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.

This paper describes Inuit cultural considerations when defining and communicating electronic health concepts and personal health information services to urban Inuit audiences. Applying a two-eyed seeing model to build on and describe contextual meanings for Western and Inuit versions of health information and information communication technologies is critical to sustained relevance of electronic health information. Overarching concerns include reclaiming Inuit ownership and vision; sustainability; and; authority and capacity. It is within an electronic health space that Inuit can attain self-determination for the management of their own personal health data and develop a set of culturally safe and empowering practices for communicating ownership and cultural relevancy of health and health information in an evolving health care system.

Informacijos apie asmens sveikatos būklę konfidencialumas yra svarbi įstatymų saugoma vertybė. Tačiau teisės doktrinoje, teisės aktuose ir teismų praktikoje pri¬pažįstama, kad teisė į privataus gyvenimo neliečiamumą nėra absoliuti. Kai ribojama asmens teisė į privatų gyvenimą, toks ribojimas turi būti numatytas įstatymų lygmenyje ir ad hoc analizuojama, ar toks ribojimas yra būtinas demokratinėje visuomenėje, siekiant ap¬saugoti teisėtą tikslą. Darbe yra nagrinėjami ir vertinami informacijos apie asmens sveikatos būklę atskleidimo tretiesiems asmenims atvejai, identifikuojami pažeidimai ir pateikiamos rekomendacijos, kokių teisinių priemonių įgyvendinimas padėtų tinkamai užtikrinti asmens teisę į šią privataus gyvenimo sritį. Darbe pristatoma asmens sveikatos informacijos konfidencialumo samprata, aprašoma, koks yra asmens, kaip paciento, teisės į privataus gyvenimo neliečiamumą reglamentavimas Lietuvoje, pristatoma šalių praktika, identifikuojami sveikatos informacijos konfidencialumo principo ribojimai, pateikiami atvejai, kuomet informacija apie asmens sveikatos būklę yra atskleidžiama pažeidžiant teisės aktus, taip pat vertinami atvejai, kai galimai ultra vires įstatymų leidėjas priima įstatymus, kurie prieštarauja LR Konstitucijai ir tarptautinėms sutartims. Darbe yra išsikeliamos dvi hipotezės: H1 – Lietuvoje be paciento sutikimo atskleidžiant informaciją apie paciento sveikatos būklę draudimo įstaigoms pažeidžiama asmens teisė į privatų gyvenimą; H2 – Lietuvoje... [toliau žr. visą tekstą] / Confidentiality of personal health information is an important value which is protected by The Convention for the Protection of Human Rights and Fundamental Freedoms, Constitution of the Republic of Lithuania and other laws. However, the right to confidentiality is not recognized as absolute in the doctrine of law, legislation and legal cases. When there is the restriction of confidentiality of personal health information, it is necessary to emphasize the principle of necessity to protect a legitimate target which is necessary in a democratic society. It is important to notice that every restriction must be provided at the level of a piece of legislation. In the paper there is analyzed and evaluated the cases of the disclosure of personal health information to third parties, identified violations and made recommendations what legislative measures should be implemented to ensure the patient's right to private life. In the paper there has set the following objectives: to analyze the current situation in Lithuania what there is the regulation of the patient's right to privacy; to present the practice of different countries about patient's right to privacy; to carry out a theoretical analysis by comparing the various scientific researches on the personal health privacy; to determine what is the restrictions for the principle of medical confidentiality; to identify privacy problems while disclosing personal health information; to reveal when information is disclosed in accordance... [to full text]

A short (11 page) plain language summary is available under the filename "Research Summary_Peer Support Institutionalization - Troubling Everyday Work.pdf" / This study explores how the everyday work of peer supporters working within institutionalized settings are shaped by institutional forces (“ruling relations”), through a series of four (peer support) focus groups and interviews with five peer support workers in Ontario. I explore peer supporters’ approaches to writing, reading, and verbally sharing information about their peers (“documentation work”), and reveal how their experiences and “felt troubles” relating to documentation are shaped by ideas of (clinical) confidentiality constructed in the Personal Health Information Protection Act (2004). I also explore how both lived experience and peer support are devalued through the ways organizations and clinicians determine and describe the value of healthcare roles (“de/valuing work”), and reveal how peer supporters’ experiences of being (de)valued are shaped by discourses of “professional/ism” which equate being a professional to having a post-secondary education and working through clinical frameworks. I describe the work that peer supporters, clinicians, and organizations (can) engage in to ground peer support workers within peer values and approaches (“values work”) through accessing peer community and fostering environments of peer culture. I draw on these suggestions and the findings of the study to provide recommendations for peer support workers, organizations and clinical workers, the peer support sector as a whole, and research/ers. / Thesis / Master of Social Work (MSW)