Implementation Of Portal Research Articles

Patient and provider perspectives on the potential value and use of a bilingual online patient portal in a Spanish-speaking safety-net population.

To assess patient and provider perspectives on the potential value and use of a bilingual patient portal in a large safety-net health system serving predominantly Spanish-speaking patients. We captured patient and provider perspectives through the administration of surveys to assess Internet access, barriers, and facilitators to patient portal adoption, along with portal preferences. We report on these survey results using descriptive and comparative statistics. Four hundred patients (82% response rate) and 59 providers (80% response rate) participated in the study. Although 73% of providers believed that the patient portal would increase patient satisfaction, just 39% planned to recommend portal use to patients, citing concerns related to time and reimbursement. In contrast, 72% of patients believed the patient portal would strengthen the patient-provider relationship and 77% believed it would improve the quality of care. Latino patients in particular believed the patient portal would strengthen the patient-provider relationship. Seventy-five percent of patients reported interest in a mobile version of the portal. Patients from a safety-net health system, most of whom were Spanish-speaking, reported a high level of interest in the patient portal. Providers at the same health system expressed reluctance about the portal due to concerns related to time and reimbursement. Bilingual patient portal implementation has considerable potential to promote health care engagement within Spanish-speaking safety-net populations; however, lack of provider engagement in the process could undermine the effort.

Patient-Centered Personal Health Record and Portal Implementation Toolkit for Ambulatory Clinics

Personal health records and patient portals have been shown to be effective in managing chronic illnesses. Despite recent nationwide implementation efforts, the personal health record and patient portal adoption rates among patients are low, and the lack of support for patients using the programs remains a critical gap in most implementation processes. In this study, we implemented the Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit in a large diabetes/endocrinology center and assessed its preliminary impact on personal health record and patient portal knowledge, self-efficacy, patient-provider communication, and adherence to treatment plans. Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit is composed of Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General, clinic-level resources for clinicians, staff, and patients, and Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit Plus, an optional 4-week online resource program for patients ("MyHealthPortal"). First, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit-General was implemented, and all clinicians and staff were educated about the center's personal health record and patient portal. Then general patient education was initiated, while a randomized controlled trial was conducted to test the preliminary effects of "MyHealthPortal" using a small sample (n = 74) with three observations (baseline and 4 and 12 weeks). The intervention group showed significantly greater improvement than the control group in patient-provider communication at 4 weeks (t56 = 3.00, P = .004). For other variables, the intervention group tended to show greater improvement; however, the differences were not significant. In this preliminary study, Patient-Centered Personal Health Record and Patient Portal Implementation Toolkit showed potential for filling the gap in the current personal health record and patient portal implementation process. Further studies are needed using larger samples in other settings to ascertain if these results are generalizable to other populations.

Primary Care Practice Reengineering and Associations With Patient Portal Use, Service Utilization, and Disease Control Among Patients With Hypertension and/or Diabetes.

We describe the role of primary care reengineering in the Ochsner Health System (OHS) patient portal implementation strategy and compare subsequent trends in service utilization and disease control among portal users vs nonusers within this context. This retrospective cohort study includes 101,019 patients with hypertension or diabetes who saw an OHS primary care provider (PCP) between 2012 and 2014. Inverse probability treatment weighting was used to reduce case-mix differences between study groups. We used generalized estimating equation modeling to compare changes in encounter rates (PCP, telephone, specialty services, emergency department [ED], inpatient hospitalization), blood pressure (BP), and hemoglobin A1c (HbA1c). Age, sex, race, comorbidities, insurance, preindex utilization, and portal use were associated with changes in utilization, BP, and HbA1C; however, the strength and direction of these differences varied. An adjusted analysis comparing portal users to nonusers showed an increase in PCP (rate ratio per patient per year of 1.18, 95% confidence interval [CI] 1.14-1.22) and telephone encounter rates (1.15, 95% CI 1.08-1.22; both P<0.001) but no significant differences in specialty, ED, or inpatient hospitalization encounters. Among patients with preindex systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, portal users compared to nonusers had a greater decline in their BP, although the between-group difference was small (mmHg [SE], -1.1 [0.42] and -1.2 [0.34], respectively; both P<0.01). Portal users with diabetes compared to nonusers with diabetes also had greater decreases in HbA1c (all patients, % [SE], -0.13 [0.06]; patients with a preindex HbA1c ≥8, -0.43 [0.13], both P<0.05). Our findings may reflect patient factors and system-level portal implementation strategies that focused heavily on accessibility to care.

Meaningful use in the safety net: a rapid ethnography of patient portal implementation at five community health centers in California.

US 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. Our 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). Our 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. Health 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. We found a mismatch between MU-based metrics of patient engagement and the priorities and needs of safety net patient populations.

Open Data Portal Based on Collaborative Sharing in Visualizing Health Information

Data openness is one of the government policy focuses in many countries. In Indonesia, this can be seen in Laws no. 14/2008 on Public Information Openness. On the other hand, open data in Indonesia is still difficult to find, obtain and reprocessed by public. This is shown by the position of Indonesia that considered low in global ranking. Furthermore, health data is very important in research and development of science. In this paper, we present a national open health data portal based on collaborative sharing that expected to improve the potential use of health data by public. This portal focuses on representing and visualizing open health data and considering other aspects, namely data license, data formats, data description and data sensitivity. The main features of this portal are data search, data visualization, data access and data sharing. The methodology of this research consists of several stages: requirement analysis, the collection and categorization of data, portal design, portal implementation, and testing and evaluation. In this case, we collected the sample of health data that are obtained indirectly from some of credible and reliable sources such as Ministry of Health, Republic of Indonesia (pusdatin.kemkes.go.id) and the Indonesia Data Portal (data.go.id). The expected benefit of this study for public is improving accessibility to open data in Indonesia especially health data where people can find, obtain and share accurate health data with ease.

Healthcare Team Perceptions of a Portal for Parents of Hospitalized Children Before and After Implementation.

Patient electronic health record (EHR) portals can enhance patient and family engagement by providing information and a way to communicate with their healthcare team (HCT). However, portal implementation has been limited to ambulatory settings and met with resistance from HCTs. We evaluated HCT perceptions before and 6-months after implementation of an inpatient EHR portal application on a tablet computer given to parents of hospitalized children. This repeated cross-sectional study was conducted with HCT members (nurses, physicians, ancillary staff) on a medical/surgical unit at a quaternary children's hospital. From December 2014-June 2015, parents of children <12 years old were given a portal application on a tablet computer. It provided real-time vitals, medications, lab results, schedules, education, HCT information and a way to send the HCT messages/requests. HCT members completed surveys pre- and post-implementation regarding their portal perceptions. Pre-post differences in HCT perceptions were compared using chi-squared, Mann-Whitney and Kruskall Wallis tests. Pre-implementation, HCT respondents (N=94) were generally optimistic about the benefits of a portal for parents; however, all anticipated challenges to portal use. Over the next 6-months, 296 parents used the portal, sending 176 requests and 36 messages. Post-implementation, HCT respondent (N=70) perceptions of these challenges were significantly reduced (all p<0.001), including: parents (will) have too many questions (69 vs. 3%, pre-post), parents (will) know results before the HCT (65 vs. 1%), staff (would be/are) skeptical (43 vs. 21%) and there (will be/is) not enough technical support (28 vs. 1%). All HCT respondents anticipated challenges in providing a portal to parents of hospitalized children; however, these concerns were minimized after implementation.

Encouraging patient empowerment in a general hospital using e-Health

Contribution and responsibility of patients in the area of patient safety is encouraged by the Dutch government.Technology has provided the means to give the patient better access to health care information. The role of the patient is changing. In the past health care providers had a more paternal approach (the patient does exactly what(ever) the doctor says), whereas nowadays the doctor and patient make decisions together. Furthermore, people are starting to organize their own health care. Health care providers offer expertise and support instead of making decisions for the patients. (VWS,2014)As an answer to this different approach, the Jeroen Bosch Hospital has developed several actions.Joost van de Mortel (2013) made it clear with a qualitative research (N=13) the hospital (community) is open to the application of patient empowerment and already applies it, consciously or subconsciously. Despite the good intentions, there are misconceptions regarding patient empowerment that obstruct proper application. In the organization the structure, applied systems and the lack of a management model in which patient empowerment is central, prevent full implementation of patient empowerment.In a consecutive study Jean Marc Reinold (2014) made an inventory which functionalities in a patient portal (“An online gateway that gives the patient control in gathering and sharing information about their health through multiple websites and / or functionalities”) would contribute to ‘patient empowerment’.Besides an extensive literature review, the researcher has gathered information by means of a questionnaire (168 patients, a 95% reliable sample), focus group discussion with 7 patients and the result of a Digi panel inquiry (50% of the 150 panel members i.c. patients responded) of the Jeroen Bosch Hospital (JBZ).The research made clear the patients want to have direct access to their complete medical record, including lab results, research results and imagery. The function ‘inspection of medical records’ makes it possible to take more control of their own treatment (patient empowerment). Besides seeing their medical records the patients of the JBZ want to be able to make several (combined) appointments themselves and to have the possibility of email correspondence with their own doctor. The real empowering ability of a patient portal has to do with the attitude of the doctor and his patient to move towards dialogue and cooperation.This means that in addition to the practical development and implementation of the portal, now in progress after the deployment of the Electronic Patient File (EPF), the strategic reasons for the use of the portal need to be promoted and spread within the organization.To implement the portal successfully within the organization some misunderstandings among the staff has to be resolved:- the abilities of the patients regarding eHealth are sufficient in general and still developing,- the exact content of the patient portal (test-results, images, diagnosis/reports, treatment plan) by using a demo,- the influence on the work processes and financial consequences .Further staff training and a helpdesk should facilitate the implementation.Direct active involvement in the development and implementation of the patient portal of motivated patients will contribute to increasing support and will have a positive marketing effect.Use of e-Health and patient empowerment is a powerful combination. Technology and most patients are ready, a lot of professionals in health care in the Netherlands are positive on patient empowerment and are using e-Health fragmented.Barriers to implement are merely the absence of a clear policy of the organization, the organizational structure, the systems, the skills and attitude of a minority of the professionals and the adjustment of the system of financial compensation (a negotiation with the insurance companies is necessary to compensate digital interaction with the patient).In a presentation the impact and outcomes of several actions to improve patient empowerment and e-Health (project Digital Working) within the Jeroen Bosch Hospital and developments on the implementation of eHealth in the Netherlands can be shared.

Accelerating Intercommunication in Highly Parallel Systems

Every HPC system consists of numerous processing nodes interconnect using a number of different inter-process communication protocols such as Messaging Passing Interface (MPI) and Global Arrays (GA). Traditionally, research has focused on optimizing these protocols and identifying the most suitable ones for each system and/or application. Recently, there has been a proposal to unify the primitive operations of the different inter-processor communication protocols through the Portals library. Portals offer a set of low-level communication routines which can be composed in order to implement the functionality of different intercommunication protocols. However, Portals modularity comes at a performance cost, since it adds one more layer in the actual protocol implementation. This work aims at closing the performance gap between a generic and reusable intercommunication layer, such as Portals, and the several monolithic and highly optimized intercommunication protocols. This is achieved through the development of a novel hardware offload engine efficiently implementing the basic Portals’ modules. Our innovative system is up to two2 orders of magnitude faster than the conventional software implementation of Portals’ while the speedup achieved over the conventional monolithic software implementations of MPI and GAs is more than an order of magnitude. The power consumption of our hardware system is less than 1/100th of what a low-power CPU consumes when executing the Portal's software while its silicon cost is less than 1/10th of that of a very simple RISC CPU. Moreover, our design process is also innovative since we have first modeled the hardware within an untimed virtual prototype which allowed for rapid design space exploration; then we applied a novel methodology to transform the untimed description into an efficient timed hardware description, which was then transformed into a hardware netlist through a High-Level Synthesis (HLS) tool.

Parent Perspectives on the Implementation of a Digital Documentation Portal in an Early Learning Centre

THE TRANSFER FROM PAPER-BASED systems to digital documentation portals is revolutionising how information is delivered to parents in early childhood education and care settings. This study used a mixed-method approach to document the implementation and use of a digital portal in a large early learning centre from the perspectives of parents. Findings revealed a number of concerns for parents such as privacy, ethical use of images, storage of data and documentation content. However, the significant uptake of the portal by parents, attributed to a desire for greater connections with their child and with other parents, and the facilitation of these connections via the digital portal, was a key finding of this study.

Patient Portals in Child and Adolescent Psychiatry.

Utilization of patient portals in the child and adolescent population presents an exciting and somewhat complex opportunity for providers and young patients. This article summarizes the limited information currently available in the literature about child and adolescent patient portals. The concept and implementation of patient portals are discussed in detail. Data referencing provider, parent, and young patient opinion regarding patient portals are discussed. Important considerations regarding confidentiality and adherence to federal, state, and local regulations, as well as potential institution level solutions are presented. Potential problems and benefits of utilizing patient portals for child and adolescent psychiatric populations are discussed.

Knowledge, Workflow and Electronic Document Management in the System of the State Nuclear Regulatory Inspectorate of Ukraine. Preparing the Platform, Deployment and Implementation of the Knowledge Portal

The previous paper considered the creation of the system for management of nuclear knowledge, workflow and electronic documents (hereinafter called the Knowledge Portal) in the field of safe nuclear energy use. It presented initial steps needed to make an informed decision on the feasibility of implementing the Knowledge Portal and proposed methodological approaches based on practical experience of the State Nuclear Regulatory Inspectorate of Ukraine and the SSTC NRS. Further pre-project activities of the state body, local authorities, enterprises, institutions and organizations irrespective of ownership (hereinafter called the Institution) involve the development and drawing attention to the package of analytical, technical and feasibility documents. In particular, it is recommended to take into account the results of analyzing world trends in the development of information technology, audit status information and telecommunication systems (hereinafter — ITS) of the Institution, detailed strategy for the development of ITS Institution (hereinafter — the Strategy), the concept of the Knowledge Portal (hereinafter - the Concept) and preliminary technical solution.&#x0D; The results of review and approval of the Concept and architecture solution by scientific and technical council of the Institution is the basis for the preparation of Terms of Reference (hereinafter — TOR) on the development of the Knowledge Portal, forming schedules for the procurement of hardware and software, works on the development and implementation of portal solutions and information security systems.&#x0D; These issues are the subject of this publication.

Towards a New Methodology for Web GIS Development

There has been an increasing need for geospatial information that is delivered through internet technologies. This broad category of systems is referred to as Web Geographic Information Systems (Web GIS). These systems exhibit characteristics common to both stand-alone and web-based systems making it necessary to apply a hybrid methodology during their development. This paper proposes a methodology for developing Web GIS that is herein referred to as the Y-Model Web GIS Development Methodology (YWDM) which has been adapted from existing software development methodologies and applied to the context of Web GIS development. The paper outlines in details the phases of the methodology. Its viability as a methodology has been tested through its use in the implementation of the Emuhaya Web GIS portal. The methodology presented here is not intended to be a rigid guide for web GIS development but instead it provides a useful framework for guiding the process.

Consumption of public institutions’ open data by Spanish citizens

The consumption practices of Spanish citizens of open data published by public institutions are evaluated, within the context of the implementation of the Transparency Portal in Spain. Through an online survey, representative of the studied universe, and through an analysis of descriptive statistics, contingency tables and association measures for nominal variables, the degree of awareness about the availability of open data offered by public bodies are compared, their use is described, and reasons for their use are identified. The results reveal low penetration of the open data culture, and citizen distrust of the actions carried out by public institutions for the access, use, and reuse of open data, which will require a change of orientation in communication and stimulation policies.

Implementing and using a patient portal: a qualitative exploration of patient and provider perspectives on engaging patients

BackgroundThe use of portals might be expected to rise; however, adoption has been slow. Development of portals has occurred with limited patient involvement. This paper fills a need for literature...

Acute care patient portals: a qualitative study of stakeholder perspectives on current practices

To describe current practices and stakeholder perspectives of patient portals in the acute care setting. We aimed to: (1) identify key features, (2) recognize challenges, (3) understand current practices for design, configuration, and use, and (4) propose new directions for investigation and innovation. Mixed methods including surveys, interviews, focus groups, and site visits with stakeholders at leading academic medical centers. Thematic analyses to inform development of an explanatory model and recommendations. Site surveys were administered to 5 institutions. Thirty interviews/focus groups were conducted at 4 site visits that included a total of 84 participants. Ten themes regarding content and functionality, engagement and culture, and access and security were identified, from which an explanatory model of current practices was developed. Key features included clinical data, messaging, glossary, patient education, patient personalization and family engagement tools, and tiered displays. Four actionable recommendations were identified by group consensus. Design, development, and implementation of acute care patient portals should consider: (1) providing a single integrated experience across care settings, (2) humanizing the patient-clinician relationship via personalization tools, (3) providing equitable access, and (4) creating a clear organizational mission and strategy to achieve outcomes of interest. Portals should provide a single integrated experience across the inpatient and ambulatory settings. Core functionality includes tools that facilitate communication, personalize the patient, and deliver education to advance safe, coordinated, and dignified patient-centered care. Our findings can be used to inform a "road map" for future work related to acute care patient portals.

Adoption of a Portal for the Primary Care Management of Pediatric Asthma: A Mixed-Methods Implementation Study.

BackgroundPatient portals may improve communication between families of children with asthma and their primary care providers and improve outcomes. However, the feasibility of using portals to collect patient-reported outcomes from families and the barriers and facilitators of portal implementation across diverse pediatric primary care settings have not been established.ObjectiveWe evaluated the feasibility of using a patient portal for pediatric asthma in primary care, its impact on management, and barriers and facilitators of implementation success.MethodsWe conducted a mixed-methods implementation study in 20 practices (11 states). Using the portal, parents of children with asthma aged 6-12 years completed monthly surveys to communicate treatment concerns, treatment goals, symptom control, medication use, and side effects. We used logistic regression to evaluate the association of portal use with child characteristics and changes to asthma management. Ten clinician focus groups and 22 semistructured parent interviews explored barriers and facilitators of use in the context of an evidence-based implementation framework.ResultsWe invited 9133 families to enroll and 237 (2.59%) used the portal (range by practice, 0.6%-13.6%). Children of parents or guardians who used the portal were significantly more likely than nonusers to be aged 6-9 years (vs 10-12, P=.02), have mild or moderate/severe persistent asthma (P=.009 and P=.04), have a prescription of a controller medication (P<.001), and have private insurance (P=.002). Portal users with uncontrolled asthma had significantly more medication changes and primary care asthma visits after using the portal relative to the year earlier (increases of 14% and 16%, respectively). Qualitative results revealed the importance of practice organization (coordinated workflows) as well as family (asthma severity) and innovation (facilitated communication and ease of use) characteristics for implementation success.ConclusionsAlthough use was associated with higher treatment engagement, our results suggest that achieving widespread portal adoption is unlikely in the short term. Implementation efforts should include workflow redesign and prioritize enrollment of symptomatic children.ClinicalTrialClinicaltrials.gov NCT01966068; https://clinicaltrials.gov/ct2/show/NCT01966068 (Archived by WebCite at http://www.webcitation.org/6i9iSQkm3)

한의 건강 지식의 공유를 위한 포털의 설계 및 구현

한의 건강 지식의 공유를 위한 포털의 설계 및 구현

Coordinating Systems of Care Using Health Information Technology: Development of the ADHD Care Assistant.

Perhaps the two principal venues for the delivery of mental health services are schools and primary care practices. Unfortunately, these systems of care are poorly connected, which may result in care that is fragmented and suboptimal. This article describes the development and implementation of an electronic health record portal, known as the ADHD Care Assistant, to facilitate the sharing of information between schools and primary care offices to promote the use of evidence-based practices for managing children with behavioral health conditions. A feasibility study was conducted across 19 diverse primary care practices with 105 participating providers. Across the practices, 67% of providers activated the system for at least one patient and 32% activated it for five or more cases. Care Assistant use was lower in practices with a relatively high percentage of Medicaid patients (≥ 25%). The article discusses challenges that have arisen among primary care providers, parents, and schools in using the Care Assistant, potential strategies for addressing the challenges, and directions for future research and practice.

Supporting Client and Family Engagement in Care Through the Planning and Implementation of an Online Consumer Health Portal.

Web-based portals and electronic health records are making it easier for clients and families to access health information. This improved transparency and access to information has the potential to promote activation and improve outcomes, but to realize these benefits, the information needs to be valuable, meaningful, and understandable. Engagement of the end users in the planning and implementation will ensure that the product meets the needs of the consumers. The purpose of this case study is to describe the client and family engagement strategies that were employed to support the process of planning and implementing an online consumer health portal at a pediatric rehabilitation hospital to support the successful launch of this new information-sharing technology platform.

Preferences of Current and Potential Patients and Family Members Regarding Implementation of Electronic Communication Portals in Intensive Care Units.

The quality of communication with patients and family members in intensive care units (ICUs) is a focus of current interest for clinical care improvement. Electronic communication portals are commonly used in other healthcare settings to improve communication. We do not know whether patients and family members desire such portals in ICUs, and if so, what functionality they should provide. To define interest in and desired elements of an electronic communication portal among current and potential ICU patients and their family members. We surveyed, via an Internet panel, 1,050 English-speaking adults residing in the United States with a personal or family history of an ICU admission within 10 years (cohort A) and 1,050 individuals without a history of such admission (cohort B). We also administered a survey instrument in person to 105 family members of patients currently admitted to ICUs at an academic medical center in Boston (cohort C). Respondents, especially current ICU family members, supported an electronic communication portal, including access via an electronic tablet. They wanted at least daily updates, one-paragraph summaries of family meetings including a list of key decisions made, and knowledge of the role and experience of treating clinicians. Overall, they preferred detailed rather than "big picture" information. Respondents were generally comfortable sharing information with their family members. Preferences regarding a communication portal varied significantly by age, sex, ethnicity, and prior experience with ICU hospitalization. Electronic communication portals appear welcome in contemporary ICUs. Frequent updates, knowledge about the professional qualifications of clinicians, detailed medical information, and documentation of family meetings are particularly desired.