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Informed & safe patients are happy patients. 

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Informed & safe patients are happy patients. 

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 Patient Portals Help Patient Engagement & Education

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 Patient Portals Help Patient Engagement & Education

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Principal Findings

The current principal driver of patient portal development is CMS and Medicaid EHR incentive program meaningful use (MU) criteria [ 6]. While MU criteria clearly outline requirements of basic functionality and targeted adoption rates, they do not delineate the steps or features required to engage patients in a sustained and relevant way. Presently there is no clear definition of patient portal adoption beyond the minimum use requirements outlined in the MU criteria. However, in order for health care institutions to track the success of patient portals in terms of patient engagement, a multi-dimensional definition of portal adoption should include both motivating factors for initiation and use over time A definition of this kind would inform a set of universal quality and efficiency reporting measures beyond the current minimal MU criteria to include more relevant patient engagement data.

Current research has demonstrated that patients' interest and ability to use patient portals is strongly influenced by personal factors such age, ethnicity, education level, health literacy, health status, and role as a caregiver. Health care delivery factors, mainly provider endorsement and patient portal usability, also contribute to patients' ability to engage through and with the patient portal.

While health literacy has been identified as an important factor in the successful use of patient portals, few studies have used validated health literacy measures, making it difficult for future research to build on the findings. Research demonstrates that specific aspects of health literacy, mainly numeracy and familiarity with medical terminology, greatly impact the ability of patients to accurately input data and interpret the information provided in the patient portal. The direct relationship between health literacy and effective use of the patient portal supports the argument for the use of specific health literacy heuristics as part of overall usability testing.

Research also demonstrates that objective testing (as opposed to solely subjective) should also be a part of patient portal usability testing. Although objective usability testing is expensive and time consuming, studies demonstrate the need for continued work in this area in order to ensure patient portal interfaces promote patient comprehension and data entry accuracy. The promotion of content accuracy and patient comprehension impacts the overall usefulness of the information for both patients and providers.

The perceived usefulness of patient portals from the providers' perspectives cannot be underestimated. Provider endorsement is one of the most influential factors impacting patients' initial adoption, as well as its continued use as a tool for collaborative communication [ 20]. Yet, current research demonstrates the difficulty in aligning information management tools, such as the patient portal, with current provider workflow and care delivery priorities.

While current development and research is focused on demonstrating feasibility and efficiency of medication reconciliation and SM reminders, the research has revealed roadblocks to successful implementation rooted in the lack of provider workflow adaptations A greater understanding of the essential adjustments in provider workflow, including potential changes in the roles and responsibilities of the care team overall, is necessary in order to translate findings into practice. Few studies have focused on exploring how patient portal use should unfold within the context of the patient-provider interaction, or how it might impact the overall organization and workflow of the health care team including potential liability concerns, reimbursement, and relationships with patients.

Ultimately, successful implementation requires health care institutions to invest time and resources to systematically assess the health needs of their specific patient and caregiver populations, their individual stages of readiness to adopt a patient portal, and the types of assistance needed to do so [ 140]. Ideally, interactive sites would collect information on individuals' health, health behaviors and personal goals, and assess health literacy and functional ability, which would then inform the adaptation of the patient portal to accommodate the needs of the individual and/or what additional or alternative resources may be useful [ 2]. Such adaptations include personalized content and tailored data presentations specifically designed to enhance interpretation and comprehension of key personal health concerns and timely and pertinent action steps.

In addition, external environmental and contextual factors, such as distance between patient and clinic, and complexity and trajectory of health concerns, may impact which form of access is preferred for a specific person, provider, location, and situation. Future directions of research should focus on identifying specific populations and contextual considerations that would benefit most from a greater degree of patient engagement through a patient portal. This information could then lead to the creation of health care service policies that promote the use of a patient portal by both providers and patients within the most appropriate settings.

Conclusions

If institutions are to engage patients via the patient portal in a way that encourages them to become active members of the care team, support their competence in making health-related decisions, and help them to act on those decisions, institutional leaders must consider the contributing factors that impact efficacy and sustained use of patient portals. According to this review, these factors include attention to the topical areas of patient adoption, provider endorsement, health literacy, usability, and utility. Ultimately, adoption by patients and endorsement by providers will come when existing patient portal features align with patients' and providers' information needs and functionality. Conceptualizing patient portals as a dynamic component of the patient-provider relationship and health care delivery system as a synergetic whole, rather than an isolated repository of information or a set of disconnected functions meant to collect patient data for provider use, may help to inform future research, improve patient portal design, and efforts to promote adoption and effectiveness.

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Patient Portals and Patient Engagement: A State of the Science Review

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The current principal driver of patient portal development is CMS and Medicaid EHR incentive program meaningful use (MU) criteria [ 6]. While MU criteria clearly outline requirements of basic functionality and targeted adoption rates, they do not delineate the steps or features required to engage patients in a sustained and relevant way.

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Better Patient Particpiation = Better Outcomes !

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Better Patient Particpiation = Better Outcomes !

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Increase Patient Participation in Their Care | HealthIT.gov

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Providers and patients who share access to electronic health information can collaborate in informed decision making. Patient participation is especially important in managing and treating chronic conditions such as asthma, diabetes, and obesity. How EHRs Foster Patient Participation Electronic health records (EHRs) can help providers:

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Benefits of Informatics for the Healthcare Consumer

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Benefits of Informatics for the Healthcare Consumer

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Benefits of Informatics for the Healthcare Consumer (Nelson, Emily)-3

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Action Record - The impact of health information technology on patient safety

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Health Information Technology Reduces Errors

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Health Information Technology Reduces Errors

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Health IT Safety
Andrew Gettinger, M.D. and Kathy Kenyon, J.D. | April 27, 2015

The potential for health IT to reduce errors has been a pillar of health policy on patient safety since the Institute of Medicine's To Err is Human (2000) and Crossing the Quality Chasm (2001). In 2012, in Health IT and Patient Safety: Building Safer Systems for Better Care the IOM found the evidence on the impact of health IT on patient safety was "mixed." Since then, whether health IT actually improves patient safety has remained an open question.

The nation has seen widespread adoption of health IT as a result of the Medicare and Medicaid EHR Incentive Programs. With that increase in adoption, there should be more and better evidence on the actual impact of health IT on safety. Health IT should raise the floor on patient safety, and the evidence shows that it has.
ONC "Issue Brief" looks at evidence on health IT safety
To help answer questions about the role health IT plays in patient safety, we recently posted an Issue Brief titled " Recent Evidence that Health IT Improves Patient Safety." On balance, the report found health IT has clearly made care safer. These studies mean that health IT has almost certainly led to far fewer people being harmed than would have been without widespread health IT adoption. The Issue Brief reviews four systematic literature reviews that used a consistent methodology and finds consistent and significant net benefits on patient safety from the adoption of health IT.

The Issue Brief also identifies specific studies that show advanced health IT has reduced adverse events, medication errors, and procedure-related errors. One recent study also showed health IT has improved surgical safety.

The Issue Brief acknowledges and cites evidence on unintended consequences associated with health IT. One study funded by the Agency for Healthcare Research and Quality found that adverse drug events increased 14 percent in hospitals reporting resistance to the "meaningful use" incentive program, while they declined 52 percent in hospitals where physicians accepted the program. This is the first of four Issue Briefs on health IT and patient safety we expect to post by September 2015 through a contract with RTI International on a roadmap for a potential health IT safety center.
Institute of Medicine and Health IT in Redesigned Systems of Care
To add perspective, it's useful to recall that in 2000 the IOM promoted health IT as part of "redesigned systems of care." The IOM found that the large number of avoidable deaths identified in To Err is Human could not be decreased by trying harder in the same old (paper-based) healthcare system. The IOM explained, "Health care has safety and quality problems because it relies on outmoded systems of work. Poor designs set the workforce up to fail, regardless of how hard they try. If we want safer, higher-quality care, we will need to have redesigned systems of care, including the use of information technology to support clinical and administrative processes."

Health IT is not and never will be a "silver bullet" that reduces unsafe conditions, errors, and adverse events. To improve safety and quality, health IT is an important part of delivery system reform and redesigned systems of care. Health IT, when well designed and implemented, is a tool that can help health information flow in ways that allow for improvements in patient health and safety. Whatever the drawbacks to health IT systems, the evidence suggests that health IT has raised the floor on safety. At ONC, we are committed to working with clinicians, health care organizations, and health IT developers who share a commitment to making care safer and better by continuously improving the safety and safe use of health IT.

It is good to know that the evidence, so far, suggests that the IOM was right back in 2000. We should be going down this path. The widespread adoption of health IT has been a clear benefit to patient safety. We need to continue to work on making health IT even better in a redesigned health system with patient safety and quality its first priority.

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The Evidence Shows IOM Was Right on Health IT and Patient Safety

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Health IT Safety Andrew Gettinger, M.D. and Kathy Kenyon, J.D. | April 27, 2015 The potential for health IT to reduce errors has been a pillar of health policy on patient safety since the Institute of Medicine's To Err is Human (2000) and Crossing the Quality Chasm (2001).

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Improved Patient Safety via Technology

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1.) How do you think informatics has improved patient safety at your place of work or what technology do you think your place of work could benefit from to improve patient safety?

2.) Does your organization offer a patient portal system and do you find your patients utilize it? If not, how do you feel a portal could benefit your patient population?