Patient Experiences Using an Inpatient Personal Health Record

Janet Woollen; Jennifer Prey; Lauren Wilcox; Alexander Sackeim; Susan Restaino; Syed T. Raza; Suzanne Bakken; Steven Feiner; George Hripcsak; David Vawdrey

doi:10.4338/ACI-2015-10-RA-0130

Applied Clinical Informatics, Table of Contents

Appl Clin Inform 2016; 07(02): 446-460
DOI: 10.4338/ACI-2015-10-RA-0130

Research Article

Schattauer GmbH

Patient Experiences Using an Inpatient Personal Health Record

Authors

Janet Woollen

¹Department of Biomedical Informatics, Columbia University, New York, NY
Jennifer Prey

¹Department of Biomedical Informatics, Columbia University, New York, NY
Lauren Wilcox

²School of Interactive Computing, Georgia Institute of Technology, Atlanta, GA
Alexander Sackeim

³University of Pennsylvania Health System, Pennsylvania, PA
Susan Restaino

⁴College of Physicians and Surgeons, Columbia University Medical Center, New York, NY
Syed T. Raza

⁴College of Physicians and Surgeons, Columbia University Medical Center, New York, NY
Suzanne Bakken

¹Department of Biomedical Informatics, Columbia University, New York, NY

⁵School of Nursing, Columbia University, New York, NY
Steven Feiner

⁶Department of Computer Science, Columbia University, New York, NY
George Hripcsak

¹Department of Biomedical Informatics, Columbia University, New York, NY
David Vawdrey

¹Department of Biomedical Informatics, Columbia University, New York, NY

⁷NewYork-Presbyterian Hospital, New York, NY

Abstract

Summary

Objective

To investigate patients’ experience using an inpatient personal health record (PHR) on a tablet computer to increase engagement in their hospital care.

Methods

We performed observations and conducted semi-structured interviews with 14 post-operative cardiac surgical patients and their family members who received an inpatient PHR. Themes were identified using an inductive coding scheme.

Results

All participants responded favorably to having access to view their clinical information. A majority (85.7%) of participants used the application following an initial training session. Patients reported high satisfaction with being able to view their hospital medications and access educational materials related to their medical conditions. Patients reported a desire to view daily progress reports about their hospital stay and have access to educational information about their postacute recovery. In addition, patients expressed a common desire to view their diagnoses, laboratory test results, radiology reports, and procedure notes in language that is patient-friendly.

Conclusion

Patients have unmet information needs in the hospital setting. Our findings suggest that for some inpatients and their family members, providing personalized health information through a tablet computer may improve satisfaction, decrease anxiety, increase understanding of their health conditions, and improve safety and quality of care.

Keywords

Patient engagement - inpatient - technology - personal health records

Full Text

References

References
1 Gammon. Analysis of the stressful effects of hospitalisation and source isolation on coping and psychological constructs: Coping and psychological constructs. Int J Nurs Pract 2008; 04 (02) 84-96.
2 Thompson DR. A randomized controlled trial of in-hospital nursing support for first time myocardial infarction patients and their partners: effects on anxiety and depression*. J Adv Nurs 1989; 14 (04) 291-297.
3 Elliott D. Measuring patient anxiety in coronary care. Aust Crit Care 1992; 05 (02) 12-16.
4 Teasdale K. Information and anxiety: a critical reappraisal. J Adv Nurs 1993; 18 (07) 1125-1132.
5 Shuldham CM, Cunningham G, Hiscock M, Luscombe P. Assessment of anxiety in hospital patients. J Adv Nurs 1995; 22 (01) 87-93.
6 Baker A. Crossing the Quality Chasm: A New Health System for the 21st Century. BMJ 2001; 323 7322 1192.
7 Neuner J, Fedders M, Caravella M, Bradford L, Schapira M. Meaningful Use and the Patient Portal Patient Enrollment, Use, and Satisfaction With Patient Portals at a Later-Adopting Center. Am J Med Qual. 2014 Feb 21; 1062860614523488.
8 deBronkart D. How the e-patient community helped save my life: an essay by Dave deBronkart. BMJ 2013; 346 (apr02 1): f1990-f1990.
9 Terry SF. Life as a numerator: Putting the person in personal genomics. Appl Transl Genomics. [cited 2016 Feb 22]; Available from: http://www.sciencedirect.com/science/article/pii/S2212066116300072
10 Bondy LR, Sims N, Schroeder DR, Offord KP, Narr BJ. The effect of anesthetic patient education on preoperative patient anxiety. Reg Anesth Pain Med 1999; 24 (02) 158-164.
11 Guo P, East L, Arthur A. A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: a randomized controlled trial. Int J Nurs Stud 2012; 49 (02) 129-137.
12 Kiyohara LY, Kayano LK, Oliveira LM, Yamamoto MU, Inagaki MM, Ogawa NY. et al. Surgery information reduces anxiety in the pre-operative period. Rev Hosp Clin Fac Med Sao Paulo 2004; 59 (02) 51-56.
13 Luck A, Pearson S, Maddem G, Hewett P. Effects of video information on precolonoscopy anxiety and knowledge: a randomised trial. The Lancet 1999; 354 9195 2032-2035.
14 Marteau TM, Kidd J, Cuddeford L, Walker P. Reducing anxiety in women referred for colposcopy using an information booklet. Br J Health Psychol 1996; 01 (02) 181-189.
15 Dennis KE. Dimensions of Client Control. Nurs Res 1987; 36 (03) 151-155.
16 Lin C-T, Wittevrongel L, Moore L, Beaty BL, Ross SE. An Internet-Based Patient-Provider Communication System: Randomized Controlled Trial. J Med Internet Res 2005; 07 (04) e47.
17 Edgman-Levitan S, Cleary PD. What information do consumers want and need?. Health Aff (Millwood) 1996; 15 (04) 42-56.
18 Pell J, Mancuso M, Limon S, Oman K, Lin C. Patient access to electronic health records during hospitalization. JAMA Intern Med 2015; 175 (05) 856-858.
19 Tang PC, Newcomb C. Informing Patients A Guide for Providing Patient Health Information. J Am Med Inform Assoc 1998; 05 (06) 563-570.
20 Caine K, Hanania R. Patients want granular privacy control over health information in electronic medical records. J Am Med Inform Assoc JAMIA 2013; 20 (01) 7-15.
21 Delbanco TL, Stokes DM, Cleary PD, Edgman-Levitan S, Walker JD, Gerteis M. et al. Medical patients’ assessments of their care during hospitalization: insights for internists. J Gen Intern Med 1995; 10 (12) 679-685.
22 Doherty C, Stavropoulou C. Patients’ willingness and ability to participate actively in the reduction of clinical errors: a systematic literature review. Soc Sci Med 1982 2012; Jul|; 75 (02) 257-263.
23 Civan A, Skeels MM, Stolyar A, Pratt W. Personal Health Information Management: Consumers’ Perspectives. AMIA Annu Symp Proc 2006; 2006: 156-160.
24 Bronson DL, Rubin AS, Tufo HM. Patient education through record sharing. QRB Qual Rev Bull 1978; 04 (12) 2-4.
25 Blinder D, Rotenberg L, Peleg M, Taicher S. Patient compliance to instructions after oral surgical procedures. Int J Oral Maxillofac Surg 2001; 30 (03) 216-219.
26 Cumbler E, Wald H, Kutner J. Lack of patient knowledge regarding hospital medications. J Hosp Med 2010; 05 (02) 83-86.
27 Calkins DR, Davis RB, Reiley P. et al. Patient-physician communication at hospital discharge and patients’ understanding of the postdischarge treatment plan. Arch Intern Med 1997; 157 (09) 1026-1030.
28 Bronson DDL, O’Meara K. The impact of shared medical records on smoking awareness and behavior in ambulatory care. J Gen Intern Med 1986; 01 (01) 34-37.
29 Kim E-H, Stolyar A, Lober WB, Herbaugh AL, Shinstrom SE, Zierler BK. et al. Challenges to Using an Electronic Personal Health Record by a Low-Income Elderly Population. J Med Internet Res 2009; 11 (04) e44.
30 Tsai J, Rosenheck RA. Use of the internet and an online personal health record system by US veterans: comparison of Veterans Affairs mental health service users and other veterans nationally. J Am Med Inform Assoc 2012; 19 (06) 1089-1094.
31 Archer N, Fevrier-Thomas U, Lokker C, McKibbon KA, Straus SE. Personal health records: a scoping review. J Am Med Inform Assoc 2011; 18 (04) 515-522.
32 Hourcade JP, Chrischilles EA, Gryzlak BM, Hanson BM, Dunbar DE, Eichmann DA. et al. Design Lessons for Older Adult Personal Health Records Software from Older Adults. In: Stephanidis C. editor. Universal Access in Human-Computer Interaction Users Diversity [Internet]. Springer Berlin Heidelberg; 2011. [cited 2014 Jan 5]. 176-85 Available from: http://link.springer.com/chapter/10.1007/978–3–642–21663–3_19
33 Caligtan CA, Carroll DL, Hurley AC, Gersh-Zaremski R, Dykes PC. Bedside information technology to support patient-centered care. Int J Med Inf 2012; 81 (07) 442-451.
34 Dykes PC, Carroll DL, Hurley AC, Benoit A, Chang F, Pozzar R. et al. Building and Testing a Patient-Centric Electronic Bedside Communication Center. J Gerontol Nurs 2013; 39 (01) 15-19.
35 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; 09 (06) 396-399.
36 Pell J, Mancuso M, Limon S, Oman K, Lin C. Patient access to electronic health records during hospitalization. JAMA Intern Med 2015; 175 (05) 856-858.
37 Prey JE, Woollen J, Wilcox L, Sackeim AD, Hripcsak G, Bakken S. et al. Patient engagement in the inpatient setting: a systematic review. J Am Med Inform Assoc. 2013 Nov 22;amiajnl - 2013-002141.
38 Vawdrey DK, Wilcox LG, Collins SA, Bakken S, Feiner S, Boyer A. et al. A Tablet Computer Application for Patients to Participate in Their Hospital Care. AMIA Annu Symp Proc 2011; 2011: 1428-1435.
39 Wilcox L, Feiner S, Liu A, Restaino S, Collins S, Vawdrey D. Designing Inpatient Technology to Meet the Medication Information Needs of Cardiology Patients. Proceedings of the 2Nd ACM SIGHIT International Health Informatics Symposium. New York, NY, USA: ACM; 2012. [cited 2014 Feb 27]. 831-6 Available from: http://doi.acm.org/10.1145/2110363.2110466
40 Davis FD. Perceived Usefulness, Perceived Ease of Use, and User Acceptance of Information Technology. MIS Q 1989; 13 (03) 319-340.
41 Morse JM, Barrett M, Mayan M, Olson K, Spiers J. Verification Strategies for Establishing Reliability and Validity in Qualitative Research. Int J Qual Methods 2008; 01 (02) 13-22.
42 Guest G, Bunce A, Johnson L. How Many Interviews Are Enough? An Experiment with Data Saturation and Variability. Field Methods 2006; 18 (01) 59-82.
43 Elo S, Kyngäs H. The qualitative content analysis process. J Adv Nurs 2008; 62 (01) 107-115.
44 Businger A, Buckel L, Gandhi T, Grant R, Poon E, Schnipper J. et al. Patient review of selected electronic health record data improves visit experience. AMIA Annu Symp Proc AMIA Symp AMIA Symp. 2007: 887.
45 Delbanco T, Walker J, Bell SK, Darer JD, Elmore JG, Farag N. 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.
46 Berg M, Langenberg C, Kwakkernaat J. Considerations for sociotechnical design: experiences with an electronic patient record in a clinical context. Int J Med Inf 1998; 52 (01) 243-251.
47 Hassol A, Walker JM, Kidder D, Rokita K, Young D, Pierdon S. et al. Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging. J Am Med Inform Assoc JAMIA 2004; 11 (06) 505-513.
48 Keselman A, Slaughter L, Arnott-Smith C, Kim H, Divita G, Browne A. et al. Towards Consumer-Friendly PHRs: Patients’ Experience with Reviewing Their Health Records. AMIA Annu Symp Proc 2007; 2007: 399.
49 Weingart SN, Rind D, Tofias Z, Sands DZ. Who Uses the Patient Internet Portal? The PatientSite Experience. J Am Med Inform Assoc 2006; 13 (01) 91-95.
50 Trewin VF, Veitch GBA. Patient sources of drug information and attitudes to their provision: a corticosteroid model. Pharm World Sci 2003; 25 (05) 191-196.
51 Galesic M, Garcia-Retamero R. Do low-numeracy people avoid shared decision making?. Health Psychol 2011; 30 (03) 336-341.
52 Weed LL. Quality control and the medical record. Arch Intern Med 1971; 127 (01) 101-105.
53 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.
54 Sarkar U, Karter AJ, Liu JY, Adler NE, Nguyen R, López A. 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 (sup2): 183-196.
55 Baum S. Can making data beautiful engage patients and boost health literacy?. [Internet]. MedCity News. 2013 [cited 2014 Jan 19]. Available from: http://medcitynews.com/2013/05/can-making-data-beautiful-engage-patients-and-boost-health-literacyvideo/
56 Noblin AM, Wan TTH, Fottler M. The Impact of Health Literacy on a Patient’s Decision to Adopt a Personal Health Record. Perspect Health Inf Manag AHIMA Am Health Inf Manag Assoc. 2012 Fall [cited 2013 Dec 15]; 9(Fall). Available from: /pmc/articles/PMC3510648/?report=abstract.
57 Faden RR, Becker C, Lewis C, Freeman J, Faden AI. Disclosure of Information to Patients in Medical Care. Med Care 1981; 19 (07) 718-733.
58 Fielding R, Wong L, Ko L. Strategies of information disclosure to Chinese cancer patients in an Asian community. Psychooncology 1998; 07 (03) 240-251.
59 Mazur DJ. Information Disclosure and Beyond: How Do Patients Understand and Use the Information They Report They Want?. Med Decis Making 2000; 20 (01) 132-134.
60 Mystakidou K, Parpa E, Tsilika E, Katsouda E, Vlahos L. Cancer information disclosure in different cultural contexts. Support Care Cancer 2003; 12 (03) 147-154.
61 Dalal AK, Dykes PC, Collins S, Lehmann LS, Ohashi K, Rozenblum R. 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. 2015 Aug 2; ocv093.
62 Zeng-Treitler Q, Goryachev S, Kim H, Keselman A, Rosendale D. Making Texts in Electronic Health Records Comprehensible to Consumers: A Prototype Translator. AMIA Annu Symp Proc 2007; 2007: 846-850.
63 Keselman A, Logan R, Smith CA, Leroy G, Zeng-Treitler Q. Developing Informatics Tools and Strategies for Consumer-centered Health Communication. J Am Med Inform Assoc 2008; 15 (04) 473-483.
64 Wilkins V, Elliott MN, Richardson A, Lozano P, Mangione-Smith R. The Association between Care Experiences and Parent Ratings of Care for Different Racial, Ethnic, and Language Groups in a Medicaid Population. Health Serv Res 2011; 46 (03) 821-839.
65 Weiskopf NG, Hripcsak G, Swaminathan S, Weng C. Defining and measuring completeness of electronic health records for secondary use. J Biomed Inform 2013; 46 (05) 830-836.
66 Siteman E, Businger A, Gandhi T, Grant R, Poon E, Schnipper J. et al. Physicians value patient review of their electronic health record data as a means to improve accuracy of medication list documentation. AMIA Annu Symp Proc AMIA Symp AMIA Symp. 2007: 1116.
67 Hack TF, Degner LF, Dyck DG. Relationship between preferences for decisional control and illness information among women with breast cancer: A quantitative and qualitative analysis. Soc Sci Med 1994; 39 (02) 279-289.
68 Hayward RA, Hofer TP. Estimating hospital deaths due to medical errors: Preventability is in the eye of the reviewer. JAMA 2001; 286 (04) 415-420.
69 Comstock J. KP discharge app is early step in future care vision | mobihealthnews. Mobihealthnews.com. 2014 [cited 2015 Jan 20]. Available from: http://mobihealthnews.com/30287/kps-discharge-app-is-early-step-in-future-care-vision/
70 Dolan B. Ohio medical center discusses mobile first strategy and Epic’s MyChart Bedside iPad app. 2014 Feb 26;.
71 Morris D, Karlson A. Dynamic Accessibility Requirements for Hospital Patients. SIGCHI Computing Conference on Human Factors in Systems [Internet]. 2011 Available from: http://research.microsoft.com/enus/um/redmond/groups/cue/publications/Morris_Karlson_CHI_2011_Dynamic_Accessibilit y_Workshop.pdf
72 Sarkar U, Bates DW. Care partners and online patient portals. JAMA 2014; 311 (04) 357-358.