Patient Portal Utilization Research Articles

Patient Portal Utilization Improves Outcomes in Patients with Multiple Myeloma

Patient Portal Utilization Improves Outcomes in Patients with Multiple Myeloma

Patient- and Provider-Level Factors Associated with Patient Portal Usage Among Medicaid Recipients.

Background: Patient portals can improve access to electronic health information and enhance patient engagement. However, disparities in patient portal utilization remain, affecting disadvantaged communities disproportionately. This study examined patient- and provider-level factors associated with portal usage among Medicaid recipients in a large federally qualified health center (FQHC) network in Texas. Methods: Deidentified electronic medical records of patients 18 years or older from a large Texas FQHC network were analyzed. The dependent variable was a binary flag indicating portal usage during the study period. Independent variables included patient- and provider-level factors. Patient-level factors included sociodemographic, geographic, and clinical characteristics. Provider characteristics included primary service line, provider type, provider language, and years in practice. Because the analysis was at the individual level, a multivariable logistic regression model focused on adjusted associations between independent variables and portal usage. Results: The analytic sample consisted of 9,271 individuals. Compared with individuals 18-39 years, patients 50 years and older had lower odds (50-64 OR: 0.60, p < 0.001; 65+ OR: 0.51, p < 0.001) of portal usage. Males were less likely to use portals (OR: 0.44, p = 0.03), and compared to Non-Hispanic Whites, Non-Hispanic Black (OR: 0.86, p = 0.02) and Hispanics (OR: 0.83, p < 0.001) were significantly less likely to use portals. Individuals with 1 or more telemedicine consults had a two-times greater odds of portal usage (OR: 1.97, p < 0.001). Compared to individuals who had clinic visits in December 2018, portal usage was significantly higher in the pandemic months (March 2020-November 2020, all p's < 0.01). Importantly, the behavioral health service line had the greatest odds (OR: 1.52, p < 0.001), whereas the dental service line had the lowest odds (OR: 0.69, p = 0.01) compared to family practice. No other provider characteristics were significant. Conclusion: Our finding of significant patient-level factors is important and can contribute to developing appropriate patient-focused health information technology approaches to ensure equitable access and maximize the potential benefits of patient portals in health care delivery.

Socioeconomic Disparities in Online Patient Portal Utilization Among Total Knee Arthroplasty Recipients

BackgroundSince 2021, the Centers for Medicare and Medicaid Services have mandated that patients have open access to their medical records. Many institutions use online portals, which allow patients to access their health information and communicate with care teams. Our research aimed to evaluate demographic patterns for online patient portal utilization in patients undergoing total knee arthroplasty (TKA). Further, we assessed if and how portal engagement contributes to perioperative outcomes. MethodsThis study retrospectively reviewed primary and elective TKA from 2017 to 2022 at a single academic institution. Patients were stratified into 2 groups based on their online portal status: activated (A) or not-activated (NA). Baseline characteristics and postoperative outcomes were collected from the electronic medical record and compared. ResultsIn total, 10,995 patients were included: 8,330 (75.8%) were A and 2,625 (24.2%) were NA. The NA group was significantly older (P < .001); more likely to be Black (P < .001), women (P < .001), single/divorced/widowed (P < .001), non-English speaking (P < .001), and Medicare or Medicaid insured (P < .001); from zip codes with median incomes below $50,000 (P < .001), and more likely to be American Society of Anesthesiologists class III or IV (P < .001). Patient-reported outcome measure completion rates were significantly lower in the NA group (15.3 versus 47.7%, P < .001). Lengths of stay (LOS) were significantly higher in the NA group (2.7 versus 2.1 days, P < .001). The NA group was significantly more likely to be discharged to skilled nursing facilities (P < .001). Comparable rates of 90-day emergency department visits, readmissions, as well as 90-day and 2-year revisions, were observed across groups. ConclusionsThere are significant disparities in online portal activation status based on patient demographics. Patients who have A portals had significantly higher Patient-reported outcome measure completion rates, shorter LOS, and higher rates of home discharge. Further research should determine which other factors may affect patient portal utilization and inform interventions to improve portal utilization among minority populations.

Secure Messaging: Demonstration and Enrollment Patient Portal Program: Patient Portal Use in Vulnerable Populations.

Vulnerable populations face challenges gaining access to quality healthcare, which places them at a high risk for poor health outcomes. Using patient portals and secure messaging can improve patient activation, access to care, patient follow-up adherence, and health outcomes. Developing and testing quality improvement strategies to help reduce disparities is vital to ensure patient portals benefit all, especially vulnerable populations. This quality improvement initiative aimed to increase enrollment in a patient portal, use secure messages, and adhere to follow-up appointments. Before the project, no patients were enrolled in the portal at this practice site. Over 8 weeks, 61% of invited patients were enrolled in the patient portal. Eighty-five percent were Medicaid recipients, and the others were underinsured. Eight patients utilized the portal for secure messaging. The follow-up appointment attendance rate was better in the enrolled patients than in those who did not enroll. The majority of survey respondents reported satisfaction in using the patient portal. Patient portal utilization and adoption in vulnerable groups can improve when a one-on-one, hands-on demonstration and technical assistance are provided.

CARE PARTNERS OF PERSONS WITH DEMENTIA USE OF SHARED ACCESS TO THE PATIENT PORTAL

Abstract The patient portal plays a significant and growing role in health system navigation, and most patient portals offer shared access for care partners. Care partners are at the forefront of dementia care, yet little is known about their use of the portal through shared access. We conducted an observational cohort study of patient portal utilization for a 5-year period (10/3/2017-10/2/2022) at an academic health system. The cohort consisted of 49,382 patients ages 65+ with 2+ visits in 24 months. More than half (57.34%) of the cohort was female and white (67.19%) and the average age was 76.56 (SD 8.60). We operationalized diagnosed dementia from ICD10 codes and problem lists. Shared access use was defined as activity happening through “proxy” credentials. We operationalized the patient portal activity metric as the ratio of portal sessions in relation to number of clinical encounters. Older adults with (versus without) diagnosed dementia were similarly likely to be registered for the patient portal (71.20% versus 71.51%, p=0.16) but more likely to have a shared access user (10.41% vs. 3.31%; p&amp;lt;0.001). Among patients with dementia, those who had a shared access user, compared to those who did not, had 341.32 versus 164.33 patient portal sessions, sent 47.56 versus 27.42 messages, and had a 19.22 versus 11.22 patient portal activity metric over the 5-year period (p&amp;lt;0.001 all contrasts). Policy initiatives and organizational efforts that encourage use of shared access may benefit care quality of persons with dementia and their care partners.

PREVALENCE AND TYPES OF PATIENT PORTAL USE AMONG OLDER ADULTS RECEIVING HOME HEALTH CARE

Abstract Home health care (HHC) delivers skilled nursing and therapy services in the patient’s home and is a valuable source of care for community-living older adults, particularly those living with complex conditions such as dementia. However, lack of visibility into patients’ clinical records and difficulty communicating with other providers are perennial challenges to HHC quality. Patient portals― provider-sponsored online applications that allow patients to perform care management tasks including viewing health information and messaging providers―present a promising opportunity to bridge this gap. However, no prior work has examined patterns of portal use among HHC patients. We leveraged a unique dataset containing electronic health record and patient portal utilization data for 10,212 older adults who received HHC between 2017-2019. We found that 25% of HHC patients had an active patient portal prior to HHC and, of those with an active portal, 85% used their portal during HHC. Among those who used their portal during HHC, the most common portal activities were reviewing the clinical record (82%), managing appointments (60%), and seeking provider advice (45%). Compared to community-referred patients, hospital-referred patients were more likely to use their portal to manage appointments or review their clinical record. Compared to patients without dementia, patients with dementia were more likely to use their portal to message their provider but less likely to view their clinical record. Findings suggest that portal users are actively engaging with their portal during HHC, indicating an opportunity to empower patients to facilitate information transfer between HHC and other providers.

Factors Associated with Online Patient Portal Utilization Experience in an Arkansas Phone Survey.

Introduction: Accessing electronic health record information through a patient portal is associated with numerous benefits to both health care providers and patients. However, patient portal utilization remains low. Little is known about the factors associated with patient portal utilization following the onset of the COVID-19 pandemic. Methods: In March 2022, we conducted a random digit dial phone survey of both cell phones and landlines of adults living in Arkansas that asked numerous demographic and health-related measures, including patient portal utilization in the past 12 months. A total of 2,201 adult Arkansans completed the survey between March 1 and March 28, 2022. Weighted estimates were generated using rank ratio estimation to approximate the 2019 American Community Survey 1-year Arkansas estimates for race/ethnicity (72% White, 15% Black/African American, 7.8% Hispanic, 4.9% other race/ethnicity), age (73% 18-39, 32% 40-59, and 31% 60+), and gender (49% male, 51% female). We fit the data to a logistic regression model. Results: We found that education, employment, prior telehealth experience, having a check-up in the past 2 years, and having a primary care provider were all positively associated with patient portal utilization. We also found that non-Hispanic Black/African-American respondents were less likely to access a patient portal relative to non-Hispanic White respondents. Discussion: Patient portal utilization is related to several demographic and health-related factors among an adult population in Arkansas. Given that the documented benefits of patient portal utilization are broad, under-utilization by groups that already experience relatively worse health outcomes could reproduce or even exacerbate existing health disparities. Additional research is needed to further investigate what barriers to patient portal utilization remain for these populations.

Sociodemographic Trends in Telemedicine Visit Completion in Spine Patients During the COVID-19 Pandemic.

Retrospective cohort study. This study identifies potential disparities in telemedicine utilization in the wake of the COVID-19 pandemic and its aftermath in patients receiving spine surgery. COVID-19 led to the rapid uptake of telemedicine in the spine surgery patient population. While previous studies in other medical subspecialties have identified sociodemographic disparities in telemedicine uptake, this is the first study to identify disparities in patients undergoing spine surgery. This study included patients who underwent spine surgery between June 12, 2018 and July 19, 2021. Patients were required to have at least one scheduled patient visit, either virtual (video or telephone visit) or in-person. Binary socioeconomic variables used for modeling included: urbanicity, age at the time of the procedure, sex, race, ethnicity, language, primary insurer, and patient portal utilization. Analyses were conducted for the entire cohort and separately for cohorts of patients who had visits scheduled within specific timeframes: Pre-COVID-19 surge, initial COVID-19 surge, and post-COVID-19 surge. After adjusting for all variables in our multivariable analysis, patients who utilized the patient portal had higher odds of completing a video visit compared with those who did not (OR: 5.21; 95% CI: 1.28, 21.23). Hispanic patients (OR: 0.44; 95% CI: 0.2, 0.98) or those living in rural areas (OR: 0.58; 95% CI: 0.36, 0.93) had lower odds of completing a telephone visit. Patients with no insurance or on public insurance had higher odds of completing a virtual visit of either type (OR: 1.88; 95% CI: 1.10, 3.23). This study demonstrates the disparity in telemedicine utilization across different populations within the surgical spine patient population. Surgeons may use this information to guide interventions aimed at reducing existing disparities and work with certain patient populations to find a solution.

The Association Between Sociodemographic Factors, Social Determinants of Health, and Spine Surgical Patient Portal Utilization.

Retrospective cohort study. To examine patient portal use among the surgical spine patient population across different sociodemographic groups and assess the impact of patient portal use on clinical outcomes. Patient portals (PP) have been shown to improve outcomes and quality of care. Engaging them requires internet access, technological literacy, and dexterity, which may serve as access barriers. After exclusion criteria were applied, the study included data for 9211 encounters from 7955 patients. PP utilization was defined as having activated and used the Duke University Medical Center patient portal system, MyChart, at least once. Sociodemographic characteristics included urbanicity, age, race, ethnicity, language, employment, and primary insurer. Clinical outcomes included the length of hospital stay during the procedure, 30-day return to the emergency department, 30-day readmission, and being discharged somewhere other than home. Being older than 65, non-White, unemployed, non-English-speaking, male, not-partnered, uninsured or publicly insured (Medicaid, Medicare and under 65 years of age, or other government insurance), and living in a rural environment were all risk factors for decreased PP utilization among surgical spine patients. A one-risk factor decrease in the number of social risk factors was associated with a 78% increase in the odds of PP utilization [odds ratio (OR): 1.78; 95% Confidence interval (CI): 1.69-1.87; P <0.001]. Patients not utilizing the portal at the time of their procedure had higher odds of 30-day readmission (OR: 1.59; 95% CI: 1.26-2.00), discharge somewhere other than home (OR: 2.41, 95% CI: 1.95-2.99), and an increased length of hospital stay (geometric mean ratio: 1.21; 95% CI: 1.12-1.30) compared with those who utilized it. In patients undergoing spine procedures, PPs are not equally utilized among different sociodemographic groups. PP utilization is also associated with better outcomes. Interventions aimed at increasing PP uptake may improve care for certain patients.

Using a Machine Learning Algorithm to Predict Online Patient Portal Utilization: A Patient Engagement Study.

There is a low rate of online patient portal utilization in the U.S. This study aimed to utilize a machine learning approach to predict access to online medical records through a patient portal. This is a cross-sectional predictive machine learning algorithm-based study of Health Information National Trends datasets (Cycles 1 and 2; 2017-2018 samples). Survey respondents were U.S. adults (≥18 years old). The primary outcome was a binary variable indicating that the patient had or had not accessed online medical records in the previous 12 months. We analyzed a subset of independent variables using k-means clustering with replicate samples. A cross-validated random forest-based algorithm was utilized to select features for a Cycle 1 split training sample. A logistic regression and an evolved decision tree were trained on the rest of the Cycle 1 training sample. The Cycle 1 test sample and Cycle 2 data were used to benchmark algorithm performance. Lack of access to online systems was less of a barrier to online medical records in 2018 (14%) compared to 2017 (26%). Patients accessed medical records to refill medicines and message primary care providers more frequently in 2018 (45%) than in 2017 (25%). Privacy concerns, portal knowledge, and conversations between primary care providers and patients predict portal access. Methods described here may be employed to personalize methods of patient engagement during new patient registration.

P92. The association between patient portal utilization and clinical outcomes

BACKGROUND CONTEXT Health care systems have augmented the role that patients have in their care through the adoption of patient portals like MyChart. Studies across subspecialties have shown that these portals are associated with improved clinical outcomes. PURPOSE The purpose of this study was to compare clinical outcomes between patient portal users and non-users specifically in the surgical spine patient population. METHODS A retrospective clinical outcome analysis in adult spine patients at Duke University Medical Center between January 1, 2019, and June 30, 2021 was performed. The association between patient portal utilization and clinical outcomes was assessed using multivariable generalized linear mixed effects models including covariates for social risk variables (age, employment status, language, sex, marital status, race, ethnicity, insurance type and urbanicity of residence). Outcomes measured were 30-day readmission, 30-day return to the emergency room, discharge to places other than home, and length of hospital stay during procedure. Fixed effects estimates (odds ratios for binary outcomes and rate ratios for continuous outcomes) and 95% confidence intervals were reported. RESULTS Patients who did not use the patient portal had higher odds of 30-day readmission (OR: 1.59; 95% CI: 1.26, 2.00), being discharged somewhere other than home (OR: 2.41, 95% CI: 1.95, 2.99), and had 1.21 times the length of stay compared to those who utilized the patient portal at the time of the procedure (Rate Ratio: 1.21; 95% CI: 1.12, 1.30). The difference in 30-day return to Emergency department rate was not statistically different between those who did and did not utilize the patient portal (OR: 1.10; 95% CI; 0.92,1.32) CONCLUSIONS Our analysis of the association between patient portal utilization and clinical outcomes revealed that patients who use patient portals may have better clinical outcomes. Although additional studies need to be done to understand the underlying drivers of this association, this study is a promising preliminary look and may inform us of the value of patient portals in improving patient care. Additionally, it stresses the importance of identifying gaps in patient portal uptake as their use has been shown to positively impact health outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Health care systems have augmented the role that patients have in their care through the adoption of patient portals like MyChart. Studies across subspecialties have shown that these portals are associated with improved clinical outcomes. The purpose of this study was to compare clinical outcomes between patient portal users and non-users specifically in the surgical spine patient population. A retrospective clinical outcome analysis in adult spine patients at Duke University Medical Center between January 1, 2019, and June 30, 2021 was performed. The association between patient portal utilization and clinical outcomes was assessed using multivariable generalized linear mixed effects models including covariates for social risk variables (age, employment status, language, sex, marital status, race, ethnicity, insurance type and urbanicity of residence). Outcomes measured were 30-day readmission, 30-day return to the emergency room, discharge to places other than home, and length of hospital stay during procedure. Fixed effects estimates (odds ratios for binary outcomes and rate ratios for continuous outcomes) and 95% confidence intervals were reported. Patients who did not use the patient portal had higher odds of 30-day readmission (OR: 1.59; 95% CI: 1.26, 2.00), being discharged somewhere other than home (OR: 2.41, 95% CI: 1.95, 2.99), and had 1.21 times the length of stay compared to those who utilized the patient portal at the time of the procedure (Rate Ratio: 1.21; 95% CI: 1.12, 1.30). The difference in 30-day return to Emergency department rate was not statistically different between those who did and did not utilize the patient portal (OR: 1.10; 95% CI; 0.92,1.32) Our analysis of the association between patient portal utilization and clinical outcomes revealed that patients who use patient portals may have better clinical outcomes. Although additional studies need to be done to understand the underlying drivers of this association, this study is a promising preliminary look and may inform us of the value of patient portals in improving patient care. Additionally, it stresses the importance of identifying gaps in patient portal uptake as their use has been shown to positively impact health outcomes.

Disparities in Use of Patient Portals Among Adults in Family Medicine.

This study examined patient portal utilization by analyzing the pattern of time and feature use of patients, and thus to identify functionalities of portal use and patient characteristics that may inform future strategies to enhance communication and care coordination through online portals. We conducted a retrospective study of patients at 18 family medicine clinics over a 5-year period using access log records in the electronic health record database. Dimensionality reduction analysis was applied to group portal functionalities into 4 underlying feature domains: messaging, health information management, billing/insurance, and resource/education. Negative binomial regression analysis was used to evaluate how patient and practice characteristics affected the use of each feature domain. Patients with more chronic conditions, lab tests, or prescriptions generally showed greater patient portal usage. However, patients who were male, elderly, in minority groups, or living in rural areas persistently had lower portal usage. Individuals on public insurance were also less likely than those on commercial insurance to use patient portals, although Medicare patients showed greater portal usage on health information management features, and uninsured patients had greater usage on viewing resource/education features. Having Internet access only affected the use of messaging features. Efforts to enroll patients in online portals do not guarantee patients will use the portals to manage their health. When considering the use of patient portals for improving telehealth, clinicians need to be aware of technological, socioeconomic, and cultural challenges faced by their patients.

EHealth literacy and web-based patient portal usage among kidney and liver transplant recipients.

Patient portals promote self-management, but require skills with electronic health information which can be measured by a patient's eHealth literacy. We aimed to describe eHealth literacy among a population of kidney transplant (KT) and liver transplant (LT) recipients and to investigate the relationship between eHealth literacy and Web-based patient portal utilization. We conducted phone surveys (August 2016-March 2017) among 178 KT and 110 LT recipients at two large transplant centers, including the eHealth Literacy Scale (eHEALS) and items assessing routine portal usage. Portal users were defined as routine if usage was every day, weekly, or monthly. The mean eHEALS score was 30.9 (SD: 5.4), and 45.4% routinely used the patient portal more than a few times per month. Routine users had higher eHealth literacy than non-routine users and non-users (31.97 vs. 29.97 vs. 28.20, p<.001). Routine users had higher eHealth literacy scores compared with non-users after adjusting for transplant organ type, age, educational level, employment status, mobile Internet access, and transplant center (OR: 1.10, 95% CI: 1.03-1.17). KT and LT recipients who routinely use patient portals have high eHealth literacy compared with other diseased populations, which should be leveraged by encouraging routine usage to improve post-transplant health and medication adherence.

Sociodemographic Differences and Factors Affecting Patient Portal Utilization.

The primary function of the patient portal is to give patients greater access to their personal health information. Granting patients electronic access allows them to make well-informed health care decisions. This study aimed to identify sociodemographic differences in patient portal use and examine factors affecting patient portal utilization following the final stage of the Meaningful Use program which aimed to promote the use of certified electronic health record (EHR) technology. Survey data from Health Information National Trends Survey (HINTS) 5, cycles 1, 2, and 3 were analyzed. The sample included 8291 completed surveys. Multivariable logistic regression on a selected response for each surveyed question was used to assess the racial and ethnic difference after controlling for age, sex, income, and education. Subjects included English and Spanish speaking adults in the USA. Measures included assessment of patient portal use, patient portal access, understanding health information, usefulness of health records, and privacy and security. After adjusting for age, sex, income, and education, there was a significant association between race/ethnicity and patient portal non-users responding, "no need to use online medical record" as the reason for not using the patient portal (P = 0.005). Among the portal users, there were significant associations between race/ethnicity and health care provider maintaining an EHR (P = 0.006), being offered access to their portal (P < 0.001), understanding health information in the portal (P = 0.004), finding the portal useful for health monitoring (P < 0.001), reporting concern about unauthorized access (P = 0.017), and keeping information from health care providers (P = 0.012). Race/ethnicity affects perceptions on the need for the patient portal, being offered access to a portal, and the reasons to access information online. Understanding the factors affecting patient portal use can inform future strategies aimed at increasing adoption.

Electronic patient portal utilization by neurology patients and association with outcomes.

Existing literature on electronic patient portals demonstrates mixed findings for portal user demographic patterns and relationships between portal usage and clinical outcomes. This study sought to determine characteristics of portal users specific to a neurology patient population and examine whether usage predicted decreased clinic visits and risk of hospitalization. A cross-sectional analysis on 13,483 patients seen at a tertiary neurology outpatient clinic over a 1-year period found significant associations between demographics, and interactions between age, sex, and race. Black and Hispanic patients were less likely to be portal users. While females had higher odds of portal usage overall, their probability decreased with increasing age. Portal users had higher rates of clinic utilization but no difference in hospitalization risk. These results highlight demographics that may need strategic targeting to increase portal uptake and the need for other interventions for populations more likely to experience health events resulting in hospitalization.

Personal Health Records Buck Traditional Medical Culture

New financial incentives from the Centers for Medicare and Medicaid Services, along with new user-friendly technology, may be the impetus for a significant shift in ownership of health records from providers to patients. An evaluation of an early patient portal implementation, including a usability study with potential patients, a mapping of technical workflow for implementation, and a survey of physician users is presented. The results from the 2008 survey are compared with current studies, showing that, despite advances in technology and patient attitudes, until now patient portal utilization has barely grown, due in part to stagnant opinions and work routines among the clinician user community.

Exploration of Portal Activation by Patients in a Healthcare System.

A study of patient portal utilization was conducted at a not-for-profit healthcare system in Northern Virginia. The healthcare system serves more than 2 million people each year. The encounters with the portal included 461 700 different patients occurring between July 2014 and June 2015. Univariate analysis and multivariable logistic regression indicated associations between patient portal activation and predictive factors. Multiple findings emerged: patient portal activation was greater for English-speaking patients; differences in portal activation were observed by patient age; and patients who had an identified primary care provider were more likely to use the portal. The implications were that patients who have limited English skills and have economic challenges may be less engaged. This review demonstrates the importance of understanding the population using a patient portal and provides insight for future development on how to engage patients to interact with their providers through the portals.

Patient Portal Utilization Among Ethnically Diverse Low Income Older Adults: Observational Study.

BackgroundPatient portals can improve patient communication with providers, provide patients with greater health information access, and help improve patient decision making, if they are used. Because research on factors facilitating and limiting patient portal utilization has not been conceptually based, no leverage points have been indicated for improving utilization.ObjectiveThe primary objective for this analysis was to use a conceptual framework to determine potentially modifiable factors affecting patient portal utilization by older adults (aged 55 years and older) who receive care at clinics that serve low income and ethnically diverse communities. The secondary objective was to delineate how patient portal utilization is associated with perceived usefulness and usability.MethodsPatients from one urban and two rural clinics serving low income patients were recruited and completed interviewer-administered questionnaires on patient portal utilization.ResultsA total of 200 ethnically diverse patients completed questionnaires, of which 41 (20.5%) patients reported utilizing portals. Education, social support, and frequent Internet utilization improve the odds of patient portal utilization; receiving health care at a rural clinic decreases the odds of portal utilization.ConclusionsLeverage points to address disparities in patient portal utilization include providing training for older adults in patient portal utilization, involving spouses or other care partners in this training, and making information technology access available at public places in rural and urban communities.

An analysis of patient portal utilization: what can we learn about online patient behavior by examining portal click data?

This paper presents a study of online patient portal utilization through the analysis of system logs. We analyze click data generated between August 2009 and July 2011 by 1886 users of an online patient portal. We investigate variations in utilization for Login and the top five system features (Appointment Review, Lab Tests, Medical Advice Request, Messaging and Result Component Graphing), and examine how age and gender influence these variations. Our findings indicate that the effects of age and gender on system use vary by feature, and that efficiency of use (how clicks are spread across sessions) varies across age, gender and feature. We provide a new approach for understanding system use through click data analysis utilizing system logs (an underutilized data source available to all health-care organizations), an example of how big data can help health-care organizations learn more about their patients’ utilization of patient portals.

Implementation of the Integrated Electronic Patient Portal in the Pediatric Population: A Systematic Review.

This study assessed the current state of knowledge regarding the use of the integrated electronic health record (EHR) patient portal for pediatric clinical care. A systematic examination of the research on implementation, utilization, and evaluation of the integrated EHR patient portal among pediatric patients has not been previously conducted. Therefore, the purpose of the present study was to systematically review existing research on the state of the science, describe the way others have defined the patient portal, and examine pediatric patient portal utilization. Covering a period from 1992 to 2014 a literature search was conducted on four electronic databases. Only articles in English were reviewed. Studies were included if they reported the use of a patient portal integrated with an electronic health record and captured pediatric medial encounters. Qualitative or quantitative studies of any design were eligible as long as they focused on patients (or parents) who access their health records through an electronic portal tied to an EHR and reported measures of satisfaction, attitudes on use, barriers and facilitators, adherence, or clinical and health outcomes. Content analysis of each article was performed independently by at least two authors using an extraction grid of study qualities, and quality and relevance of the studies were also assessed. Of a total of 189 potentially relevant publications identified, 31 full-text publications were obtained after screening titles and abstracts. After a full review, 11 publications corresponding to seven studies met the inclusion criteria. The methodological approaches included cross-sectional surveys, retrospective analysis, qualitative studies, and usability testing. In general, feedback was positive. The most frequent negative comments about the portal reflected concern about teenager interaction with the portal and how that might affect communication among patient, parent, and provider. Some users were frustrated with the complexity of medical terminology used. Reflecting the additional considerations of pediatric proxy access and fewer chronically ill patients, pediatric medicine has yet to use the patient portal as a modality for outcomes measurement. Given the paucity of studies within this age group, it is difficult to measure outcome improvements or the effect of patient record access on healthcare behaviors. This systematic review presents innovative research on the general acceptance of the patient portal among parents and highlights that the implementation of the portal is still in its early stages and has yet to be used widely in diverse populations or studies in a longitudinal manner. Further studies should confirm that protected access to health information and secure communication and information sharing with healthcare providers have an impact in the pediatric population on healthcare outcomes.