Abstract
BackgroundGrowing evidence that patient engagement improves health outcomes and reduces health care costs has fueled health providers’ focus on patient portals as the primary access point for personal health information and patient-provider communication. Whereas much attention has been given to identifying characteristics of older adults who do and do not adopt patient portals and necessary adaptions to portal design, little is known about their attitudes and perceptions regarding patient portal use as a tool for engagement in their health care within the context of health literacy, experience navigating Web-based health information, and previous patient portal use.ObjectiveThe specific aims of this study were to explore attitudes toward portal adoption and its perceived usefulness as a tool for health care engagement among adults (65 years and older) who have varying levels of health literacy and degrees of prior patient portal use.MethodsA phone survey of 100 community dwelling adults gathered sociodemographic, health, and technology related information. Older adults were purposefully selected for 4 follow-up focus groups based on survey responses to health literacy and previous patient portal use. A mixed-method approach was used to integrate phone survey data with thematic analysis of 4 focus groups. Due to variability in attitudes between focus group participants, an individual case analysis was performed and thematic patterns were used as the basis for subgroup formation.ResultsDifferences in health literacy, comfort navigating health information on the Web, and previous portal experience explained some but not all differences related to the 7 themes that emerged in the focus groups analysis. Individual cases who shared attitudes were arranged into 5 subgroups from least to most able and willing to engage in health care via a patient portal. The subgroups’ overall portal adoption attitudes were: (1) Don’t want to feel pushed into anything, (2) Will only adopt if required, (3) Somebody needs to help me, (4) See general convenience of the portal for simple tasks and medical history, but prefer human contact for questions, and (5) Appreciates current features and excited about new possibilities .ConclusionsMost of the older adults are interested in using a patient portal regardless of health literacy level, previous patient portal adoption, or experience navigating health information on the Web. Research targeting informal caregivers of older adults who are unable or unwilling to engage with information technology in health care on their own is warranted. Health care organizations should consider tailored strategies to meet the needs of older adults (and their informal caregivers) and explore alternative workflows that integrate patient portal information into phone conversations and face-to-face contact with health care providers.
Highlights
Comment: Commenters almost unanimously said that requiring an eligible professionals (EPs), eligible hospital or critical access hospitals (CAHs) to meet all of the objectives and their associated measures in order to qualify as a meaningful electronic health record (EHR) user was too ambitious given the current state of EHR technology, adoption levels, the timeline for certification of EHR technologies, the realities of implementing EHR technology and the timeline proposed for Stage 1 of meaningful use in our proposed rule
Response: We acknowledge that the percentage-based measures, as expressed in the proposed rule, would create a reporting burden for EPs, eligible hospitals, and CAHs, and we examined a number of alternatives that potentially reduce the burden of reporting
Response: In the proposed rule, we state, ‘‘the reason we propose to base the measure on unique patients as opposed to every patient encounter, is that a problem list would not necessarily have to be updated at every visit.’’ To further describe the concept of ‘‘unique patient’’ we mean that if a patient is seen by an EP or admitted to an eligible hospital’s or CAH’s inpatient or emergency department (POS 21 or 23) more than once during the EHR reporting period srobinson on DSKHWCL6B1PROD with RULES2
Summary
Title IV of Division B of ARRA amends Titles XVIII and XIX of the Social Security Act (the Act) by establishing incentive payments to eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs), and Medicare Advantage Organizations to promote the adoption and meaningful use of interoperable health information technology (HIT) and qualified electronic health records (EHRs). On January 13, 2010 we published a proposed rule (75 FR 1844), entitled ‘‘Medicare and Medicaid Programs; Electronic Health Record Incentive Program’’ to implement the provisions of ARRA that provide incentive payments to EPs, eligible hospitals, and CAHs participating in Medicare and Medicaid programs that adopt and successfully demonstrate meaningful use of ‘‘certified EHR technology,’’ and incentive payments to certain Medicare Advantage Organizations for their affiliated EPs and eligible hospitals that meaningfully use certified EHR technology Through this final rule, we are developing the incentive programs which are outlined in Division B, Title IV of the HITECH Act. Through this final rule, we are developing the incentive programs which are outlined in Division B, Title IV of the HITECH Act This final rule sets forth the definition of ‘‘meaningful use of certified EHR technology.’’.
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