files on 2282 patients using a Web-based portal to their electronic health record (EHR). We obtained data for patients with cardiovascular disease and/or diabetes who had a Geisinger Clinic primary care provider and were registered “MyGeisinger” Web portal users. Hierarchical cluster analysis was applied to longitudinal data to profile users based on their frequency, intensity, and consistency of use. User types were characterized by basic demographic data from the EHR.

Results

We identified eight distinct portal user groups. The two largest groups (41.98%, 948/2258 and 24.84%, 561/2258) logged into the portal infrequently but had markedly different levels of engagement with their medical record. Other distinct groups were characterized by tracking biometric measures (10.54%, 238/2258), sending electronic messages to their provider (9.25%, 209/2258), preparing for an office visit (5.98%, 135/2258), and tracking laboratory results (4.16%, 94/2258).

Conclusions

There are naturally occurring groups of EHR Web portal users within a population of adult primary care patients with chronic conditions. More than half of the patient cohort exhibited distinct patterns of portal use linked to key features. These patterns of portal access and interaction provide insight into opportunities for electronic patient engagement strategies.