Appl Clin Inform 2018; 09(04): 860-868
DOI: 10.1055/s-0038-1675814
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Understanding Secure Messaging in the Inpatient Environment: A New Avenue for Communication and Patient Engagement

Cynthia J. Sieck
1   Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
2   Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
,
Daniel M. Walker
1   Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
2   Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
,
Jennifer L. Hefner
1   Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
2   Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
,
Jaclyn Volney
2   Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
,
Timothy R. Huerta
1   Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
2   Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
3   Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
4   Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, United States
,
Ann Scheck McAlearney
1   Department of Family Medicine, College of Medicine, The Ohio State University, Columbus, Ohio, United States
2   Center for the Advancement of Team Science, Analytics, and Systems Thinking, College of Medicine, The Ohio State University, Columbus, Ohio, United States
3   Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, Ohio, United States
4   Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, United States
› Institutsangaben
Funding This work was supported by the Agency for Healthcare Research and Quality (AHRQ) Grants R01 HS024091–01 and R21 HS024349–01 as well as the AHRQ Grant P30-HS024379 through The Ohio State University Institute for the Design of Environments Aligned for Patient Safety (IDEA4PS).
Weitere Informationen

Publikationsverlauf

19. Juni 2018

05. Oktober 2018

Publikationsdatum:
05. Dezember 2018 (online)

Abstract

Background Patient portals, and the secure messaging feature in particular, have been studied in the outpatient setting, but research in the inpatient setting is relatively less mature.

Objective To understand the topics discussed in secure messaging in the inpatient environment, we analyzed and categorized messages sent within an inpatient portal.

Materials and Methods This observational study examined the content of all secure messages sent from December 2013 to June 2017 within an inpatient portal at a large Midwestern academic medical center (AMC). We analyzed a total of 2,598 messages, categorizing them by sender (patient, family, or care team member), type, and topic, and conducted a descriptive analysis of categories and an examination of code co-occurrence.

Results Patients were the most frequent message senders (63%); family members sent the fewest messages (10%). We identified five types of messages: Alert/Request; Thanks; Response; Question; and Other (typo/test message). Patient messages included Alerts/Requests (38%), Questions (31%), Statements of Thanks (24%), Response (1.2%), and Other (5%). We also identified 14 nonmutually exclusive message topics: Medication; Procedure/Treatment Plan; Schedule; Pain; Results; Diet; Discharge; Non-Medication Questions; Provider Requests; Symptoms; Custodial; Technical Issues; Potential Error; and Contact Information. Patient message topics most commonly discussed Symptoms (18%), Procedure/Treatment Plan (14%), or Pain (12%).

Conclusion Our analysis of secure message content suggests certain message types and topics such as Alerts/Requests and Questions about symptoms and treatment plans are particularly important to patients. These findings demonstrate that both patients and family members utilize the secure messaging function to engage in the care process by posing questions, making requests, and alerting staff to problems. As this technology is implemented in additional facilities, future work should examine how use of secure messaging may be influenced by factors including patients' demographics, reasons for hospitalization, and length of stay.

Protection of Human and Animal Subjects

This study was approved by the Institutional Review Board of The Ohio State University.


 
  • References

  • 1 Krist AH, Woolf SH, Rothemich SF. , et al. Interactive preventive health record to enhance delivery of recommended care: a randomized trial. Ann Fam Med 2012; 10 (04) 312-319
  • 2 Osborn CY, Mayberry LS, Mulvaney SA, Hess R. Patient web portals to improve diabetes outcomes: a systematic review. Curr Diab Rep 2010; 10 (06) 422-435
  • 3 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
  • 4 Collins SA, Rozenblum R, Leung WY. , et al. Acute care patient portals: a qualitative study of stakeholder perspectives on current practices. J Am Med Inform Assoc 2017; 24 (e1): e9-e17
  • 5 Sieck CJ, Hefner JL, Schnierle J. , et al. The rules of engagement: Perspectives on secure messaging from experienced ambulatory patient portal users. JMIR Med Inform 2017; 5 (03) e13
  • 6 Walker DM, Sieck CJ, Menser T, Huerta TR, Scheck McAlearney A. Information technology to support patient engagement: where do we stand and where can we go?. J Am Med Inform Assoc 2017; 24 (06) 1088-1094
  • 7 Shah SD, Liebovitz D. It takes two to tango: engaging patients and providers with portals. PM R 2017; 9 (5S): S85-S97
  • 8 Ali SB, Romero J, Morrison K, Hafeez B, Ancker JS. Focus section health IT usability: applying a task-technology fit model to adapt an electronic patient portal for patient work. Appl Clin Inform 2018; 9 (01) 174-184
  • 9 Wieland D, Gibeau A, Dewey C, Roshto M, Frankel H. Patient portal readiness among postpartum patients in a safety net setting. Appl Clin Inform 2017; 8 (03) 698-709
  • 10 Walker DM, Menser T, Yen PY, McAlearney AS. Optimizing the user experience: identifying opportunities to improve use of an inpatient portal. Appl Clin Inform 2018; 9 (01) 105-113
  • 11 Walker DM, Hefner JL, Sieck CJ, Huerta TR, McAlearney AS. Framework for evaluating and implementing inpatient portals: a multi-stakeholder perspective. J Med Syst 2018; 42 (09) 158
  • 12 Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med 2010; 363 (06) 501-504
  • 13 Kruse CS, Bolton K, Freriks G. The effect of patient portals on quality outcomes and its implications to meaningful use: a systematic review. J Med Internet Res 2015; 17 (02) e44
  • 14 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
  • 15 Nelson JA. Personal health records. Home Health Care Manage Pract 2009; 21 (02) 141-142
  • 16 Murphy J. Engaging patients and families in ehealth. Nurs Econ 2011; 29 (06) 339-341
  • 17 Halamka JD, Mandl KD, Tang PC. Early experiences with personal health records. J Am Med Inform Assoc 2008; 15 (01) 1-7
  • 18 Kelly MM, Dean SM, Carayon P, Wetterneck TB, Hoonakker PL. Healthcare team perceptions of a portal for parents of hospitalized children before and after implementation. Appl Clin Inform 2017; 8 (01) 265-278
  • 19 Steitz B, Cronin RM, Davis SE, Yan E, Jackson GP. Long-term patterns of patient portal use for pediatric patients at an academic medical center. Appl Clin Inform 2017; 8 (03) 779-793
  • 20 Kelly MM, Coller RJ, Hoonakker P. Inpatient portals for hospitalized patients and caregivers: a systematic review. J Hosp Med 2018; 13 (06) 405-412
  • 21 Chen C, Garrido T, Chock D, Okawa G, Liang L. The Kaiser Permanente Electronic Health Record: transforming and streamlining modalities of care. Health Aff (Millwood) 2009; 28 (02) 323-333
  • 22 Prey JE, Woollen J, Wilcox L. , et al. Patient engagement in the inpatient setting: a systematic review. J Am Med Inform Assoc 2014; 21 (04) 742-750
  • 23 Britto MT, Jimison HB, Munafo JK, Wissman J, Rogers ML, Hersh W. Usability testing finds problems for novice users of pediatric portals. J Am Med Inform Assoc 2009; 16 (05) 660-669
  • 24 Masterson Creber R, Prey J, Ryan B. , et al. Engaging hospitalized patients in clinical care: study protocol for a pragmatic randomized controlled trial. Contemp Clin Trials 2016; 47: 165-171
  • 25 Dykes PC, Stade D, Chang F. , et al. Participatory design and development of a patient-centered toolkit to engage hospitalized patients and care partners in their plan of care. In AMIA Annual Symposium Proceedings; 2014 . American Medical Informatics Association
  • 26 Greysen SR, Magan Mendoza Y, Rosenthal J. , et al. Using tablet computers to increase patient engagement with electronic personal health records: protocol for a prospective, randomized interventional study. JMIR Res Protoc 2016; 5 (03) e176
  • 27 Kelly MM, Hoonakker PL, Dean SM. Using an inpatient portal to engage families in pediatric hospital care. J Am Med Inform Assoc 2017; 24 (01) 153-161
  • 28 Woollen J, Prey J, Wilcox L. , et al. Patient experiences using an inpatient personal health record. Appl Clin Inform 2016; 7 (02) 446-460
  • 29 Cronin RM, Fabbri D, Denny JC, Jackson GP. Automated classification of consumer health information needs in patient portal messages. In AMIA Annual Symposium Proceedings; 2015 . American Medical Informatics Association
  • 30 Shimada SL, Petrakis BA, Rothendler JA. , et al. An analysis of patient-provider secure messaging at two Veterans Health Administration medical centers: message content and resolution through secure messaging. J Am Med Inform Assoc 2017; 24 (05) 942-949
  • 31 Holtrop JS, Corser W, Jones G, Brooks G, Holmes-Rovner M, Stommel M. Health behavior goals of cardiac patients after hospitalization. Am J Health Behav 2006; 30 (04) 387-399
  • 32 Coulter A, Ellins J. Effectiveness of strategies for informing, educating, and involving patients. BMJ 2007; 335 (7609): 24-27
  • 33 Kelley T, Docherty S, Brandon D. Information needed to support knowing the patient. ANS Adv Nurs Sci 2013; 36 (04) 351-363
  • 34 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
  • 35 Ralston JD, Rutter CM, Carrell D, Hecht J, Rubanowice D, Simon GE. Patient use of secure electronic messaging within a shared medical record: a cross-sectional study. J Gen Intern Med 2009; 24 (03) 349-355
  • 36 Weppner WG, Ralston JD, Koepsell TD. , et al. Use of a shared medical record with secure messaging by older patients with diabetes. Diabetes Care 2010; 33 (11) 2314-2319
  • 37 Huerta TR, McAlearney AS, Rizer MK. Introducing a patient portal and electronic tablets to inpatient care. Ann Intern Med 2017; 167 (11) 816-817
  • 38 Constas MA. Qualitative analysis as a public event: the documentation of category development procedures. Am Educ Res J 1992; 29 (02) 253-266
  • 39 Scientific Software. D., Atlas.ti Berlin: Scientific Software Development; 2008
  • 40 Namey E, Guest G, Thairu L, Johnson L. Data reduction techniques for large qualitative data sets. Handbook Team Based Qual Res 2008; 2 (01) 137-161
  • 41 Dalal AK, Dykes PC, Collins S. , et al. A web-based, patient-centered toolkit to engage patients and caregivers in the acute care setting: a preliminary evaluation. J Am Med Inform Assoc 2016; 23 (01) 80-87
  • 42 O'Leary KJ, Sharma RK, Killarney A. , et al. Patients' and healthcare providers' perceptions of a mobile portal application for hospitalized patients. BMC Med Inform Decis Mak 2016; 16 (01) 123
  • 43 Nazi KM. The Personal Health Record Paradox: Health Care Professionals' Perspectives and the Information Ecology of PHR Systems in Organizational and Clinical Settings. In Medicine 2.0 Conference; 2012. . JMIR Publications Inc., Toronto, Canada
  • 44 Hefner JL, Sieck CJ, McAlearney AS. Training to optimize collaborative use of an inpatient portal. Appl Clin Inform 2018; 9 (03) 558-564
  • 45 Pell JM, Mancuso M, Limon S, Oman K, Lin CT. Patient access to electronic health records during hospitalization. JAMA Intern Med 2015; 175 (05) 856-858
  • 46 Yoo S, Lee KH, Baek H. , et al. Development and user research of a smart bedside station system toward patient-centered healthcare system. J Med Syst 2015; 39 (09) 86
  • 47 Hefner JL, Sieck CJ, Walker DM, Huerta TR, McAlearney AS. System-wide inpatient portal implementation: survey of health care team perceptions. JMIR Med Inform 2017; 5 (03) e31
  • 48 Vawdrey DK, Wilcox LG, Collins SA. , et al. A tablet computer application for patients to participate in their hospital care. In AMIA Annual Symposium Proceedings; 2011 . American Medical Informatics Association
  • 49 Health in the United States; 2016 Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/nchs/hus/contents2016.htm#older . Accessed November 20, 2017
  • 50 O'Leary KJ, Lohman ME, Culver E, Killarney A, Randy Smith Jr G, Liebovitz DM. The effect of tablet computers with a mobile patient portal application on hospitalized patients' knowledge and activation. J Am Med Inform Assoc 2016; 23 (01) 159-165