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Appl Clin Inform 2022; 13(05): 1123-1130
DOI: 10.1055/a-1951-3268
Research Article

Real-Time Patient Portal Use Among Emergency Department Patients: An Open Results Study

Robert W. Turer
1   Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
2   Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas, United States
,
Katherine R. Martin
1   Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
,
Daniel Mark Courtney
1   Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
,
Deborah B. Diercks
1   Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
,
Ling Chu
2   Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas, United States
3   Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
,
DuWayne L. Willett
2   Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas, United States
3   Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
,
Bhaskar Thakur
1   Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
4   Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, United States
,
Amy Hughes
4   Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, United States
,
Christoph U. Lehmann
2   Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas, United States
4   Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, Texas, United States
5   Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, United States
6   Lyda Hill Department of Bioinformatics, UT Southwestern Medical Center, Dallas, Texas, United States
,
Samuel A. McDonald
1   Department of Emergency Medicine, UT Southwestern Medical Center, Dallas, Texas, United States
2   Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas, United States
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Abstract

Objectives We characterized real-time patient portal test result viewing among emergency department (ED) patients and described patient characteristics overall and among those not enrolled in the portal at ED arrival.

Methods Our observational study at an academic ED used portal log data to trend the proportion of adult patients who viewed results during their visit from May 04, 2021 to April 04, 2022. Correlation was assessed visually and with Kendall's τ. Covariate analysis using binary logistic regression assessed result(s) viewed as a function of time accounting for age, sex, ethnicity, race, language, insurance status, disposition, and social vulnerability index (SVI). A second model only included patients not enrolled in the portal at arrival. We used random forest imputation to account for missingness and Huber-White heteroskedasticity-robust standard errors for patients with multiple encounters (α = 0.05).

Results There were 60,314 ED encounters (31,164 unique patients). In 7,377 (12.2%) encounters, patients viewed results while still in the ED. Patients were not enrolled for portal use at arrival in 21,158 (35.2%) encounters, and 927 (4.4% of not enrolled, 1.5% overall) subsequently enrolled and viewed results in the ED. Visual inspection suggests an increasing proportion of patients who viewed results from roughly 5 to 15% over the study (Kendall's τ = 0.61 [p <0.0001]). Overall and not-enrolled models yielded concordance indices (C) of 0.68 and 0.72, respectively, with significant overall likelihood ratio χ 2 (p <0.0001). Time was independently associated with viewing results in both models after adjustment. Models revealed disparate use between age, race, ethnicity, SVI, sex, insurance status, and disposition groups.

Conclusion We observed increased portal-based test result viewing among ED patients over the year since the 21st Century Cures act went into effect, even among those not enrolled at arrival. We observed disparities in those who viewed results.

Keywords

emergency service, hospital - social vulnerability index - patient portals - after visit summary - electronic health record

Protection of Human and Animal Subjects

This study was reviewed by our institution's institutional review board and deemed “Exempt.”




Publication History

Received: 14 June 2022

Accepted: 23 September 2022

Accepted Manuscript online:
27 September 2022

Article published online:
30 November 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 114th Congress of the United States. H.R.34 - Public Law No: 114 - 255 - 21st Century Cures Act. Washington, DC; 2016
    PubMedGoogle Scholar
  • 2 Office of the National Coordinator for Health Information Technology USDoHaHS. Federal Register: 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program; 2020
    PubMed
  • 3 Steitz BD, Sulieman L, Wright A, Rosenbloom ST. Association of immediate release of test results to patients with implications for clinical workflow. JAMA Netw Open 2021; 4 (10) e2129553-e2129553
    CrossrefPubMedGoogle Scholar
  • 4 Arvisais-Anhalt S, Lau M, Lehmann CU. et al. The 21st century cures act and multiuser electronic health record access: potential pitfalls of information release. J Med Internet Res 2022; 24 (02) e34085
    CrossrefPubMedGoogle Scholar
  • 5 Office of the National Coordinator for Health Information Technology USDoHaHS. United States Core Data for Interoperability (USCDI). Accessed June 9, 2022 at: https://www.healthit.gov/uscdi
    PubMedGoogle Scholar
  • 6 Turer RW, DesRoches CM, Salmi L, Helmer T, Rosenbloom ST. Patient perceptions of receiving COVID-19 test results via an online patient portal: an open results survey. Appl Clin Inform 2021; 12 (04) 954-959
    Article in Thieme ConnectPubMedGoogle Scholar
  • 7 Walker J, Leveille S, Bell S. et al. OpenNotes after 7 years: patient experiences with ongoing access to their clinicians' outpatient visit notes. J Med Internet Res 2019; 21 (05) e13876
    CrossrefPubMedGoogle Scholar
  • 8 Giardina TD, Baldwin J, Nystrom DT, Sittig DF, Singh H. Patient perceptions of receiving test results via online portals: a mixed-methods study. J Am Med Inform Assoc 2018; 25 (04) 440-446
    CrossrefPubMedGoogle Scholar
  • 9 Foster B, Krasowski MD. The use of an electronic health record patient portal to access diagnostic test results by emergency patients at an academic medical center: retrospective study. J Med Internet Res 2019; 21 (06) e13791
    CrossrefPubMedGoogle Scholar
  • 10 Ratliff-Schaub K, Valleru J. Increasing patient portal activation in a pediatric subspecialty clinic. Pediatr Qual Saf 2017; 2 (06) e049
    CrossrefPubMedGoogle Scholar
  • 11 Wuerz RC, Travers D, Gilboy N, Eitel DR, Rosenau A, Yazhari R. Implementation and refinement of the emergency severity index. Acad Emerg Med 2001; 8 (02) 170-176
    CrossrefPubMedGoogle Scholar
  • 12 Institute of Medicine. Race, ethnicity, and language data: Standardization for health care quality improvement. 2009 Accessed August 24, 2022 at: https://www.ahrq.gov/research/findings/final-reports/iomracereport/index.html
    PubMedGoogle Scholar
  • 13 Amutah C, Greenidge K, Mante A. et al. Misrepresenting race—the role of medical schools in propagating physician bias. N Engl J Med 2021; 384 (09) 872-878
    CrossrefPubMedGoogle Scholar
  • 14 Centers for Disease Control and Prevention/ Agency for Toxic Substances and Disease Registry/ Geospatial Research A, and Services Program. CDC/ATSDR Social Vulnerability Index. Accessed June 2, 2022 at: https://www.atsdr.cdc.gov/placeandhealth/svi/data_documentation_download.html
    PubMedGoogle Scholar
  • 15 Harrell Jr FE. Regression Modeling Strategies. 2nd ed.. Springer International Publishing; 2015
    CrossrefGoogle Scholar
  • 16 Mayer M. missRanger: Fast Imputation of Missing Values. Accessed June 2, 2022 at: https://cran.r-project.org/package=missRanger
    PubMedGoogle Scholar
  • 17 The R Project for Statistical Computing. Accessed June 2, 2022 at: https://www.r-project.org/
    PubMed
  • 18 Graetz I, Gordon N, Fung V, Hamity C, Reed ME. The digital divide and patient portals: internet access explained differences in patient portal use for secure messaging by age, race, and income. Med Care 2016; 54 (08) 772-779
    CrossrefPubMedGoogle Scholar
  • 19 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
  • 20 Huang J, Chen Y, Landis JR, Mahoney KB. Difference between users and nonusers of a patient portal in health behaviors and outcomes: retrospective cohort study. J Med Internet Res 2019; 21 (10) e13146
    CrossrefPubMedGoogle Scholar
  • 21 Ukoha EP, Feinglass J, Yee LM. Disparities in electronic patient portal use in prenatal care: retrospective cohort study. J Med Internet Res 2019; 21 (09) e14445
    CrossrefPubMedGoogle Scholar
  • 22 Jhamb M, Cavanaugh KL, Bian A. et al. Disparities in electronic health record patient portal use in nephrology clinics. Clin J Am Soc Nephrol 2015; 10 (11) 2013-2022
    CrossrefPubMedGoogle Scholar
  • 23 El-Toukhy S, Méndez A, Collins S, Pérez-Stable EJ. Barriers to patient portal access and use: evidence from the health information national trends survey. J Am Board Fam Med 2020; 33 (06) 953-968
    CrossrefPubMedGoogle Scholar