Subscribe to RSS
Optimizing the User Experience: Identifying Opportunities to Improve Use of an Inpatient PortalFunding This work was supported by the Agency for Healthcare Research and Quality (AHRQ) Grants R01 HS024091–01 and R21 HS024349–01 as well as P30-HS024379 through The Ohio State University Institute for the Design of Environments Aligned for Patient Safety (IDEA4PS). While this research was funded by the Agency for Healthcare Research and Quality, the study sponsor had no involvement in the collection, analysis, or interpretation of data; in the writing of this manuscript; or in the decision to submit the manuscript for publication.
26 September 2017
13 December 2017
14 February 2018 (online)
Background Patient portals specifically designed for the inpatient setting have significant potential to improve patient care. However, little is known about how the users of this technology, the patients, may interact with the inpatient portals. As a result, hospitals have limited ability to design approaches that support patient use of the portal.
Objectives This study aims to evaluate the user experience associated with an inpatient portal.
Methods We used a Think-Aloud protocol to study user interactions with a commercially available inpatient portal—MyChart Bedside (MCB). Study participants included 19 English-speaking adults over the age of 18 years. In one-on-one sessions, participants narrated their experience using the MCB application and completing eight specific tasks. Recordings were transcribed and coded into three dimensions of the user experience: physical, cognitive, and sociobehavioral.
Results Our analysis of the physical experience highlighted the navigational errors and technical challenges associated with the use of MCB. We also found that issues associated with the cognitive experience included comprehension problems that spurred anxiety and uncertainty. Analysis of the sociobehavioral experience suggested that users have different learning styles and preferences for learning including self-guided, handouts, and in-person training.
Conclusion Inpatient portals may be an effective tool to improve the patient experience in the hospital. Moreover, making this technology available to inpatients may help to foster ongoing use of technology across the care continuum. However, deriving the benefits from the technology requires appropriate support. We identified multiple opportunities for hospital management to intervene. In particular, teaching patients to use the application by making a variety of instructional materials available could help to reduce several identified barriers to use. Additionally, hospitals should be prepared to manage patient anxiety and increased questioning arising from the availability of information in the inpatient portal application.
Protection of Human and Animal Subjects
Institutional Review Board approval was obtained from the Office of Responsible Research Practices at The Ohio State University to conduct this research.
- 1 Ford EW, Hesse BW, Huerta TR. Personal health record use in the United States: forecasting future adoption levels. J Med Internet Res 2016; 18 (03) e73
- 2 Wald JS, Middleton B, Bloom A. , et al. A patient-controlled journal for an electronic medical record: issues and challenges. Stud Health Technol Inform 2004; 107 (Pt 2): 1166-1170
- 3 Ammenwerth E, Schnell-Inderst P, Hoerbst A. The impact of electronic patient portals on patient care: a systematic review of controlled trials. J Med Internet Res 2012; 14 (06) e162
- 4 Greysen SR, Magan Mendoza Y, Rosenthal J. , et al. Using tablet computers to increase patient engagement with electronic personal health records: protocol for a prospective, randomized interventional study. JMIR Res Protoc 2016; 5 (03) e176
- 5 O'Leary KJ, Lohman ME, Culver E, Killarney A, Randy Smith Jr G, Liebovitz DM. The effect of tablet computers with a mobile patient portal application on hospitalized patients' knowledge and activation. J Am Med Inform Assoc 2016; 23 (01) 159-165
- 6 Prey JE, Woollen J, Wilcox L. , et al. Patient engagement in the inpatient setting: a systematic review. J Am Med Inform Assoc 2014; 21 (04) 742-750
- 7 Rief JJ, Hamm ME, Zickmund SL. , et al. Using health information technology to foster engagement: patients' experiences with an active patient health record. Health Commun 2017; 32 (03) 310-319
- 8 Delbanco T, Walker J, Bell SK. , et al. Inviting patients to read their doctors' notes: a quasi-experimental study and a look ahead. Ann Intern Med 2012; 157 (07) 461-470
- 9 McAlearney AS, Sieck CJ, Hefner JL. , et al. High Touch and High Tech (HT2) proposal: transforming patient engagement throughout the continuum of care by engaging patients with portal technology at the bedside. JMIR Res Protoc 2016; 5 (04) e221
- 10 Peute LWP, Jaspers MWM. The significance of a usability evaluation of an emerging laboratory order entry system. Int J Med Inform 2007; 76 (2-3): 157-168
- 11 Sheehan B, Lucero RJ. Initial usability and feasibility evaluation of a personal health record-based self-management system for older adults. EGEMS (Wash DC) 2015; 3 (02) 1152
- 12 Ryu B, Kim S, Lee KH, Hwang H, Yoo S. Inpatient satisfaction and usage patterns of personalized smart bedside station system for patient-centered service at a tertiary university hospital. Int J Med Inform 2016; 95: 35-42
- 13 Walker DM, Sieck CJ, Menser T, Huerta TR, Scheck McAlearney A. Information technology to support patient engagement: where do we stand and where can we go?. J Am Med Inform Assoc 2017; 24 (06) 1088-1094
- 14 Huerta TR, McAlearney AS, Rizer MK. Introducing a patient portal and electronic tablets to inpatient care. Ann Intern Med 2017; 167 (11) 816-817
- 15 Law EC, Roto V, Hassenzahl M, Vermeeren A, Kort J. Understanding, scoping and defining user experience: a survey approach. Proceedings of the SIGCHI conference on human factors in computing systems. ACM 2009; 719-728
- 16 Bolle S, Romijn G, Smets EM, Loos EF, Kunneman M, van Weert JC. Older cancer patients' user experiences with web-based health information tools: a Think-Aloud study. J Med Internet Res 2016; 18 (07) e208
- 17 Haun JN, Lind JD, Shimada SL. , et al. Evaluating user experiences of the secure messaging tool on the Veterans Affairs' patient portal system. J Med Internet Res 2014; 16 (03) e75
- 18 Kim J. A qualitative analysis of user experiences with a self-tracker for activity, sleep, and diet. Interact J Med Res 2014; 3 (01) e8
- 19 O'Leary KJ, Sharma RK, Killarney A. , et al. Patients' and healthcare providers' perceptions of a mobile portal application for hospitalized patients. BMC Med Inform Decis Mak 2016; 16 (01) 123
- 20 Wade-Vuturo AE, Mayberry LS, Osborn CY. Secure messaging and diabetes management: experiences and perspectives of patient portal users. J Am Med Inform Assoc 2013; 20 (03) 519-525
- 21 Cohen T, Kaufman D, White T. , et al. Cognitive evaluation of an innovative psychiatric clinical knowledge enhancement system. Stud Health Technol Inform 2004; 107 (Pt 2): 1295-1299
- 22 Yu H, Lee M, Kaufman D. , et al. Development, implementation, and a cognitive evaluation of a definitional question answering system for physicians. J Biomed Inform 2007; 40 (03) 236-251
- 23 Ericsson KA, Simon HA. Verbal reports as data. Psychol Rev 1980; 87 (03) 215-251
- 24 Faulkner L. Beyond the five-user assumption: benefits of increased sample sizes in usability testing. Behav Res Methods Instrum Comput 2003; 35 (03) 379-383
- 25 Yen PY, Walker DM, Smith JG, Zhou MP, Menser T, McAlearney AS. Usability evaluation of a commercial inpatient portal. Int J Med Inf 2017; 110: 10-18
- 26 Holden RJ, Carayon P, Gurses AP. , et al. SEIPS 2.0: a human factors framework for studying and improving the work of healthcare professionals and patients. Ergonomics 2013; 56 (11) 1669-1686
- 27 Carayon P, Wetterneck TB, Rivera-Rodriguez AJ. , et al. Human factors systems approach to healthcare quality and patient safety. Appl Ergon 2014; 45 (01) 14-25
- 28 Valdez RS, Holden RJ, Novak LL, Veinot TC. Transforming consumer health informatics through a patient work framework: connecting patients to context. J Am Med Inform Assoc 2015; 22 (01) 2-10
- 29 Weir CR, Nebeker JJ, Hicken BL, Campo R, Drews F, Lebar B. A cognitive task analysis of information management strategies in a computerized provider order entry environment. J Am Med Inform Assoc 2007; 14 (01) 65-75
- 30 Kruse CS, Bolton K, Freriks G. The effect of patient portals on quality outcomes and its implications to meaningful use: a systematic review. J Med Internet Res 2015; 17 (02) e44
- 31 Laccetti AL, Chen B, Cai J. , et al. Increase in cancer center staff effort related to electronic patient portal use. J Oncol Pract 2016; 12 (12) e981-e990
- 32 Grossman LV, Choi SW, Collins S. , et al. Implementation of acute care patient portals: recommendations on utility and use from six early adopters. J Am Med Inform Assoc 2017; DOI: 10.1093/jamia/ocx074.
- 33 Dalal AK, Dykes PC, Collins S. , et al. A web-based, patient-centered toolkit to engage patients and caregivers in the acute care setting: a preliminary evaluation. J Am Med Inform Assoc 2016; 23 (01) 80-87
- 34 Collins SA, Rozenblum R, Leung WY. , et al. Acute care patient portals: a qualitative study of stakeholder perspectives on current practices. J Am Med Inform Assoc 2017; 24 (e1): e9-e17
- 35 Delbanco T, Walker J, Darer JD. , et al. Open notes: doctors and patients signing on. Ann Intern Med 2010; 153 (02) 121-125
- 36 Hefner JL, Sieck CJ, Walker DM, Huerta TR, McAlearney AS. System-wide inpatient portal implementation: survey of health care team perceptions. JMIR Med Inform 2017; 5 (03) e31
- 37 Office of the National Coordinator for Health Information Technology. Certified Health IT Vendors and Editions Reported by Hospitals Participating in the Medicare EHR Incentive Program. Secondary Certified Health IT Vendors and Editions Reported by Hospitals Participating in the Medicare EHR Incentive Program; 2016. Available at: https://dashboard.healthit.gov/quickstats/pages/FIG-Vendors-of-EHRs-to-Participating-Hospitals.php . Accessed September 14, 2017