Download PDF
CC BY-NC-ND 4.0 · Appl Clin Inform 2018; 09(04): 875-883
DOI: 10.1055/s-0038-1676333
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Communicating with Vulnerable Patient Populations: A Randomized Intervention to Teach Inpatients to Use the Electronic Patient Portal

Jacob N. Stein
1   Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
,
Jared W. Klein
1   Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
,
Thomas H. Payne
1   Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
2   Information Technology Services, University of Washington School of Medicine, Seattle, Washington, United States
,
Sara L. Jackson
1   Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
,
Sue Peacock
1   Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
,
Natalia V. Oster
1   Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
,
Trinell P. Carpenter
1   Department of Medicine, University of Washington School of Medicine, Seattle, Washington, United States
,
Joann G. Elmore
3   University of California, Los Angeles, California, United States
› Author Affiliations Funding This study was generously funded by the Robert Wood Johnson Foundation, the Gordon & Betty Moore Foundation, the Peterson Center on Healthcare, and the Cambia Health Foundation.
Further Information

Publication History

28 June 2018

14 October 2018

Publication Date:
12 December 2018 (online)

   Permissions and Reprints

Abstract

Background Patient portals are expanding as a means to engage patients and have evidence for benefit in the outpatient setting. However, few studies have evaluated their use in the inpatient setting, or with vulnerable patient populations.

Objective This article assesses an intervention to teach hospitalized vulnerable patients to access their discharge summaries using electronic patient portals.

Methods Patients at a safety net hospital were randomly assigned to portal use education or usual care. Surveys assessed perceptions of discharge paperwork and the electronic portal.

Results Of the 202 prescreened eligible patients (e.g., deemed mentally competent, spoke English, and had a telephone), only 43% had working emails. Forty-four percent of participants did not remember receiving or reading discharge paperwork. Patients trained in portal use (n = 47) or receiving usual care (n = 23) preferred hospitals with online record access (85 and 83%, respectively), and felt that online access would increase their trust in doctors (85 and 87%) and satisfaction with care (91% each). Those who received training in portal use were more likely to register for the portal (48% vs. 11%; p < 0.01).

Conclusion Patients had positive perceptions of portals, and education increased portal use. Lack of email access is a notable barrier to electronic communication with vulnerable patients.

Keywords

patient portal - discharge summary - communication barriers - inpatient care - discharge planning

Protection of Human and Animal Subjects

This study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research involving Human Subjects and was reviewed by the University of Washington Institutional Review Board.


Supplementary Material

 

  • References

  • 1 Walker J, Meltsner M, Delbanco T. US experience with doctors and patients sharing clinical notes. BMJ 2015; 350: g7785
    CrossrefPubMedGoogle Scholar
  • 2 Bronson DL, Costanza MC, Tufo HM. Using medical records for older patient education in ambulatory practice. Med Care 1986; 24 (04) 332-339
    CrossrefPubMedGoogle Scholar
  • 3 Ross SE, Moore LA, Earnest MA, Wittevrongel L, Lin CT. Providing a web-based online medical record with electronic communication capabilities to patients with congestive heart failure: randomized trial. J Med Internet Res 2004; 6 (02) e12
    CrossrefPubMedGoogle Scholar
  • 4 Pagliari C, Detmer D, Singleton P. Potential of electronic personal health records. BMJ 2007; 335 (7615): 330-333
    CrossrefPubMedGoogle Scholar
  • 5 Wright E, Darer J, Tang X. , et al. Sharing physician notes through an electronic portal is associated with improved medication adherence: quasi-experimental study. J Med Internet Res 2015; 17 (10) e226
    CrossrefPubMedGoogle Scholar
  • 6 Esch T, Mejilla R, Anselmo M, Podtschaske B, Delbanco T, Walker J. Engaging patients through open notes: an evaluation using mixed methods. BMJ Open 2016; 6 (01) e010034
    CrossrefPubMedGoogle Scholar
  • 7 Delbanco T, Walker J, Bell SK. , et al. Inviting patients to read their doctors' notes: a quasi-experimental study and a look ahead. Ann Intern Med 2012; 157 (07) 461-470
    CrossrefPubMedGoogle Scholar
  • 8 Dhanireddy S, Walker J, Reisch L, Oster N, Delbanco T, Elmore JG. The urban underserved: attitudes towards gaining full access to electronic medical records. Health Expect 2014; 17 (05) 724-732
    CrossrefPubMedGoogle Scholar
  • 9 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
    CrossrefPubMedGoogle Scholar
  • 10 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
  • 11 Delbanco T, Walker J, Darer JD. , et al. Open notes: doctors and patients signing on. Ann Intern Med 2010; 153 (02) 121-125
    PubMedGoogle Scholar
  • 12 Huerta TR, McAlearney AS, Rizer MK. Introducing a patient portal and electronic tablets to inpatient care. Ann Intern Med 2017; 167 (11) 816-817
    CrossrefPubMedGoogle Scholar
  • 13 Irizarry T, DeVito Dabbs A, Curran CR. Patient portals and patient engagement: a state of the science review. J Med Internet Res 2015; 17 (06) e148
    CrossrefPubMedGoogle Scholar
  • 14 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
    CrossrefPubMedGoogle Scholar
  • 15 Hefner JL, Sieck CJ, McAlearney AS. Training to optimize collaborative use of an inpatient portal. Appl Clin Inform 2018; 9 (03) 558-564
    Article in Thieme ConnectPubMedGoogle Scholar
  • 16 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Griffin A, Skinner A, Thornhill J, Weinberger M. Patient portals: who uses them? What features do they use? And do they reduce hospital readmissions?. Appl Clin Inform 2016; 7 (02) 489-501
    Article in Thieme ConnectPubMedGoogle Scholar
  • 18 Paterson B, Kieloch B, Gmiterek J. ‘They never told us anything’: postdischarge instruction for families of persons with brain injuries. Rehabil Nurs 2001; 26 (02) 48-53
    CrossrefPubMedGoogle Scholar
  • 19 Herzig SJ, Schnipper JL, Doctoroff L. , et al. Physician perspectives on factors contributing to readmissions and potential prevention strategies: a multicenter survey. J Gen Intern Med 2016; 31 (11) 1287-1293
    CrossrefPubMedGoogle Scholar
  • 20 Scotten M, Manos EL, Malicoat A, Paolo AM. Minding the gap: interprofessional communication during inpatient and post discharge chasm care. Patient Educ Couns 2015; 98 (07) 895-900
    CrossrefPubMedGoogle Scholar
  • 21 Feldman HJ, Walker J, Li J, Delbanco T. OpenNotes: hospitalists' challenge and opportunity. J Hosp Med 2013; 8 (07) 414-417
    CrossrefPubMedGoogle Scholar
  • 22 Sheffield JV, Young A, Goldstein EA, Logerfo JP. The public hospital mission at Seattle's Harborview Medical Center: high-quality care for the underserved and excellence in medical education. Acad Med 2006; 81 (10) 886-890
    CrossrefPubMedGoogle Scholar
  • 23 UW Medicine Harborview Medical Center. Available at: http://www.uwmedicine.org/about/Documents/HMC-FS-final.pdf . Accessed June 11, 2017
    PubMed
  • 24 U.S. Census Bureau Population Division. Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2016. 2017. Available at: https://factfinder.census.gov/faces/nav/jsf/pages/index.xhtml . Accessed October, 2018
    PubMed
  • 25 Chew LD, Griffin JM, Partin MR. , et al. Validation of screening questions for limited health literacy in a large VA outpatient population. J Gen Intern Med 2008; 23 (05) 561-566
    CrossrefPubMedGoogle Scholar
  • 26 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
    CrossrefPubMedGoogle Scholar
  • 27 Mafi JN, Mejilla R, Feldman H. , et al. Patients learning to read their doctors' notes: the importance of reminders. J Am Med Inform Assoc 2016; 23 (05) 951-955
    CrossrefPubMedGoogle Scholar
  • 28 Peacock S, Reddy A, Leveille SG. , et al. Patient portals and personal health information online: perception, access, and use by US adults. J Am Med Inform Assoc 2017; 24 (e1): e173-e177
    PubMedGoogle Scholar
  • 29 Wen KY, Kreps G, Zhu F, Miller S. Consumers' perceptions about and use of the internet for personal health records and health information exchange: analysis of the 2007 Health Information National Trends Survey. J Med Internet Res 2010; 12 (04) e73
    CrossrefPubMedGoogle Scholar
  • 30 McCloud RF, Okechukwu CA, Sorensen G, Viswanath K. Beyond access: barriers to internet health information seeking among the urban poor. J Am Med Inform Assoc 2016; 23 (06) 1053-1059
    CrossrefPubMedGoogle Scholar
  • 31 Hargittai E. Second-level digital divide: differences in people's online skills. First Monday 2002; 7(04). Available at: http://webuse.org/pdf/Hargittai-SecondLevelFM02.pdf . Accessed December 6, 2018
    PubMedGoogle Scholar
  • 32 Jawhari B, Keenan L, Zakus D. , et al. Barriers and facilitators to electronic medical record (EMR) use in an urban slum. Int J Med Inform 2016; 94 (Oct): 246-254
    CrossrefPubMedGoogle Scholar
  • 33 Tieu L, Schillinger D, Sarkar U. , et al. Online patient websites for electronic health record access among vulnerable populations: portals to nowhere?. JAMA 2016
    PubMedGoogle Scholar
  • 34 Schickedanz A, Huang D, Lopez A. , et al. Access, interest, and attitudes toward electronic communication for health care among patients in the medical safety net. J Gen Intern Med 2013; 28 (07) 914-920
    CrossrefPubMedGoogle Scholar
  • 35 Bureau USC. Computer and Internet Use in the United States; 2015 . Available at: https://www.census.gov/content/dam/Census/library/publications/2017/acs/acs-37.pdf . Accessed June 2018
    PubMed
  • 36 Anderson M. Racial and ethnic differences in how people use mobile technology. FactTank: News in the Numbers; 2015 . Available at: http://www.pewresearch.org/fact-tank/2015/04/30/racial-and-ethnic-differences-in-how-people-use-mobile-technology/ . Accessed February 15, 2017
    PubMedGoogle Scholar