Abstract
BackgroundGiving patients access to their health information is a provincial and national goal, and it is critical to the delivery of patient-centered care. With this shift, patient portals have become more prevalent. In Alberta, the Alberta Health Services piloted a portal (MyChart). There was a need to identify factors that promoted the use of this portal. Furthermore, it was imperative to understand why there was variability in uptake within the various clinics that participated in the pilot.ObjectiveThis study aims to identify potential factors that could improve the uptake of MyChart from the perspectives of both users and nonusers at pilot sites. We focused on factors that promoted the use of MyChart along with related benefits and barriers to its use, with the intention that this information could be incorporated into the plan for its province-wide implementation.MethodsA qualitative comparative case study was conducted to determine the feasibility, acceptability, and initial perceptions of users and to identify ways to increase uptake. Semistructured interviews were conducted with 56 participants (27 patients, 21 providers, 4 nonmedical staff, and 4 clinic managers) from 5 clinics. Patients were asked about the impact of MyChart on their health and health care. Providers were asked about the impact on the patient-provider relationship and workflow. Managers were asked about barriers to implementation. The interviews were recorded, transcribed verbatim, and entered into NVivo. A thematic analysis was used to analyze the data.ResultsResults from a comparison of factors related to uptake of MyChart in 5 clinics (2 clinics with high uptake, 1 with moderate uptake, 1 with low uptake, and 1 with no uptake) are reported. Some theoretical constructs in our study, such as intention to use, perceived value, similarity (novelty) of the technology, and patient health needs, were similar to findings published by other research teams. We also identified some new factors associated with uptake, including satisfaction or dissatisfaction with the current status quo, performance expectancy, facilitating conditions, behavioral intentions, and use behavior. All these factors had an impact on the level of uptake in each setting and created different opportunities for end users.ConclusionsThere is limited research on factors that influence the uptake of patient portals. We identified some factors that were consistent with those reported by others but also several new factors that were associated with the update of MyChart, a new patient portal, in the clinics we studied. On the basis of our results, we posit that a shared understanding of the technology among patients, clinicians, and managers, along with dissatisfaction with nonportal-based communications, is foundational and must be addressed for patient portals to support improvements in care.
Highlights
IntroductionGiving patients access to their health information is a provincial and national goal, and it is critical to the delivery of patient-centered care
There is limited research on factors that influence the uptake of patient portals
We identified some factors that were consistent with those reported by others and several new factors that were associated with the update of MyChart, a new patient portal, in the clinics we studied
Summary
Giving patients access to their health information is a provincial and national goal, and it is critical to the delivery of patient-centered care With this shift, patient portals have become more prevalent. The rising costs of health care services and the increased prevalence of chronic conditions necessitate transformative changes in health care delivery Deliberations on these changes have focused on access to information and the interconnectedness of health information systems [1]. Providing patients secure access to their health information is a provincial [2,3,4,5] and national goal in Canada [6,7], and it is considered critical to the delivery of patient- and family-centered care [2,3,4]. The goals of the study were to determine whether MyChart would help patients and their families participate actively in the maintenance and monitoring of their health information and to provide information that could be used to scale up the use of MyChart by documenting factors that both hindered and promoted MyChart uptake
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