Empowering Patients during Hospitalization: Perspectives on Inpatient Portal UseFunding This research was supported by grants from the Agency for Healthcare Research on Quality [Grant# R01HS024091, Grant #R21HS024767, and Grant #P30HS024379].
30. Juni 2018
10. Dezember 2018
13. Februar 2019 (online)
Background Patients have demonstrated an eagerness to use portals to access their health information and connect with care providers. While outpatient portals have been extensively studied, there is a recognized need for research that examines inpatient portals.
Objective We conducted this study to improve our understanding about the role of a portal in the context of inpatient care. Our study focused on a large sample of the general adult inpatient population and obtained perspectives from both patients and care team members about inpatient portal use.
Methods We interviewed patients (n = 120) who used an inpatient portal during their hospitalization at 15 days or 6 months after discharge to learn about their portal use. We also interviewed care team members (n = 331) 4 weeks, 6 months, and 12 months after inpatient portal implementation to collect information about their ongoing perspectives about patients' use of the portal.
Results The perspectives of patients and care team members generally converged on their views of the inpatient portal. Three features—(1) ordering meals, (2) looking up health information, and (3) viewing the care team—were most commonly used; the secure messaging feature was less commonly used and of some concern to care team members. The inpatient portal benefited patients in four main ways: (1) promoted independence, (2) reduced anxiety, (3) informed families, and (4) increased empowerment.
Conclusion Inpatient portals are recognized as a tool that can enhance the delivery of patient-centered care. In addition to empowering patients by increasing their sense of control, inpatient portals can support family members and caregivers throughout the hospital stay. Given the consistency of perspectives about portal use across patients and care team members, our findings suggest that inpatient portals may facilitate shifts in organizational culture that increase the patient centeredness of care and improve patient experience in the hospital context.
Protection of Human and Animal Subjects
Conduct of this research was reviewed and approved by the Institutional Review Board affiliated with the authors' institution.
- 1 McAlearney AS, Sieck CJ, Hefner JL. , et al. High Touch and High Tech (HT2) proposal: transforming patient engagement throughout the continuum of care by engaging patients with portal technology at the bedside. JMIR Res Protoc 2016; 5 (04) e221
- 2 Prochaska JO, Velicer WF. The transtheoretical model of health behavior change. Am J Health Promot 1997; 12 (01) 38-48
- 3 Rosenstock IM. The health belief model and preventative health behavior. Health Educ Monogr 1974; 2 (04) 354-386
- 4 Okunrintemi V, Spatz ES, Di Capua P. , et al. Patient-provider communication and health outcomes among individuals with atherosclerotic cardiovascular disease in the United States: Medical Expenditure Panel Survey 2010 to 2013. Circ Cardiovasc Qual Outcomes 2017; 10 (04) e003635
- 5 Hughes TM, Merath K, Chen Q. , et al. Association of shared decision-making on patient-reported health outcomes and healthcare utilization. Am J Surg 2018; 216 (01) 7-12
- 6 Davis K, Schoenbaum SC, Audet AMA. A 2020 vision of patient-centered primary care. J Gen Intern Med 2005; 20 (10) 953-957
- 7 Aboumatar HJ, Chang BH, Al Danaf J. , et al. Promising practices for achieving patient-centered hospital care: a national study of high-performing US hospitals. Med Care 2015; 53 (09) 758-767
- 8 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
- 9 Risling T, Martinez J, Young J, Thorp-Froslie N. Evaluating patient empowerment in association with eHealth technology: scoping review. J Med Internet Res 2017; 19 (09) e329
- 10 Phelps RG, Taylor J, Simpson K, Samuel J, Turner AN. Patients' continuing use of an online health record: a quantitative evaluation of 14,000 patient years of access data. J Med Internet Res 2014; 16 (10) e241
- 11 Ford EW, Hesse BW, Huerta TR. Personal health record use in the United States: forecasting future adoption levels. J Med Internet Res 2016; 18 (03) e73
- 12 Tarver WL, Menser T, Hesse BW. , et al. Growth dynamics of patient-provider Internet communication: trend analysis using the Health Information National Trends Survey (2003 to 2013). J Med Internet Res 2018; 20 (03) e109
- 13 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
- 14 Woollen J, Prey J, Wilcox L. , et al. Patient experiences using an inpatient personal health record. Appl Clin Inform 2016; 7 (02) 446-460
- 15 Kelly MM, Coller RJ, Hoonakker PL. Inpatient portals for hospitalized patients and caregivers: a systematic review. J Hosp Med 2018; 13 (06) 405-412
- 16 Miles MB, Huberman AM. Qualitative Data Analysis: An Expanded Sourcebook. Thousand Oaks, CA: Sage Publications; 1994
- 17 Crabtree BF, Miller WL. Using codes and code manuals: a template organizing style of interpretation. In: Crabtree BF, Miller WL. , eds. Doing Qualitative Research. Vol. 2. Thousand Oaks, CA: Sage; 1999: 163-177
- 18 Glasser BG, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. Hawthorne, NY: Aldine de Gruyter; 1967
- 19 Lincoln YS, Guba EG. Naturalistic Inquiry. Newbury Park, CA: Sage; 1985
- 20 Greysen SR, Khanna RR, Jacolbia R, Lee HM, Auerbach AD. Tablet computers for hospitalized patients: a pilot study to improve inpatient engagement. J Hosp Med 2014; 9 (06) 396-399
- 21 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
- 22 Umar A, Mundy D. Re-thinking models of patient empowerment. Stud Health Technol Inform 2015; 209: 175-181
- 23 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
- 24 Caligtan CA, Carroll DL, Hurley AC, Gersh-Zaremski R, Dykes PC. Bedside information technology to support patient-centered care. Int J Med Inform 2012; 81 (07) 442-451
- 25 Grossman LV, Choi SW, Collins S. , et al. Implementation of acute care patient portals: recommendations on utility and use from six early adopters. J Am Med Inform Assoc 2018; 25 (04) 370-379
- 26 Gammon J. Analysis of the stressful effects of hospitalisation and source isolation on coping and psychological constructs. Int J Nurs Pract 1998; 4 (02) 84-96
- 27 Prey JE, Restaino S, Vawdrey DK. Providing Hospital Patients with Access to Their Medical Records. Paper presented at: AMIA Annual Symposium Proceedings; 2014
- 28 Shuldham CM, Cunningham G, Hiscock M, Luscombe P. Assessment of anxiety in hospital patients. J Adv Nurs 1995; 22 (01) 87-93
- 29 Teasdale K. Information and anxiety: a critical reappraisal. J Adv Nurs 1993; 18 (07) 1125-1132
- 30 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
- 31 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
- 32 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
- 33 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
- 34 Coughlin SS, Stewart JL, Young L, Heboyan V, De Leo G. Health literacy and patient web portals. Int J Med Inform 2018; 113: 43-48
- 35 Yen PY, Walker DM, Smith JMG, Zhou MP, Menser TL, McAlearney AS. Usability evaluation of a commercial inpatient portal. Int J Med Inform 2018; 110: 10-18
- 36 Hefner JL, Sieck CJ, McAlearney AS. Training to optimize collaborative use of an inpatient portal. Appl Clin Inform 2018; 9 (03) 558-564
- 37 Kelley T, Docherty S, Brandon D. Information needed to support knowing the patient. ANS Adv Nurs Sci 2013; 36 (04) 351-363
- 38 Alpert JM, Morris BB, Thomson MD, Matin K, Brown RF. Implications of patient portal transparency in oncology: qualitative interview study on the experiences of patients, oncologists, and medical informaticists. JMIR Cancer 2018; 4 (01) e5