Download PDF
Appl Clin Inform 2018; 09(01): 174-184
DOI: 10.1055/s-0038-1632396
Review Article
Schattauer GmbH Stuttgart

Focus Section Health IT Usability: Applying a Task-Technology Fit Model to Adapt an Electronic Patient Portal for Patient Work

Sana B. Ali
,
Juana Romero
,
Kevin Morrison
,
Baria Hafeez
,
Jessica S. Ancker
 Funding This study was supported by AHRQ K01 HS021531 (Ancker, principle investigator).
Further Information

Publication History

05 July 2017

08 January 2018

Publication Date:
14 March 2018 (online)

   Permissions and Reprints

Abstract

Objectives Although electronic patient portals are offered by most health care organizations, poor usability and poor fit to patient needs may pose barriers to adoption. We collaborated with an academic hospital to conduct iterative user evaluation of a newly deployed portal designed to deliver inpatient data upon hospital discharge.

Methods Three evaluators applied heuristic usability evaluation and conducted 23 individual user testing sessions with patients with chronic disease or managing the care of family members with chronic disease. Evaluation and development/improvement were conducted iteratively. User testing and analysis of qualitative data were both conducted from the perspective of a task-technology fit framework, to assess the degree of fit between the portal and patient work.

Results Ability to complete health information management tasks, perceived usability, and positive comments from users improved over the course of the iterative development. However, patients still encountered significant difficulties accomplishing certain tasks such as setting up proxy accounts. The problems were most severe when patients did not start with a clear understanding of tasks that they could accomplish. In exploring the portal, novice users frequently described anecdotes from their own medical history or constructed fictional narratives about a hypothetical patient.

Conclusion Chronic illness imposes a significant workload on patients, and applying a task-technology framework for evaluation of a patient portal helped improve the portal's fit to patient needs. However, it also revealed that patients often lack a clear understanding of tasks that would help them accomplish personal health information management. Portal developers may need to educate patients about types of patient work involving medical centers, in a way that developers of clinical information systems do not need to do. An approach to doing this might be to provide narratives about hypothetical patients.

Keywords

electronic patient portal - health information management - chronic disease - workload - usability - task-technology fit

Protection of Human and Animal Subjects

This study was approved by the Weill Cornell Institutional Review Board.


 

  • References

  • 1 Blumenthal D. Stimulating the adoption of health information technology. N Engl J Med 2009; 360 (15) 1477-1479
    CrossrefPubMedGoogle Scholar
  • 2 Ancker JS, Hafeez B, Kaushal R. Socioeconomic disparities in adoption of personal health records over time. Am J Manag Care 2016; 22 (08) 539-540
    PubMedGoogle Scholar
  • 3 Ancker JS, Silver M, Kaushal R. Rapid growth in use of personal health records in New York, 2012-2013. J Gen Intern Med 2014; 29 (06) 850-854
    CrossrefPubMedGoogle Scholar
  • 4 Lin CT, Wittevrongel L, Moore L, Beaty BL, Ross SE. An Internet-based patient-provider communication system: randomized controlled trial. J Med Internet Res 2005; 7 (04) e47
    CrossrefPubMedGoogle Scholar
  • 5 Ammenwerth E, Schnell-Inderst P, Hoerbst A. The impact of electronic patient portals on patient care: a systematic review of controlled trials. J Med Internet Res 2012; 14 (06) e162
    CrossrefPubMedGoogle Scholar
  • 6 Wilcox LG, Gatewood J, Morris D, Tan DS, Feiner S, Horvitz E. Physician attitudes about patient-facing information displays at an urban emergency department. AMIA Annu Symp Proc 2010; 2010: 887-891
    PubMedGoogle Scholar
  • 7 Card RF. Critically Thinking about Medical Ethics. Upper Saddle River, NJ: Prentice Hall; 2004
    Google Scholar
  • 8 Cimino JJ, Patel VL, Kushniruk AW. What do patients do with access to their medical records?. Stud Health Technol Inform 2001; 84 (Pt 2): 1440-1444
    PubMedGoogle Scholar
  • 9 Collins SA, Vawdrey DK, Kukafka R, Kuperman GJ. Policies for patient access to clinical data via PHRs: current state and recommendations. J Am Med Inform Assoc 2011; 18 (Suppl. 01) i2-i7
    CrossrefPubMedGoogle Scholar
  • 10 Greenhalgh T, Wood GW, Bratan T, Stramer K, Hinder S. Patients' attitudes to the summary care record and HealthSpace: qualitative study. BMJ 2008; 336 (7656): 1290-1295
    CrossrefPubMedGoogle Scholar
  • 11 Hassol A, Walker JM, Kidder D. , et al. Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging. J Am Med Inform Assoc 2004; 11 (06) 505-513
    CrossrefPubMedGoogle Scholar
  • 12 Johnson KB. Project HealthDesign: advancing the vision of consumer-clinician-computer collaborations. J Biomed Inform 2010; 43 (5, Suppl): S1-S2
    CrossrefPubMedGoogle Scholar
  • 13 Kaelber DC, Jha AK, Johnston D, Middleton B, Bates DW. A research agenda for personal health records (PHRs). J Am Med Inform Assoc 2008; 15 (06) 729-736
    CrossrefPubMedGoogle Scholar
  • 14 Nazi KM, Hogan TP, Wagner TH. , et al. Embracing a health services research perspective on personal health records: lessons learned from the VA My HealtheVet system. J Gen Intern Med 2010; 25 (Suppl. 01) 62-67
    CrossrefPubMedGoogle Scholar
  • 15 Ralston JD, Carrell D, Reid R, Anderson M, Moran M, Hereford J. Patient web services integrated with a shared medical record: patient use and satisfaction. J Am Med Inform Assoc 2007; 14 (06) 798-806
    CrossrefPubMedGoogle Scholar
  • 16 Reti SR, Feldman HJ, Ross SE, Safran C. Improving personal health records for patient-centered care. J Am Med Inform Assoc 2010; 17 (02) 192-195
    CrossrefPubMedGoogle Scholar
  • 17 Tang PC, Lee TH. Your doctor's office or the Internet? Two paths to personal health records. N Engl J Med 2009; 360 (13) 1276-1278
    CrossrefPubMedGoogle Scholar
  • 18 Halamka JD, Mandl KD, Tang PC. Early experiences with personal health records. J Am Med Inform Assoc 2008; 15 (01) 1-7
    CrossrefPubMedGoogle Scholar
  • 19 Ricciardi L, Mostashari F, Murphy J, Daniel JG, Siminerio EP. A national action plan to support consumer engagement via e-health. Health Aff (Millwood) 2013; 32 (02) 376-384
    CrossrefPubMedGoogle Scholar
  • 20 Goldzweig CL, Orshansky G, Paige NM. , et al. Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review. Ann Intern Med 2013; 159 (10) 677-687
    CrossrefPubMedGoogle Scholar
  • 21 Simon GE, Ralston JD, Savarino J, Pabiniak C, Wentzel C, Operskalski BH. Randomized trial of depression follow-up care by online messaging. J Gen Intern Med 2011; 26 (07) 698-704
    CrossrefPubMedGoogle Scholar
  • 22 Lau M, Campbell H, Tang T, Thompson DJS, Elliott T. Impact of patient use of an online patient portal on diabetes outcomes. Can J Diabetes 2014; 38 (01) 17-21
    CrossrefPubMedGoogle Scholar
  • 23 McMahon GT, Gomes HE, Hickson Hohne S, Hu TM, Levine BA, Conlin PR. Web-based care management in patients with poorly controlled diabetes. Diabetes Care 2005; 28 (07) 1624-1629
    CrossrefPubMedGoogle Scholar
  • 24 Fowles JB, Terry P, Xi M, Hibbard J, Bloom CT, Harvey L. Measuring self-management of patients' and employees' health: further validation of the Patient Activation Measure (PAM) based on its relation to employee characteristics. Patient Educ Couns 2009; 77 (01) 116-122
    CrossrefPubMedGoogle Scholar
  • 25 Remmers C, Hibbard J, Mosen DM, Wagenfield M, Hoye RE, Jones C. Is patient activation associated with future health outcomes and healthcare utilization among patients with diabetes?. J Ambul Care Manage 2009; 32 (04) 320-327
    CrossrefPubMedGoogle Scholar
  • 26 Sarkar U, Karter AJ, Liu JY. , et al. The literacy divide: health literacy and the use of an internet-based patient portal in an integrated health system-results from the diabetes study of northern California (DISTANCE). J Health Commun 2010; 15 (Suppl. 02) 183-196
    CrossrefPubMedGoogle Scholar
  • 27 Sarkar U, Karter AJ, Liu JY. , et al. Social disparities in internet patient portal use in diabetes: evidence that the digital divide extends beyond access. J Am Med Inform Assoc 2011; 18 (03) 318-321
    CrossrefPubMedGoogle Scholar
  • 28 Ancker JS, Barrón Y, Rockoff ML. , et al. Use of an electronic patient portal among disadvantaged populations. J Gen Intern Med 2011; 26 (10) 1117-1123
    CrossrefPubMedGoogle Scholar
  • 29 Smith SG, O'Conor R, Aitken W, Curtis LM, Wolf MS, Goel MS. Disparities in registration and use of an online patient portal among older adults: findings from the LitCog cohort. J Am Med Inform Assoc 2015; 22 (04) 888-895
    CrossrefPubMedGoogle Scholar
  • 30 Goel MS, Brown TL, Williams A, Hasnain-Wynia R, Thompson JA, Baker DW. Disparities in enrollment and use of an electronic patient portal. J Gen Intern Med 2011; 26 (10) 1112-1116
    CrossrefPubMedGoogle Scholar
  • 31 Yamin CK, Emani S, Williams DH. , et al. The digital divide in adoption and use of a personal health record. Arch Intern Med 2011; 171 (06) 568-574
    CrossrefPubMedGoogle Scholar
  • 32 Greenspun H, Thomas S, Scott G, Betts D. Health Care Consumer Engagement No “one-size-fits-all” Approach. Washington, DC: Deloitte Center for Health Solutions; 2015
    Google Scholar
  • 33 DeLone WH, McLean ER. The Delone and McLean model of information systems success: a 10-year update. J Manage Inf Syst 2003; 19: 9-30
    CrossrefPubMedGoogle Scholar
  • 34 Preece J, Rogers Y, Sharp H, Benyon D, Holland S, Carey T. Human-Computer Interaction. Essex, United Kingdom: Addison-Wesley Longman Ltd.; 1994: 775
    Google Scholar
  • 35 Turvey C, Klein D, Fix G. , et al. Blue Button use by patients to access and share health record information using the Department of Veterans Affairs' online patient portal. J Am Med Inform Assoc 2014; 21 (04) 657-663
    CrossrefPubMedGoogle Scholar
  • 36 Haggstrom DA, Saleem JJ, Russ AL, Jones J, Russell SA, Chumbler NR. Lessons learned from usability testing of the VA's personal health record. J Am Med Inform Assoc 2011; 18 (Suppl. 01) i13-i17
    CrossrefPubMedGoogle Scholar
  • 37 Goel MS, Brown TL, Williams A, Cooper AJ, Hasnain-Wynia R, Baker DW. Patient reported barriers to enrolling in a patient portal. J Am Med Inform Assoc 2011; 18 (Suppl. 01) i8-i12
    CrossrefPubMedGoogle Scholar
  • 38 Georgsson M, Staggers N. Quantifying usability: an evaluation of a diabetes mHealth system on effectiveness, efficiency, and satisfaction metrics with associated user characteristics. J Am Med Inform Assoc 2016; 23 (01) 5-11
    CrossrefPubMedGoogle Scholar
  • 39 Hung M, Conrad J, Hon SD, Cheng C, Franklin JD, Tang P. Uncovering patterns of technology use in consumer health informatics. Wiley Interdiscip Rev Comput Stat 2013; 5 (06) 432-447
    CrossrefPubMedGoogle Scholar
  • 40 Berry DL, Halpenny B, Bosco JLF, Bruyere Jr J, Sanda MG. Usability evaluation and adaptation of the e-health Personal Patient Profile-Prostate decision aid for Spanish-speaking Latino men. BMC Med Inform Decis Mak 2015; 15 (01) 56
    CrossrefPubMedGoogle Scholar
  • 41 Segall N, Saville JG, L'Engle P. , et al. Usability evaluation of a personal health record. AMIA Annu Symp Proc 2011; 2011: 1233-1242
    PubMedGoogle Scholar
  • 42 Taha J, Sharit J, Czaja SJ. The impact of numeracy ability and technology skills on older adults' performance of health management tasks using a patient portal. J Appl Gerontol 2014; 33 (04) 416-436
    CrossrefPubMedGoogle Scholar
  • 43 Taha J, Sharit J, Czaja SJ. Usability of an electronic personal health record (PHR) among a diverse group of adults. Proceedings of the Human Factors and Ergonomics Society 58th Annual Meeting; 2014:619–623
    PubMedGoogle Scholar
  • 44 Zarcadoolas C, Vaughon WL, Czaja SJ, Levy J, Rockoff ML. Consumers' perceptions of patient-accessible electronic medical records. J Med Internet Res 2013; 15 (08) e168
    CrossrefPubMedGoogle Scholar
  • 45 Price M, Bellwood P, Davies I. Using usability evaluation to inform Alberta's personal health record design. Stud Health Technol Inform 2015; 208: 314-318
    PubMedGoogle Scholar
  • 46 Lazard AJ, Watkins I, Mackert MS, Xie B, Stephens KK, Shalev H. Design simplicity influences patient portal use: the role of aesthetic evaluations for technology acceptance. J Am Med Inform Assoc 2016; 23 (e1): e157-e161
    CrossrefPubMedGoogle Scholar
  • 47 Finkelstein J, Knight A, Marinopoulos S. , et al. Enabling patient-centered care through health information technology. Evid Rep Technol Assess (Full Rep) 2012; (206) 1-1531
    PubMedGoogle Scholar
  • 48 Kellermann AL, Jones SS. What it will take to achieve the as-yet-unfulfilled promises of health information technology. Health Aff (Millwood) 2013; 32 (01) 63-68
    CrossrefPubMedGoogle Scholar
  • 49 Ancker JS, Witteman HO, Hafeez B, Provencher T, Van de Graaf M, Wei E. The invisible work of personal health information management among people with multiple chronic conditions: qualitative interview study among patients and providers. J Med Internet Res 2015; 17 (06) e137
    CrossrefPubMedGoogle Scholar
  • 50 Ancker JS, Witteman HO, Hafeez B, Provencher T, Van de Graaf M, Wei E. “You get reminded you're a sick person”: personal data tracking and patients with multiple chronic conditions. J Med Internet Res 2015; 17 (08) e202
    CrossrefPubMedGoogle Scholar
  • 51 Moen A, Brennan PF. Health@Home: the work of health information management in the household (HIMH): implications for consumer health informatics (CHI) innovations. J Am Med Inform Assoc 2005; 12 (06) 648-656
    CrossrefPubMedGoogle Scholar
  • 52 Corbin J, Strauss A. Managing chronic illness at home: three lines of work. Qual Sociol 1985; 8 (03) 224-247
    CrossrefPubMedGoogle Scholar
  • 53 Goodhue D, Thompson R. Task-technology fit and individual performance. Manage Inf Syst Q 1995; 19 (02) 213-236
    CrossrefPubMedGoogle Scholar
  • 54 Ammenwerth E, Iller C, Mahler C. IT-adoption and the interaction of task, technology and individuals: a fit framework and a case study. BMC Med Inform Decis Mak 2006; 6: 3
    CrossrefPubMedGoogle Scholar
  • 55 Woollen J, Prey J, Wilcox L. , et al. Patient experiences using an inpatient personal health record. Appl Clin Inform 2016; 7 (02) 446-460
    Article in Thieme ConnectPubMedGoogle Scholar
  • 56 Zhang J, Johnson TR, Patel VL, Paige DL, Kubose T. Using usability heuristics to evaluate patient safety of medical devices. J Biomed Inform 2003; 36 (1-2): 23-30
    CrossrefPubMedGoogle Scholar
  • 57 Miller WL, Crabtree BF. Qualitative analysis: how to begin making sense. Fam Pract Res J 1994; 14 (03) 289-297
    PubMedGoogle Scholar
  • 58 Morse J. The significance of saturation. Qual Health Res 1995; 5: 147-149
    CrossrefPubMedGoogle Scholar
  • 59 Morris NS, MacLean CD, Chew LD, Littenberg B. The Single Item Literacy Screener: evaluation of a brief instrument to identify limited reading ability. BMC Fam Pract 2006; 7 (21) 21
    CrossrefPubMedGoogle Scholar
  • 60 Fagerlin A, Zikmund-Fisher BJ, Ubel PA, Jankovic A, Derry HA, Smith DM. Measuring numeracy without a math test: development of the Subjective Numeracy Scale. Med Decis Making 2007; 27 (05) 672-680
    CrossrefPubMedGoogle Scholar
  • 61 Koppel R, Wetterneck T, Telles JL, Karsh B-T. Workarounds to barcode medication administration systems: their occurrences, causes, and threats to patient safety. J Am Med Inform Assoc 2008; 15 (04) 408-423
    CrossrefPubMedGoogle Scholar
  • 62 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3 (02) 77-101
    CrossrefPubMedGoogle Scholar
  • 63 Meyer D, Leventhal H, Gutmann M. Common-sense models of illness: the example of hypertension. Health Psychol 1985; 4 (02) 115-135
    CrossrefPubMedGoogle Scholar
  • 64 Leventhal H, Leventhal EA, Breland JY. Cognitive science speaks to the “common-sense” of chronic illness management. Ann Behav Med 2011; 41 (02) 152-163
    CrossrefPubMedGoogle Scholar
  • 65 LeRouge C, Ma J, Sneha S, Tolle K. User profiles and personas in the design and development of consumer health technologies. Int J Med Inform 2013; 82 (11) e251-e268
    CrossrefPubMedGoogle Scholar
  • 66 Ancker JS, Nosal S, Hauser D, Way C, Calman N. Access policy and digital divide in patient access to medical records. Health Policy and Technology 2017; 6 (01) 3-11
    CrossrefPubMedGoogle Scholar