The patient portal, a Health Information Technology (HIT) tool, was created to help patients become engaged with their health and health information to improve health outcomes. The practice problem was the low patient portal use and lack of nurses' knowledge of patient HIT tools at an urban ambulatory clinic in the northeastern United States. The practice-focused question explored whether an educational intervention with the care coordination team (CCT) would increase prescription refill requests and facilitate patient-provider communications via the patient portal. The 2 frameworks used for the project were Knowles's adult learning theory and Lewin's theory of change. The preintervention data were collected from an electronic-medical-record-generated report that provided portal usage for the 6 months prior to the intervention. The CCT members were trained on teaching and modeling portal use from the perspective of the patients. A checklist of steps was created and given to the CCT to be used in patients' education. Postintervention reports showed that the patient portal usage for patient-provider communication increased by 165%. The prescription refill requests did not show an increase because medication used to treat chronic conditions were typically supplied for 6 months. The implications of this project for social change include the potential for providers to improve how they interact with their patients by incorporating patient portal education inpatient visits.

Introduction: There is an urgent need to find new ways of improving the quality and safety of healthcare whilst achieving efficiencies of service. E-health technologies offer exciting opportunities to support patients in managing chronic disease. Following continuous advances and increasing use, the Internet provides an ideal platform to empower patients. Previous studies have demonstrated that people taking a more active role in managing their health, experience improved outcomes. Based on these principles and funded by Crohn's and Colitis UK, a new web-based care package was designed for adults with inflammatory bowel disease. Specifically 'My IBD Portal' aimed to provide greater access to information, improved communication and encourage greater engagement. Following its implementation at a single centre NHS Trust, the new IBD patient portal was evaluated in the clinical setting. Methods: Following a literature review and significant patient involvement, 'My IBD Portal' was designed and implemented within a single centre setting. The system was evaluated over a 6-month period using a pre-post observational designed study. The primary objective was to examine patient experience. Usage, usability and satisfaction were measured. Secondary objectives included assessing factors that predicted use, analysed using logistic regression models. Changes in IBD knowledge, patient engagement, medication adherence and health utilisation were also explored using univariate analysis and multiple regression models. Results: 183 participants enrolled in the 6-month observational study. 63.4% of participants visited the IBD Portal more than once and were defined as users. In total there were 2080 individual visits to the Portal. The mean number of logins was 11.4 (SD 21.5) and median 3 (IQR 1-12). The mean duration of each visit was over 5 minutes. Individual use was highly variable. Approximately a quarter of participants never or only once used the IBD Portal, with an equal proportion visiting over 10 times. Satisfaction amongst users was high. 98% of respondents were either satisfied or very satisfied. 90% perceived the IBD Portal supported their management and 32% felt it helped with treatment decisions. An overwhelming majority expressed a desire to continue using the IBD Portal after completion of the study. Viewing test results (23%) was the most common section visited, followed by clinic letters (21%). 29% of participants reported sharing their access with a partner or family member. The qualitative data supported the quantitative findings. Many users expressed considerable benefit from online provision to their IBD health record. Comparing users to non-users, logistic regression modeling showed active disease was significantly associated with use. Changes in health outcomes were explored using both univariate and regression analyses. Following multiple regression modeling, an increase in patient activation was significantly associated with Portal use (p < 0.02). A positive trend was observed in perceived support (p=0.06). Improvements in IBD knowledge and medication adherence were not observed. Health utilisation was greater amongst users with more frequent outpatient and helpline contacts observed. Conclusion: Design and implementation of an IBD Portal within the NHS setting is feasible. Technological, human and organisational factors need to be carefully considered during development to support adoption. The IBD Portal was used by a majority of participants and was perceived to support their care. Following adoption in other NHS clinical settings, a cluster randomised controlled study would provide the optimal study design to complete the evaluation process.

Patient engagement is one of the 6 quality directives issued by the Institute of Medicine for patient-centered care. Federal meaningful use regulations require health care organizations to offer patients a secure online website, or patient portal, to access their health information. Although the patient portal offers patients the opportunity to be more involved in their care, the portal has not been widely used. However, barriers to utilization are best understood from the perspective of the patient. Any barriers to patients accessing the portal are also barriers to patient engagement. The purpose of this project was to understand from the patient perspective why 99% were not using the portal at a large health system. The goal was to understand the patient preferences and their expectations for the portal as well as the perceived barriers. The Diffusion of Innovation Theory guided this quality improvement project to understand the patient perspective to initiate focused portal revisions and program changes. A focus group method was used to interview patients about their portal knowledge, willingness to use the portal, and general preferences for accessing health information. Four focus groups were conducted with 15 participants. Each session was recorded, transcribed within the program NVivo, and reviewed through content analysis. The main barrier to patient portal use is a general knowledge deficit about the purpose, usefulness, and accessibility. As possible solutions, the participants suggested education and promotion materials are essential. Also, nursing staff will need to offer patients information about how to access and use the portal. Through this project, positive social change can be achieved as patients will have better access to their personal health information with the revised portal.

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Thesis advisor: Joyce Edmonds / Background: Systemic racism contributes to the persistent and large inequities in perinatal health outcomes for pregnant people of color, particularly Black pregnant people. Poor communication between pregnant people of color and their providers contributes to these health inequities and perpetuates systemic racism in perinatal health. Pregnant people of color report being dismissed, ignored, discriminated against, and disrespected within the perinatal care system. One of the ways that patients communicate with their providers is via the patient portal. According to the Health Information National Trends Survey, around 80% of U.S. adults utilized information technology, such as patient portals, to track health data or communicate with their provider. Researchers have identified lower usage of patient portals in pregnant people of color compared to their White counterparts. Lower levels of utilization may perpetuate the digital divide for the low-resourced communities of color. Aims: The dissertation has three aims. The first aim was to synthesize and critically analyze patient-provider communication in pregnant people of color. The second aim was to examine the relationship between the quality of patient-provider communication (PPC) and the extent of patient portal use in pregnant people of color and to determine if digital health literacy is a moderating factor in this relationship. The third aim was to explore pregnant people of color’s access, use and perceptions of the patient portal in order to identify barriers and facilitators to quality digital communication with their prenatal providers. Methods: An integrative review method was applied to the empirical literature to achieve aim one. A multi-method, cross-sectional survey study with a non-probability convenience sample of 130 pregnant people of color receiving prenatal care at a large safety net hospital in Boston was conducted for aims two and three. Logistic regression and moderation models were utilized to analyze the quantitative survey data to achieve the second aim. Content analysis was used to analyze the responses to four open-ended survey questions to achieve the third aim. Results: A three-manuscript dissertation was completed. In the first manuscript, 26 articles were identified and the factors, outcomes and recommendations from communication between pregnant people of color and their prenatal providers were evaluated. There were two overarching themes: Racism and Discrimination and Unmet Information Needs along with multiple factors, outcomes and recommendations. The second manuscript reported on the quantitative results responses from 130 pregnant people of color. Participants that did not use the patient portal and who had public insurance had lower odds of rating higher quality PPC. Digital health literacy was found to be a moderating factor in the association between PPC and portal use at the level of portal users. The third manuscript reported on the content analysis and found main facilitators to communication between pregnant people of color and their providers were Provider behaviors and functionality of myChart and barriers were quality of response, multiple providers and digital access and literacy. Conclusions: The findings from this dissertation may be translated into clinical practice by informing perinatal providers on the pregnant people of color’s ratings of respectful communication and facilitators and barriers to quality health communication. Policies and strategies may be developed to improve digital health communication in order to provide inclusive and person-centered care in pregnancy. / Thesis (PhD) — Boston College, 2024. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

The Centers for Medicare and Medicaid Services wanted to ensure that electronic health records were used in a meaningful manner to improve coordination and quality of patient care. In 2011, the federal government began offering monetary incentives to help healthcare facilities and providers adopt technology that supported patient access and increased their ability to manage their own health. The hospital where this project took place encouraged patients’ involvement in their health by providing a patient portal, yet the public has underutilized it. The purpose of this project was to develop an evidence-based strategy for future implementation at the hospital that will increase patients’ use of the hospital’s portal. Education will be provided through an interaction between patients and a designated staff member. An informative video describing the functionality and benefits of the portal will be shown to patients to see if individualized education increases portal enrollment and participation in the portal. Adult learning theory informed this quality improvement project. In addition, the logic model served as the framework for the development of an evaluation strategy that the organization will use post implementation. The project targets social change through patient engagement. Ideally, patient portal education will increase portal enrollment, which will increase patients’ knowledge of their health information. Evidence indicates access to one’s own health information is a first step in improving and strengthening self-care and achieving better clinical outcomes.

Indiana University-Purdue University Indianapolis (IUPUI) / Long-term survivors (LTSs) of breast cancer are defined as patients who have been in remission for a year or longer. Even after being declared breast-cancer-free, many LTSs have questions that were not answered by clinicians. Although online resources provide some content for LTSs, none, or very little, provide immediate answers to specific questions. Thus, the aim involves proposing specifications for a system, the Health Electronic Learning Platform (HELP), that can assist survivors by becoming an all-inclusive resource for LTSs of breast cancer. To achieve this, relevant information from the literature was used to assess the needs of LTSs. Also, data from a study involving the breast cancer survivor’s forum project that had been filtered to include posts with mentions of features to be added to the website and usability issues encountered. To complete the actual design of the system, a synthesis of the results obtained from these two sources was performed. HELP is simple in terms of its layout and consists of a main search-bar, where LTSs are able to ask questions using their own terms and language. This navigator should not be taken as definitive solution, but instead, should be used as a starting point toward better patient-centered care.

Regeringen är skyldig att framställa och tillhandahålla allmänna tjänster till alla medborgare oberoende av åldersgrupp, etnicitet och kön. Regeringen har som ambition att digitalisera offentliga sektorer för att skapa en mer lättillgänglig och effektiv service, med målet att skapa en enklare vardag för medborgare. Den digitala vårdtjänst som används mest bland svenska pensionärer är 1177.se. Trots detta är personer på 65 år och uppåt som använder 1177.se betydligt färre procentuellt än personer i yngre åldrar. Detta utgör en motsägelse i förhållande till regeringens riktlinjer och mål. Tidigare studier av 1177.se har bland annat sammanställt användarstatistik och undersökt allmän användbarhet. Det har dock inte gjorts några kvalitativa studier av vilka faktorer som påverkar användningen och upplevelsen bland äldre som använder 1177.se:s personliga e-hälsoservice. Denna studie tillämpar en kvalitativ forskningsstrategi och använder sig av semistrukturerade intervjuer baserade på Unified Theory of Acceptance and Use of Technology (UTAUT). Därefter genomförs tematisk analys av intervjuerna, vilket resulterar i nio teman. Vi placerar in temana i UTAUT och gör två iakttagelser. Vi identifierar för det första ett samband mellan 1177:s ständiga tillgänglighet och informanternas benägenhet att använda 1177.se som ett sätt att undvika telefonköer. För det andra noterar vi att informanterna känner sig socialt tvingade av sina vårdgivare att använda 1177.se. Baserat på dessa resultat föreslår vi ändringar i UTAUT. Våra resultat indikerar ett centralt problem rörande hur vården introducerar 1177.se till nya användare, vilket tyder på att det behövs tydligare information. Vi föreslår att framtida jämförande studier av 1177.se utförs på yngre åldersgrupper, med stöd mot våra förändringar i UTAUT. Vi föreslår också att framtida studier undersöker åsikter om 1177.se hos äldre personer som inte använder 1177.se. Till sist föreslår vi att framtida studier undersöker hur interaktionsdesignen på 1177.se kan förbättras. / The Government is responsible for producing and providing services of general economic interest to all citizens, regardless of the citizens’ age group, ethnicity, and gender. The Government has an ambition of digitizing public sectors to increase service availability and efficiency, ultimately simplifying everyday life for citizens. The patient portal most widely used by Swedish pensioners is 1177.se. Despite this, people aged 65 and above who use 1177.se are significantly fewer in percentage than people of younger ages. This poses a contradiction in relation to the guidelines and goals outlined by the Government. Previous studies conducted on 1177.se have looked into usage statistics and general usability. However, no qualitative studies have been conducted on which factors influence the usage and experience among seniors using 1177.se’s personal e-services. This study takes on a qualitative research strategy, using semi-structured interviews based on Unified Theory of Acceptance and Use of Technology (UTAUT). Thematic analysis of the interviews is then conducted, resulting in nine themes. The themes are placed into UTAUT, and from this we make two observations. Firstly we identify a relationship between the constant availability of 1177.se and respondents’ propensity to use 1177.se as a means to veer off phone queues. Secondly we note that our respondents feel socially imposed by their caregivers to use 1177.se. Based on these findings we propose modifications to UTAUT. Our results indicate a central problem with how 1177.se is being introduced to patients, suggesting clearer information about 1177.se is needed. We suggest that future comparative studies of 1177.se be conducted on younger age groups, taking into account our modifications to UTAUT. We also suggest that future studies examine opinions about 1177.se among older people who are not users of 1177.se. Finally, we suggest that future studies examine how the interaction design on 1177.se can be improved.

Patient portals are web-based tools that provide patients with access to their health records and enhance communication with providers. Despite the efforts in expanding their use and patients interest in using them, patient portal usage remains low. Higher use of portals is associated with greater patient engagement and better healthcare quality and outcomes. This study investigated the impact of perceived usefulness (PU) and perceived ease of use (PEU) on patient portal usage. The conceptual framework was based on the Technology Acceptance Model, which suggests that PU and PEU of a system affect attitude and behavioral intention toward using the system, and ultimately the use of the system. The research questions focused on whether PU and PEU significantly affect portal usage. Participants included a convenience sample of 432 patients of Abington Health, located in Abington, PA, who had access to Abington's eClinicalWorks patient portal. Cross-sectional data collected from the completed online surveys included responses to Davis' PU and PEU measurement scale, self-reported portal login frequency and login duration, and some patient demographics. Data was analyzed by using chi-square test of independence and multinomial logistic regression. The study found that a significant relationship exists between PU and login frequency, PU and login duration, and PEU and login duration; however, the impact of PU and PEU on portal usage was not significant. The study could be repeated among a different population using a different patient portal. This study helps understand the relationship between PU/PEU and portal usage, something healthcare providers can capitalize upon when promoting portal use, and ultimately, encouraging greater patient engagement in their own health.

Yes / Background: Electronic personal health records (ePHRs) are secure Web-based tools that enable individuals to access, manage, and share their medical records. England recently introduced a nationwide ePHR called Patient Online. As with ePHRs in other countries, adoption rates of Patient Online remain low. Understanding factors affecting patients’ ePHR use is important to increase adoption rates and improve the implementation success of ePHRs. Objective: This study aimed to examine factors associated with patients’ use of ePHRs in England. Methods: The unified theory of acceptance and use of technology was adapted to the use of ePHRs. To empirically examine the adapted model, a cross-sectional survey of a convenience sample was carried out in 4 general practices in West Yorkshire, England. Factors associated with the use of ePHRs were explored using structural equation modeling. Results: Of 800 eligible patients invited to take part in the survey, 624 (78.0%) returned a valid questionnaire. Behavioral intention (BI) was significantly influenced by performance expectancy (PE; beta=.57, P<.001), effort expectancy (EE; beta=.16, P<.001), and perceived privacy and security (PPS; beta=.24, P<.001). The path from social influence to BI was not significant (beta=.03, P=.18). Facilitating conditions (FC) and BI significantly influenced use behavior (UB; beta=.25, P<.001 and beta=.53, P<.001, respectively). PE significantly mediated the effect of EE and PPS on BI (beta=.19, P<.001 and beta=.28, P=.001, respectively). Age significantly moderated 3 paths: PE→BI, EE→BI, and FC→UB. Sex significantly moderated only the relationship between PE and BI. A total of 2 paths were significantly moderated by education and internet access: EE→BI and FC→UB. Income moderated the relationship between FC and UB. The adapted model accounted for 51% of the variance in PE, 76% of the variance in BI, and 48% of the variance in UB. Conclusions: This study identified the main factors that affect patients’ use of ePHRs in England, which should be taken into account for the successful implementation of these systems. For example, developers of ePHRs should involve patients in the process of designing the system to consider functions and features that fit patients’ preferences and skills to ensure systems are useful and easy to use. The proposed model accounted for 48% of the variance in UB, indicating the existence of other, as yet unidentified, factors that influence the adoption of ePHRs. Future studies should confirm the effect of the factors included in this model and identify additional factors.