patient portal for the elderly scholarly articles

Do patient portals improve access to personal health information among older adults?

Oct 16, 2017 · Conclusions. This review focused on understanding the barriers and facilitators to older adults’ use and adoption of patient portals and ePHRs. Across the studies there were 2 main barriers: (1) concerns about privacy and security and (2) access and ability to …

What is a patient portal?

Nov 05, 2015 · A patient portal is a type of personal health record (PHR) that is connected to an electronic health record (EHR) system. ... about half used the system on only one occasion. This study concluded that the majority of the low-income elderly would not benefit from PHRs, due to poor technical skills, low health literacy and limited physical ...

Can patient portals and ephrs be integrated into older adults’ health management?

Sep 02, 2018 · A patient portal is often tethered to the EHR of the hospital and most portals offer the same set of basic functions to patients, such as a secure means to schedule appointments, view laboratory results, request medication prescriptions and send secure messages to a healthcare team. 2 –4 Older adults, aged 50 years and above, typically need healthcare …

Are patient-facing IT tools patient portals or applications more effective?

Sep 02, 2018 · A patient portal is often tethered to the EHR of the hospital and most portals offer the same set of basic functions to patients, such as a secure means to schedule appointments, view laboratory results, request medication prescriptions and send secure messages to a healthcare team. 2 –4 Older adults, aged 50 years and above, typically need healthcare …

What is a patient portal?

A patient portal is a type of personal health record (PHR) that is connected to an electronic health record (EHR) system. Patient portals provide a secure website through which patients can access their clinical data. They are a key component of most EHR architectures and an important focus of meaningful use because of their potential to streamline the delivery of patient-centered health care. Features of patient portals may include secure messaging, after-visit summaries, medication lists, allergy lists, laboratory results, and appointment scheduling. When used effectively, patient portals can empower consumers by enabling active management of their own care. However, we know little about how patient portal use fits into the broader personal health information management (PHIM) practices of various groups, such as older adults.

What are the two themes of patient portals?

From the interviews, two themes emerged with regard to patient portals: ‘facilitators,’ characterisitcs, uses or other attributes that encouraged or eased utilization of a patient portal, and ’barriers,’ individual or systems level obstacles to patient portal use.

How do patient portals empower consumers?

When used effectively, patient portals can empower consumers by enabling active management of their own care. However, we know little about how patient portal use fits into the broader personal health information management (PHIM) practices of various groups, such as older adults.

What are the challenges of using PHRs?

examined views of family practice physicians and staff about the benefits, barriers, and use of PHRs by older adults, in relation to medication use4. They concluded that the family practice physicians did not have a complete understanding of the benefits that PHRs can offer patients. Several studies highlight the challenges that older adults face when using PHRs, such as physical or cognitive limitations and low computer literacy5. Providers have also raised concern that use of PHRs could introduce privacy risks to patients4. Other providers worry that older adults may be especially vulnerable to “getting scammed”4while using electronic or online PHRs.

How old are Portal users?

Portal users ranged in age from 61 to 93 years , and most lived independently in a private residence (60%) and had college education or higher (67%). Although portal nonusers were similar in age, fewer were college educated (53%) and more lived in retirement or assisted living facilities (74%).

How many days a week do portal users use computers?

Our preliminary anaysis found that most portal users (93%) reported using a computer 6–7 days per week and 47% rated themselves as “very experienced” computer users. All reported having learned to use a computer 10 or more years ago and having Internet access where they live. In contrast, the majority of portal nonusers reported having used computers less than 6 days per week (30%) or not all all (36%), 25% lacked Internet access where they lived, and 19% reported they had not learned to use a computer. Among the 52 particpants (portal users and nonusers) who use computers, the most common use of computers was emailing and browsing the Internet.

What are the main contributors to patient portal use by older adults?

The results of the survey indicate that main contributors to patient portal use by older adults were those who experienced usefulness of the portal in question, as well as a positive attitude and belief towards patient portals in general. Main inhibitors were that patients had higher expectations of MyChart based on their idea of what functionalities a patient portal should provide, unresponsiveness of physicians to messages sent by patients via MyChart and experienced usability problems. Regarding the latter, consistent with previous literature this study acknowledges the importance of usability in relation to adoption of technology, especially for older adult target groups. 19 – 21 A main usability problem of MyChart concerned the two-factor-authentication method. Most respondents reported that it was difficult to use this method to login and suggested simpler means. An interesting finding is that about one third of patients with login problems still reported the portal to be useful to them. Lower registration rates of MyChart from 76 years upwards might, likewise, be related to login usability problems experienced by this group. The rate of patients with an expired activation code (those who received an activation code but did not activate their account in time) is higher in relation to the rate of activated accounts from 76 years upwards. A possible explanation is that this population might find the activation and login process too difficult and thus do not attempt to register or discard their registration attempt, which leads to their code expiring.

How to increase adoption of patient portals?

To increase adoption of patient portals by older adult patients, usability needs of these patients should be addressed in patient portal designs to further optimize user friendliness of portals for this apparently large user group. Ensuring privacy and security by means of the two-factor authentication standard is essential; yet to avoid non-adoption by older adults due to login issues they might experience, we encourage investigating new secure and user-friendly authentication options that may better suit an older population, for example by using biometrics during authentication (i.e. a photo of a patient’s face, a record of a patient’s voice or an image of a patient’s fingerprint). As an addition to current standard functionalities and content of patient portals, additional content should preferably include medical history data and physicians’ notes, to meet the older adult patients’ expectations. Effective patient/provider communication via a patient portal requires prompt responses of providers on questions asked by patients via the portal. Since there might be a lack of time for the physician to do so and the physician might prefer to speak to and/or see the patient in responding to questions, physicians and patients can discuss preferred communication means and response time regarding questions asked via the portal by patients during the first consultation.

What are the themes of the portal?

Six themes were identified: (a) usefulness of the portal (positive/negative); (b) usability of the portal (positive/negative); (c) attitude and beliefs towards patient portals in general (positive/negative); ( d) mismatch of portal terminology with health literacy level of the patient; (e) mismatch of portal content with prior knowledge of the patient on the portal; and (f) coordination of care communication between the patient and the provider (no problem/problem). Figure 2 and Online Appendix C indicate the number of times a theme was mentioned in the responses by patients.

What are the barriers to using a portal?

Despite the potential benefits of patient portals, previous research has identified several factors as barriers that have thus far hampered their use, including privacy concerns, 6 – 8 unresponsiveness to messages sent to physicians, 8 a mismatch between patients’ expectations and the actual functionalities of a portal 6 as well as health literacy and usability problems. 9 Further, examples of specific barriers mentioned by older adults are that they have limited access to technology or internet, are not aware that their hospital offers a portal and they are satisfied with the current, face-to-face care communication. 2, 9 – 12 These reported barriers suggest that older adult patients use portals less often compared to middle-aged or younger adults. However, a number of studies have indicated that there is a rise in older adults’ interest in using portals to manage personal health information. 5, 9 A recent systematic review by Sakaguchi-Tang et al. indicates that older adults perceive portals as useful and have an intention to use these portals. 13 A 2016 study by Walker et al. likewise reported the growing interest of older people (aged 75+) and their families in online resources such as medication lists, provider rosters, clinicians’ encounter notes and guides to community resources. 9

What are the benefits of EHR?

Over the past few decades, there has been a significant proliferation in the implementation and use of electronic health records (EHRs) creating vast opportunities for improvement in the efficiency and quality of patient care as well as reduction in healthcare costs. 1 Driven by a multitude of social and economic factors, most notably financially-overstretched healthcare systems and patients’ wishes for a more active role in the management of their disease, patient portals are increasingly being seen as powerful tools for health promotion. A patient portal is often tethered to the EHR of the hospital and most portals offer the same set of basic functions to patients, such as a secure means to schedule appointments, view laboratory results, request medication prescriptions and send secure messages to a healthcare team. 2 – 4 Older adults, aged 50 years and above, typically need healthcare services related to multi and comorbidity problems and for this reason can benefit in particular from the use of a portal. Access to their medical record content and interaction with their providers via a portal can support them specifically in maintaining wellness and independence during the management of their medical condition (s). 5

Do older adults use portals?

focused on older adults’ intention to use portals, instead of actual activation rates and use of portals by older adults. Four of the included studies evaluated the older patients’ use experience, and only one study reported on actual activation rates of portals among the older adult patient population. 13 Our study contributes to these previous studies on older adults and patient portals by examining actual registration rates of older adult patients one year after a portal’s implementation in a large academic hospital in The Netherlands. It further explores positive or negative experiences of this portal’s use amongst older adult patients with an activated account. A deeper understanding of older adults’ portal usage could be helpful to physicians and other care givers in using portals while providing care for older adults. These insights could likewise enable policy makers to adjust portals to better suit the needs of older adults. Therefore, this study aims to expand the knowledge on (a) enrollment to patient portals amongst the older adult patient population and on (b) experienced factors that contribute to or inhibit portal use by older adults.

Who approved the study of the Mijn Dossier?

This study was approved by the Medical Ethical Committee of the Academic Medical Center in Amsterdam. Consent by patients for scientific research was included in the terms and conditions of ‘ Mijn Dossier ’ of the Academic Medical Center in Amsterdam.

How do patient portals benefit the patient?

Conclusions: While the evidence is currently immature, patient portals have demonstrated benefit by enabling the discovery of medical errors, improving adherence to medications, and providing patient-provider communication, etc. High-quality studies are needed to fully understand, improve, and evaluate their impact.

How does a patient portal improve patient engagement?

Patient portals may enhance patient engagement by enabling patients to access their electronic medical records (EMRs) and facilitating secure patient-provider communication.

How many articles are in the systematic search?

Results: The systematic search identified 58 articles for inclusion. The inputs category was addressed by 40 articles, while the processes and outputs categories were addressed by 36 and 46 articles, respectively: 47 articles addressed multiple themes across the three categories, and 11 addressed only a single theme. Nineteen articles had high- to very high-quality, 21 had medium quality, and 18 had low- to very low-quality. Findings in the inputs category showed wide-ranging portal designs; patients' privacy concerns and lack of encouragement from providers were among portal adoption barriers while information access and patient-provider communication were among facilitators. Several methods were used to train portal users with varying success. In the processes category, sociodemographic characteristics and medical conditions of patients were predictors of portal use; some patients wanted unlimited access to their EMRs, personalized health education, and nonclinical information; and patients were keen to use portals for communicating with their health care teams. In the outputs category, some but not all studies found patient portals improved patient engagement; patients perceived some portal functions as inadequate but others as useful; patients and staff thought portals may improve patient care but could cause anxiety in some patients; and portals improved patient safety, adherence to medications, and patient-provider communication but had no impact on objective health outcomes.

What is a patient portal?

Patient portals are intended to engage patients by giving them access to medical information ; however, if patients are unable to understand the information or the system is not usable, patients will not take advantage of them. Despite several aforementioned drawbacks, apps have used evolving innovative designs to engage consumers and offer unique features and functions that could be translated to patient portal design. For instance, Apple's ResearchKit's Diabetes app pings the user daily to update disease and symptom-related information. Check-in questions or user-friendly alerts in portals could similarly be explored for engaging more patients their health care. Alerts could ask if the patient understands an abnormal result, direct them to helpful resources, and encourage test result follow-up. Finally, test results in the portal need to be easily understood by laypeople or displayed using simplified medical terms. For example, a portal might display elevated cholesterol as "↑LDL cholesterol," or even just display the number without a flag, whereas a health app may label it as “bad cholesterol.”

How does a patient portal help?

As a secure online website providing patients access to their health information, the portal aims to improve quality of care by engaging patients as active participants in their care. While portal functions vary, most allow patients to view laboratory test results, immunizations, medications, and allergies, as well as to send secure messages to their physician. 14 However, the portal can be difficult to navigate, and patients may struggle to understand their medical information. For instance, in our previous work we found that test result display and graphing were often confusing to patients, and they reported that portals were not user-friendly. 15 A recent systematic review of patient and provider attitudes toward patient portal use found that the most negatively-perceived feature was user-friendliness, making the portal difficult to navigate. 16 Our work exploring patient's experiences using the portal to view test results echoes this finding, as many patients reported having difficulty locating their test results in the portal. 17 When patients interact with their test results, they need to know the purpose of the test, the interpretation of the result, and next steps. 18 Addressing these issues may help improve patient-centered care.

What are the benefits of using an app for patient portal?

Although apps might serve a different purpose, patient portals could adopt certain app features that lead to better engagement success with patients. Mobile apps have the capability to record several types of data, such as activity level, nutrition, and sleep, as well as data related to a consumer's condition or disease, such as diabetes or asthma. For instance, Apple's ResearchKit, although not designed as a health tracking application, offers several features that could be useful for health monitoring. It collects data and simultaneously encourages users to track their health by prompting daily health assessments. mHealth apps offer symptom management activities, which are not a standard feature universally available in patient portals.16 For example, LifeMap Solutions (San Jose, CA) has an application for Chronic Obstructive Pulmonary Disease management that provides medication reminders and tracks users’ symptoms to identify abrupt declines in their condition. Sentrian (Aliso Viejo, CA), a patient intelligence company, uses biosensors (i.e., blood glucose biosensor) to detect deteriorating health of patients to prevent avoidable hospitalizations.20 There are also apps that allow users to view their test results, such as Healthvana (Los Angeles, CA) and Labcorp (Research Triangle Park, NC). Healthvana, for instance, provides patients with interpretation of sexually transmitted infection results and follow-up instructions. 21

How can apps improve patient engagement?

To improve user experience with future portals, developers could look towards apps in design, function, and user interface. Combining certain high-yield features of mHealth apps with the wealth of provider-generated data available in portals may improve portal use, increase patient engagement, and empower patients to track their health and disease (s). Nevertheless, continued research is necessary to understand how best to combine these features and how data can be used meaningfully by patients to improve outcomes. For further progress, informatics and human factors researchers will need to work in coordination with mHealth vendors, health care delivery organizations, and their data to determine how patients are using these health IT tools and how to make them most useful for patient care. This type of evidence is essential for creating value for patients, clinicians, and health care organizations, as well as for initiating changes to improve the patient portal. Both these health IT tools should be subjected to rigorous evaluation to ensure they meet their potential in improving patient outcomes.

How can information technology improve patient care?

There is growing interest in electronic access to health information and the use of digital data for both disease and health-related tracking. Widespread use of health information technology (IT) could potential ly increase patients’ access to their health information and facilitate future goals of advancing patient-centered care.1 For example, health IT can be used to facilitate information exchange with clinicians and instruct patients when to act upon clinical issues, such as out of range physiologic parameters, follow-up of test results, and complications of medication use. 2 Tools such as personal health records, patient portals, and various mobile health (mHealth) applications (apps) have been developed to help patients engage in their own care. Already, a significant number of patients use health IT; therefore, it is essential that patient-facing health IT be tailored to their needs. In this paper, we discuss two forms of patient-facing health IT tools—patient portals and apps—to highlight how, despite several limitations of each, combining high-yield features of mHealth apps with portals could increase patient engagement and self-management and be more effective than either of them alone. This could potentially improve both patient experience and outcomes related to patient-facing health IT.

What are some apps that track people's health?

Applications, such as Mango Health (San Francisco, CA), Fitbit (San Francisco, CA), and Apple (Cupertino, CA) iPhone 6's built in Health app, have consumer-friendly features with easy log-in access, real-time tracking, and simplified data display. 19 From a patient standpoint, these features likely make the applications more intuitive and easy-to-use than patient portals. Furthermore, mHealth apps live on mobile devices, which make them easily accessible with little effort to login after setting up the account. This ubiquitous access is one of the reasons mobile technology is rapidly replacing desktop technologies.

What is patient facing in health?

Patient-facing health IT should be simply designed to encourage and sustain use and engage patients at various levels of health literacy. 3 Patients increasingly express interest in being involved in medical decision-making and desire access to their health information.4 Despite having increased access to their health data, patients do not always understand this information or its implications, and digital health data can be difficult to navigate when displayed in a small-format, complex interface. For example, test results are not always displayed in a way that is easy for the patient to understand (e.g., with normal ranges clearly shown, along with implications of abnormal results). There is also little evidence that patient portal design addresses patients’ needs outside of meeting the “meaningful use” patient engagement criteria. 5 It is imperative to keep patients’ needs in mind because patient-facing health IT users in the long run will not be just the early adopter health and technology "enthusiasts," but regular people in need of better disease control and management. 6