Use Of Portal Research Articles

Patient Portal Use during Home Health Care at an Academic Health System

ObjectivesTo characterize patient portal use among older adults receiving skilled home health (HH) care. DesignRetrospective cohort study. Setting and ParticipantsOlder adults (aged ≥65 years) who received HH care from a large, academic health system between 2017 to 2022 (n = 8409 HH episodes provided to n = 4878 unique individuals). MethodsWe captured individual and HH episode characteristics from the electronic health record and identified specific types and dates of portal use for those with an active patient portal. We calculated the proportion of episodes in which patients engaged in specific patient portal activities (eg, viewing test results, managing appointments, sending messages). We used multivariable logistic regression to model the odds of engaging in each activity as a function of patient and episode characteristics, and charted the timing of patient portal activities across the 60-day HH episode. ResultsThe patient portal was used by older adults in more than half (58%) of the episodes examined. Among those using their portal account during an HH episode, 84% viewed test results, 77% managed an existing appointment, 72% managed medications, and 55% sent a message to a provider. Adjusted odds of portal use were higher among HH patients who were married (aOR: 1.77, P < .001), receiving HH post-COVID pandemic (aOR: 2.73, P < .001), and accessing HH following a hospitalization (aOR: 1.30, P < .001) and lower among those who were Black compared with white (aOR: 0.52, P < .001). Portal use, particularly viewing test results and clinical notes and managing existing appointments, was highest during the first 10 days of an HH episode, especially among patients referred following a hospitalization. Conclusions and ImplicationsHH patients use the patient portal to perform care management tasks and access clinical information. Study findings support opportunities to harness the patient portal to bridge information gaps and care coordination during HH care.

Chronic Health Conditions and Patient Portal Use in Caregivers of People With Alzheimer's Disease and Related Dementias.

This study aimed to investigate both chronic health conditions and the utilization of patient portals, focusing particularly on caregivers responsible for individuals with Alzheimer's disease and related dementias (ADRD). Data from the Health Information National Trends Survey 2018-2020 were analyzed, involving a sample of 304 family and unpaid caregivers of individuals with ADRD. Among caregivers of individuals with ADRD, 77.6% had at least one chronic disease. A significant proportion (46.6%) of ADRD caregivers had never accessed their patient portals. The limited utilization of patient portals among caregivers responsible for individuals with ADRD, particularly those with lower education, advanced age, and few chronic conditions, becomes apparent due to challenges associated with digital literacy and discomfort with computers. Recognizing the crucial role caregivers play for individuals with ADRD and their health risks, there's a need for tailored training to enhance their health management skills and caregiving capabilities.

Benchmarking usability of patient portals in Estonia, Finland, Norway, and Sweden

IntroductionPoor usability is a barrier to widespread adoption of electronic health records (EHR). Providing good usability is especially challenging in the health care context, as there is a wide variety of patient users. Usability benchmarking is an approach for improving usability by evaluating and comparing the strength and weaknesses of systems. The main purpose of this study is to benchmark usability of patient portals across countries. MethodsA mixed-methods survey approach was applied to benchmark the national patient portals offering patient access to EHR in Estonia, Finland, Norway, and Sweden. These Nordic countries have similar public healthcare systems, and they are pioneers in offering patients access to EHR for several years. In a survey of 29,334 patients, both patients’ quantitative ratings of usability and their qualitative descriptions of very positive and very negative peak experiences of portal use were collected. ResultsThe usability scores ranged from good to fair level of usability. The narratives of very positive and very negative experiences included the benefits of the patient portals and experienced usability issues. The regression analysis of results showed that very positive and negative experiences of patient portal use explain 19%-35% of the variation of usability scores in the four countries. The percentage of patients who reported very positive or very negative experiences in each country was unrelated to the usability scores across countries. ConclusionsThe survey approach could be used to evaluate usability with a wide variety of users and it supported learning from comparison across the countries. The combination of quantitative and qualitative data provided an approximation of the level of the perceived usability, and identified usability issues to be improved and useful features that patients appreciate. Further work is needed to improve the comparability of the varied samples across countries.

Feasibility of Telemedicine in the Management Strategy of Patients With Lymphoma Amid the COVID-19 Pandemic in Spain: Prospective Observational Study.

On March 14, 2020, a state of alarm was declared in Spain due to the spread of SARS-CoV-2. Beyond this date, COVID-19 in the country changed the practice of oncologic care. Since recurrent hospital visits were a potential risk factor for contagion, the aim of this prospective observational study was to analyze the consequences of the COVID-19 pandemic in the health care of patients with lymphoma. All data were obtained from the electronic medical record. Variables such as age, sex, reason of the visit, use of the patient portal, changes in management, enrollment in clinical trials, and COVID-19 infection were recorded. In all, 290 patients visited the lymphoma clinic, totaling 437 appointments. The median age was 66 (range 18-94) years, and 157 (54.1%) patients were male. Of them, 214 (73.8%) patients had only 1 visit to the clinic. Only 23 (7.9%) patients did not have access to the patient portal. Amid the COVID-19 pandemic, 78 (26.9%) patients remained in active treatment, 35 (12.1%) experienced delays in their treatments, and 6 (2.1%) experienced treatment discontinuation. During the follow-up, only 7 (2.4%) patients had a COVID-19 infection (6 cases with confirmed polymerase chain reaction test and 1 case with clinical suspicion). Despite the implementation of telemedicine strategies to avoid visits to the hospital, 66 (22.8%) patients had in-person visits at the lymphoma clinic. Patients who attended in-person consultations were younger than those who preferred telemedicine consultations (62 vs 66 years; P=.10) and had less use of the patient portal (17/224, 7.6% vs 6/66, 9%; P=.10), although these differences did not reach statistical significance. Patients who attended in-person visits were more likely to have had only 1 visit to the hospital (29/66, 43.9% vs 185/224, 82.6%; P<.001). Regarding the reason of in-person consultations, more patients were on active treatment in comparison to those using telemedicine resources (37/66, 56.1% vs 42/224, 18.3%; P<.001). Patients with a preference for telemedicine strategies had more surveillance visits (147/224, 65.6% vs 24/66, 36.4%; P<.001). Regarding treatment modifications, more treatment delays (29/224, 12.9% vs 6/66, 9.1%; P=.10) and more definite treatment discontinuations (6/224, 2.7% vs 0/66, 0%; P=.10) were seen in patients using telemedicine resources when compared to patients attending in-person visits, although these differences did not reach statistical significance. Regarding the type of therapy, patients attending in-person visits were more likely to receive an intravenous treatment rather than those using telemedicine (23/66, 62.2% vs 17/224, 40.5%; P<.001). Telemedicine such as patient portals are feasible strategies in the management of patients with lymphoma during the COVID-19 pandemic, with a reduction of in-person visits to the hospital and a very low contagion rate.

About two indicators of the school digital renewal process

The indicators of the process of digital technologies introduction (school digital renewal indicators) widely used today successfully capture the innovative processes that occur at the initial stages (levels) of digital renewal. At the stages of mature informatization and digital transformation, the changes associated with the expansion of the traditional classroom system and the transition to personalized and competency-based learning organization come to the fore.The authors propose two indicators that capture changes in the chronotope of study work and the teaching individualization level. The proposed indicators allow to reflect the dynamics of changes at the final stages of digital renewal. The use of school portals, which are being introduced at the final stages of digital renewal, provides conditions for assessing changes in the proposed indicators using digital traces, without contacting (surveys, questionnaires) the educational process participants.The development of bases, methods, and tools for calculating the proposed indicators is of theoretical and practical interest for solving the problems of managing the digital renewal of education at the final stages of this process.

The NORDeHEALTH 2022 Patient Survey: Cross-Sectional Study of National Patient Portal Users in Norway, Sweden, Finland, and Estonia.

Although many surveys have been conducted on patients accessing their own health records in recent years, there is a limited amount of nationwide cross-country data available on patients' views and preferences. To address this gap, an international survey of patient users was conducted in the Nordic eHealth project, NORDeHEALTH. We aimed to investigate the sociodemographic characteristics and experiences of patients who accessed their electronic health records (EHRs) through national patient portals in Norway, Sweden, Finland, and Estonia. A cross-sectional web-based survey was distributed using the national online health portals. The target participants were patients who accessed the national patient portals at the start of 2022 and who were aged ≥15 years. The survey included a mixture of close-ended and free-text questions about participant sociodemographics, usability experience, experiences with health care and the EHR, reasons for reading health records online, experience with errors, omissions and offense, opinions about security and privacy, and the usefulness of portal functions. In this paper, we summarized the data on participant demographics, past experience with health care, and the patient portal through descriptive statistics. In total, 29,334 users completed the survey, of which 9503 (32.40%) were from Norway, 13,008 (44.35%) from Sweden, 4713 (16.07%) from Finland, and 2104 (7.17%) from Estonia. National samples were comparable according to reported gender, with about two-thirds identifying as women (19,904/29,302, 67.93%). Age distributions were similar across the countries, but Finland had older users while Estonia had younger users. The highest attained education and presence of health care education varied among the national samples. In all 4 countries, patients most commonly rated their health as "fair" (11,279/29,302, 38.48%). In Estonia, participants were more often inclined to rate their health positively, whereas Norway and Sweden had the highest proportion of negative health ratings. Across the whole sample, most patients received some care in the last 2 years (25,318/29,254, 86.55%). Mental health care was more common (6214/29,254, 21.24%) than oncological care (3664/29,254, 12.52%). Overall, most patients had accessed their health record "2 to 9 times" (11,546/29,306, 39.4%), with the most frequent users residing in Sweden, where about one-third of patients accessed it "more than 20 times" (4571/13,008, 35.14%). This is the first large-scale international survey to compare patient users' sociodemographics and experiences with accessing their EHRs. Although the countries are in close geographic proximity and demonstrate similar advancements in giving their residents online records access, patient users in this survey differed. We will continue to investigate patients' experiences and opinions about national patient-accessible EHRs through focused analyses of the national and combined data sets from the NORDeHEALTH 2022 Patient Survey.

Abstract 12939: Friend or Foe: Increased Access to Care via Patient Portals

Background: Patient portals are secure online websites that grant patients access to their medical record. Portal use is associated with improved chronic disease management. Whether the use of patient portals is associated with cardiac outcomes is less well known and deserves further study. We examined the association of patient portal use with cardiac events among a large cohort of patients with CVD. We expected to find differences in portal use by sociodemographic info. We hypothesized that portal use would be negatively associated with cardiac events. Methods: De-identified data for adult patients meeting inclusion criteria were obtained between January 2018 and October 2021. The association of portal use with demographic factors was assessed using t-test and/or chi squared. Our primary outcomes were emergency department (ED) visit or all-cause readmission. We used a Cox model adjusting for demographic and clinical covariates at an alpha of 0.05. Results: The Table summarizes our findings. There was a significant difference in portal use by sex, race, ethnicity, English proficiency, and marital status. The Figure shows the adjusted findings that portal use was associated with higher hazards of ED visits and all-cause readmission at one year. Conclusions: Our data demonstrate that sociodemographic factors are associated with online patient portal use at a single institution. Contrary to our hypothesis, we found that portal use portends increased ED visits and hospitalization (lower event-free survival). These data suggest that patient portal access and closer clinician scrutiny may lead to increased health services utilization.

Abstract 18538: Results of a Self-Management Intervention to Improve Hypertension in Black Patients Using the Electronic Health Record Patient Portal

Introduction: Nearly half of American adults (47%) have hypertension (HTN), and non-Hispanic Black patients are disproportionately represented among those diagnosed (56% versus 48% for White, 46% for Asian, and 39% Hispanic adults). Models of care to reduce blood pressure for the Black patient population are not consistently implemented, in large part due to systemic and structural barriers to care. Hypothesis: The purpose of this study was to improve access to and use of digital education, skills for self-measured blood pressure (SMBP) monitoring, use of the electronic health record (EHR) patient portal, and blood pressure from baseline to 3 months in a cohort of Black Americans. Methods: A pre-post intervention design was used to evaluate the team-based, nurse-led intervention. Patients received coaching on HTN goals, screening for social determinants of health (SDOH), medication review, self-paced portal-based videos, and teach-back for BP cuff use. Post-implementation blood pressure (BP) and self-management (knowledge, cuff-use, patient portal use, and attendance at follow-up) were measured using the HELM tool, Chronic Care Model (CCM) and American Heart Association (AHA) HTN toolkit. 12-month follow-up is ongoing. Results: Black participants (n=80) averaged 59 (SD 10) years of age; most were female (n=58, 73%), employed (n=59, 75%), non-smokers (n=66, 84%), with average BMI 34.5 (SD8). From 0-3-months, views of portal-pushed videos increased to 69%, knowledge scores improved pre- (M = 67.9, SD = 16.7 to post (M = 75.2, SD = 17.4), and mean systolic BP was significantly reduced by 20.3mmHg (95%CI 16.11, 24.44). Average systolic BP pre was 152.13 (SD = 16.87) and post was 131.85 (SD = 13.13), t (79) = 9.71, p&lt; .001. Sustainability at 12-months is ongoing. Conclusions: A team-based, nurse-led model improves patient engagement, adoption of portal-prescribed education, skills for SMBP, EHR-reported BP, and visit follow-up for Black patients with uncontrolled BP.

Examining how information presentation methods and a chatbot impact the use and effectiveness of electronic health record patient portals: An exploratory study

ObjectivesExamining information presentation strategies that may facilitate patient education through patient portals is important for effective health education. MethodsA randomized exploratory study evaluated information presentation (text or videos) and a chatbot in patient education and examined several performance and outcome variables (e.g., search duration, Decisional Conflict Scale, and eye-tracking measures), along with a simple descriptive qualitative content analysis of the transcript of chatbot. ResultsOf the 92 participants, those within the text conditions (n = 46, p < 0.001), had chatbot experiences (B =−74.85, p = 0.046), knew someone with IBD (B =−98.66, p = 0.039), and preferred to engage in medical decision-making (B =102.32, p = 0.006) were more efficient in information-searching. Participants with videos spent longer in information-searching (mean=666.5 (SD=171.6) VS 480.3 (SD=159.5) seconds, p < 0.001) but felt more informed (mean score=18.8 (SD=17.6) VS 27.4 (SD=18.9), p = 0.027). The participants’ average eye fixation duration with videos was significantly higher (mean= 473.8 ms, SD=52.9, p < 0.001). ConclusionsParticipants in video conditions were less efficient but more effective in information seeking. Exploring the trade-offs between efficiency and effectiveness for user interface designs is important to appropriately deliver education within patient portals. Practice implicationsThis study suggests that user interface designs and chatbots impact health information’s efficiency and effectiveness.

Errors, Omissions, and Offenses in the Health Record of Mental Health Care Patients: Results from a Nationwide Survey in Sweden.

Previous research reports that patients with mental health conditions experience benefits, for example, increased empowerment and validation, from reading their patient-accessible electronic health records (PAEHRs). In mental health care (MHC), PAEHRs remain controversial, as health care professionals are concerned that patients may feel worried or offended by the content of the notes. Moreover, existing research has focused on specific mental health diagnoses, excluding the larger PAEHR userbase with experience in MHC. The objective of this study is to establish if and how the experiences of patients with and those without MHC differ in using their PAEHRs by (1) comparing patient characteristics and differences in using the national patient portal between the 2 groups and (2) establishing group differences in the prevalence of negative experiences, for example, rates of errors, omissions, and offenses between the 2 groups. Our analysis was performed on data from an online patient survey distributed through the Swedish national patient portal as part of our international research project, NORDeHEALTH. The respondents were patient users of the national patient portal 1177, aged 15 years or older, and categorized either as those with MHC experience or with any other health care experience (nonmental health care [non-MHC]). Patient characteristics such as gender, age, education, employment, and health status were gathered. Portal use characteristics included frequency of access, encouragement to read the record, and instances of positive and negative experiences. Negative experiences were further explored through rates of error, omission, and offense. The data were summarized through descriptive statistics. Group differences were analyzed through Pearson chi-square. Of the total sample (N=12,334), MHC respondents (n=3131) experienced errors (1586/3131, 50.65%, and non-MHC 3311/9203, 35.98%), omissions (1089/3131, 34.78%, and non-MHC 2427/9203, 26.37%) and offenses (1183/3131, 37.78%, and non-MHC 1616/9203, 17.56%) in the electronic health record at a higher rate than non-MHC respondents (n=9203). Respondents reported that the identified error (MHC 795/3131, 50.13%, and non-MHC 1366/9203, 41.26%) and omission (MHC 622/3131, 57.12%, and non-MHC 1329/9203, 54.76%) were "very important," but most did nothing to correct them (MHC 792/3131, 41.29%, and non-MHC 1838/9203, 42.17%). Most of the respondents identified as women in both groups. About 1 in 2 MHC patients identified an error in the record, and about 1 in 3 identified an omission, both at a much higher rate than in the non-MHC group. Patients with MHC also felt offended by the content of the notes more commonly (1 in 3 vs 1 in 6). These findings validate some of the worries expressed by health care professionals about providing patients with MHC with PAEHRs and highlight challenges with the documentation quality in the records.

Patient, Caregiver, and Physician Perspectives on Communication in Diagnosing and Treating Higher-Risk Myelodysplastic Syndromes: A Qualitative Study

Background: Although novel disease-modifying treatments for higher-risk myelodysplastic syndromes (HR-MDS) are emerging, current treatment options forpatients with HR-MDS are limited. This study sought to explore patients', caregivers', and hematology and oncology providers' perspectives on and experiences with patient-provider communication and its role in the diagnostic and treatment process in patients with HR-MDS. Methods: Qualitative, semi-structured interviews with patients with HR-MDS, caregivers to patients with HR-MDS, and board-certified oncologists and/or hematologists managing patients with HR-MDS in the United States. Participants were recruited through the MDS Foundation constituency and through a survey vendor partner. Thematic analysis was used to identify key factors associated with the role and impact of communication between patients, caregivers, and providers. Results: Eight patients (mean age = 68.1 years, 50% male, 88% White, 88% suburban), 6 caregivers (mean age = 64.3 years, 83% female, 100% White, 83% suburban), and 18 providers (mean age = 52.6 years, 78% male, 67% &amp;gt;10 years of clinical practice, 50% urban, 61% treated &amp;gt;10 patients with HR-MDS in past year) participated in the study. During the diagnostic workup phase, patients and caregivers described communication as limited and stated that they had not been provided with adequate information or educational resources about HR-MDS that could inform decision-making. They reported a significant lack of knowledge about the condition, their prognosis, and available treatment options. Lack of provider communication and inadequate education about HR-MDS was also viewed as a treatment barrier itself, in addition to treatment access, logistical barriers, and lack of support by a caregiver. Some patients and caregivers felt that without adequate knowledge about HR-MDS, they could not ask appropriate questions, while others reported being content with “not knowing” and relying solely on provider recommendations. Having additional education around HR-MDS was viewed as allowing patients to better articulate their preferences during treatment decision-making. Conversely, providers in the study reported consistently accounting for patient preferences when making treatment recommendations. Providers reported tailoring their communication approach to each patient and seeking equipoise when needing to adequately explain the seriousness of the condition without instilling panic or diminishing hope. However, they also noted variability in willingness to engage in decision-making among their patients with HR-MDS, attributing active participation mediated by patient age, education and health literacy level, and cultural background. Providers described struggling with making treatment recommendations (due to a current lack of effective treatment options) for their patients with HR-MDS as the most significant treatment barrier, further compounded by challenges in explaining the nuances of HR-MDS treatment to patients. Strong and continuous communication between the patient, caregiver, and clinical care team, along with the availability of resources to facilitate timely communication and education, such as telehealth options and patient portals, were viewed as facilitators by patients and caregivers. Providers noted that nurse navigators, social workers, patient assistance programs, patient advocates, and educational materials were key facilitators in improving patient-provider decision-making and patient outcomes. Conclusion: While strong patient-provider communication is desired by patients, caregivers, and providers, and can be a catalyst for educated treatment preferences, uncertainty exists around how to best involve patients in HR-MDS treatment decisions. When patients present with lower health literacy, lack of desire to be involved in decision-making, or a preference for a provider-guided decision, providers struggle to find the right balance of education and information provision. As novel therapies emerge and treatment options expand for patients with HR-MDS, it is imperative to further develop and evaluate educational materials for patients with HR-MDS delivered via novel technological methods, facilitate the use of telehealth and patient portals, and ensure patient navigation of resources to support patient-provider communication.

Disparities in electronic health record portal access and use among patients with cancer.

Electronic health record-linked portals may improve health-care quality for patients with cancer. Barriers to portal access and use undermine interventions that rely on portals to reduce cancer care disparities. This study examined portal access and persistence of portal use and associations with patient and structural factors before the implementation of 3 portal-based interventions within the Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium. Portal use data were extracted from electronic health records for the 12 months preceding intervention implementation. Sociodemographic factors, mode of accessing portals (web vs mobile), and number of clinical encounters before intervention implementation were also extracted. Rurality was derived using rural-urban commuting area codes. Broadband access was estimated using the 2015-2019 American Community Survey. Multiple logistic regression models tested the associations of these factors with portal access (ever accessed or never accessed) and persistence of portal use (accessed the portal ≤20 weeks vs ≥21 weeks in the 35-week study period). Of 28 942 eligible patients, 10 061 (35%) never accessed the portal. Male sex, membership in a racial and ethnic minority group, rural dwelling, not working, and limited broadband access were associated with lower odds of portal access. Younger age and more clinical encounters were associated with higher odds of portal access. Of those with portal access, 25% were persistent users. Using multiple modalities for portal access, being middle-aged, and having more clinical encounters were associated with persistent portal use. Patient and structural factors affect portal access and use and may exacerbate disparities in electronic health record-based cancer symptom surveillance and management.

Patient engagement with a portal-based symptom management program across six health systems.

351 Background: Collecting patient-reported outcomes (PROs) improves quality of life and self-efficacy, reduces acute care needs, and extends survival for cancer patients. Prior studies evaluating the efficacy of PROs have often relied on unrepresentative populations seen at well-resourced health systems and treated in controlled settings. As a result, widespread PRO implementation has not been achieved. We sought to study the reach of an electronic PRO-based, EHR-integrated symptom management system (eSyM) that was deployed in routine clinical practice across six diverse health systems. Methods: All patients receiving medical oncology (MO) or surgical (SURG) care for a confirmed or suspected gastrointestinal, gynecologic, or thoracic malignancy were invited to use eSyM – a patient portal-based tool that asks patients to respond to symptom questionnaires, provides symptom management resources, and fosters patient-clinician communication. Study outcomes included any portal use, sending a message via the portal, and completing an eSyM symptom questionnaire via the portal. Spearman coefficients were used to assess the correlation between portal message use and eSyM questionnaire completion. Multivariable logistic regression models were used to identify factors associated with completing at least one eSyM questionnaire. Results: From September 2019 to March 2023, 9589 MO and 13,297 SURG patients had access to eSyM. Patient characteristics and usage rates were analyzed [Table]. Among portal users, most patients accessed it via the web app only, with 39.2% of MO and 42.6% of SURG patients accessing it via both the web and mobile apps. Correlations between message use and questionnaire use were moderate (0.48 for MO, 0.43 for SURG). Notably, 17.9% of MO and 21.7% of SURG patients sent a portal message but did not submit an eSyM questionnaire. Factors associated with lower odds of eSyM questionnaire completion for both the MO and SURG cohorts included: older age, male sex, Black race, Medicaid insurance, and being single, widowed, or disabled. Conclusions: In a diverse patient population from six community-based cancer centers, over 80% used the portal for any reason, over 58% sent a message, and over 46% submitted at least one eSyM questionnaire. Strategies that improve patient engagement and ameliorate disparities with ePRO-based programs are needed. Some eSyM non-responders never used the portal, whereas others used the portal for different reasons, suggesting that technical and non-technical barriers to ePRO programs exist.[Table: see text]

“A double-edged sword”: Influence of the 21st Century Cures Act on the childhood cancer care experience.

360 Background: The 21st Century Cures Act allows patients to immediately access their electronic health record (EHR) via an online portal. For pediatric patients with cancer and their families, this federal mandate has profound implications. We sought to explore perspectives of key stakeholders on how the Cures Act influences the childhood cancer care experience, receipt of results, and communication with the oncology team. Methods: In a multi-center qualitative study at three National Cancer Institute-designated comprehensive cancer centers, we conducted semi-structured interviews with adolescent and young adult patients with cancer (n=26), parents of children with cancer (n=32), and interdisciplinary clinicians in pediatric oncology (n=23). Interviews were audio-recorded, transcribed verbatim, coded, and thematically analyzed. Results: Across 81 participants, 73% self-identified as women, 69% as White race, and 17% as Hispanic/Latinx ethnicity. Most patients and parents perceived the EHR portal to be a convenient, centralized record-keeping tool that enables them to prepare for appointments, track treatment progress, and assume greater agency in their cancer care. Many patients and parents preferred the immediacy of the portal to bypass wait times and facilitate real-time decision-making. Access to notes and results on the portal was widely perceived to enhance communication and appeared to engender greater trust in the oncology team. Simultaneously, patients and parents acknowledged that instant access to results laden with medical jargon can heighten confusion, worry, and anger, particularly upon receipt of concerning results (i.e., pathology or radiology results revealing a new diagnosis of cancer or relapse) before meeting with a clinician. Clinicians generally favored the EHR portal and reported adapting their practices to provide greater anticipatory guidance, occasionally altering language in clinical notes to avoid upsetting patients or families. However, several clinicians expressed concern about situations in which high-stakes results are instantly available to patients and the responsible clinician has not yet had an opportunity to interpret and discuss. Clinicians spoke of shifting expectations regarding prompt communication of results. Many clinicians would prefer a system in which a time delay is built into the release of particularly sensitive results. Overall, clinicians reported that the EHR portal may increase administrative burden and interfere with clinical workflow. Conclusions: While key stakeholders recognize that the Cures Act offers important patient-centered innovations, many participants identified challenges that impede on optimal implementation. This study underscores the need to establish best practices for integrating use of the EHR portal into routine childhood cancer care.

News portals as a gateway to civic engagement: the case of South Korea

Applying the communication mediation model and the communication infrastructure theory in the Korean news media environment, the current study investigates the potential of news portals as a gateway to civic engagement through online discussion. Specifically, this study distinguishes the active use of news portals for information about community issues and public affairs (e.g. commenting, passing along and searching for information) from the passive use of news portals (i.e. simple reception of information). An analysis of a national survey of 1294 Korean adults shows that active, not passive, use of news portals positively predicts online community discussion to subsequently increase cognitive, psychological, and behavioral dimensions of civic engagement: neighborhood belonging, collective efficacy, and civic participation. Importantly, active portal use's indirect positive relationship with civic engagement through online community discussion is stronger among people with higher news portal credibility. Implications are further discussed in the context of Korean news portals.

Modelling distance education students’ satisfaction and continuous use intention of students’ portal: An importance-performance map analysis

Many higher educational institutions offering distance education provide their students with electronic portals to manage their academic information and activities, as well as obtain feedback from students to management for decision-making towards improvement. However, satisfaction with the use of students’ portals remains a challenge to distance education students especially in mandatory environments where students are obliged to use the portal. However, there is also a lack of empirical evidence on the effects of portal functionality and portal information display on the easiness of use of students’ portal and portal system performance leading to satisfaction, in the literature. Accordingly, this study aims to unravel the determinants of students’ satisfaction and their continuous use intentions of portal systems. In view of this, a quantitative approach based on an exploratory sequential mixed-method design was adopted. Questionnaires were used to collect the main data from 1409 students selected through a cluster sampling technique after an initial interview guide was used for focus group discussions. Data collected were analysed using both the descriptive and Partial Least Squares-Structural Equation Modelling (PLS-SEM) techniques. Findings from the analysis revealed that portal functionality and portal information display were antecedents of portal ease of use: and portal system performance. Additionally, portal system ease of use, portal system functionality, portal system information display and portal system performance determined portal system use satisfaction. Furthermore, portal use satisfaction is a prelude to students’ continuous use intentions. Finally, the most important antecedent to student portal use satisfaction was portal system performance. These findings provide valuable insights for institutions seeking to enhance the performance of portal systems for their students. Based on the findings, recommendations were made for policy and practice towards the provision and management of student portals in distance education delivery.

Linkage of Digitalization and Perceived Organizational Performance of Small and Medium Enterprises

The purpose of this empirical research is to assess the impact of digitalization on perceived organisational performance in all areas of Small and Medium Enterprises (SMEs) in India’s rubber products manufacturing industry. The study employs a quantitative research method with an explanatory research design. The study’s primary data is gathered through surveys of top-level officials and IT managers from SMEs in the rubber products manufacturing industry. The normality and reliability of the data are assessed first using SPSS 22, followed by assessments of internal consistency, divergent validity, convergent validity, and discriminant validity using maximum likelihood estimation of the CFA. The structural equation modelling approach was chosen as the statistical instrument that enables researchers to look at complex interactions between several variables in parallel based on the nature of the research questions, the data that are available, and the theoretical underpinnings of the study. It is identified through this study that major digital technology measures such as Usefulness of Web Portals (UWP), Customer Interface through Web Portals (CIWP), and Major Functionalities of Web Portal (MFWP), Use of Online Activities in Marketing Efforts (OAME), Online Advertisements and Promotion (OAP), Availability of Trained and Skilled Employees (ATSE), and Technological Resources (TR) have a statistically significant impact on the performance of SMEs. The study results provide policymakers with insights into how to provide special incentives and exemplary services to SMEs in order to promote the digitalization in the rubber products manufacturing industry. This study expands the scope of the investigation of the adoption and diffusion of digital technology by measuring the impact of a broad range of digital technologies on SMEs.

Internet use in small tourism in Italy: what will be the role of local government?

PurposeThe digital revolution is causing profound transformations, characterised by the way companies and customers approach the market, helping to significantly transform the tourism sector. The aim of this study is to investigate how small hospitality businesses use internet in terms of marketing.Design/methodology/approachAfter analyzing the literature, which concerns the relationship that has gradually developed over the years between small businesses in the tourism sector and the use of the internet, it was decided to carry out an empirical survey conducted among the subjects managing micro-activities in the hospitality sector. The research hypothesis is that the adoption of the website is conditioned by the size of the company and the type of experience one has with small businesses.FindingsThe results show how small hospitality businesses make limited use of booking portals and social networks, and it emerges how digital marketing policies are crucial to achieve success, both in Italy and abroad.Originality/valueIt is believed that this work can provide useful insights that can be useful for the local government, aimed at promoting a greater ability of small businesses to participate more actively in the competition.

An Emerging Adults’ Patient Portal Behavioral Model: Integrating Perceived Risk Theory, Technology Acceptance Model, and Personal Innovativeness

Health information technology provides patients the ability to manage their healthcare through patient portals. Such portals increase patient involvement, self-management, and satisfaction. Despite their benefits, patient portal adoption and usage remain low, especially among emerging adults who are newly self-managed. To investigate the behavioral intentions of emerging adults toward adopting and using patient portals, this study builds upon the Technology Acceptance Model, Perceived Risk Theory, and Personal Innovativeness. A survey was administered to emerging adults aged 18-29, and structural equation modeling was used to assess the posited model’s fit. Results show the importance of developing practical insights and strategies to overcome resistance behavior. Additionally, the research found that personal innovativeness plays a significant role in adoption and usage intention. These findings extend the literature by highlighting the specific needs of emerging adults regarding patient portal adoption and utilization. The study underscores the importance of providing guidance, training, and awareness programs.

Characterization of patient portal messaging use and content among a pediatric atopic dermatitis population: A cross-sectional study

Characterization of patient portal messaging use and content among a pediatric atopic dermatitis population: A cross-sectional study