Appl Clin Inform 2020; 11(03): 433-441
DOI: 10.1055/s-0040-1713412
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Analysis of Employee Patient Portal Use and Electronic Health Record Access at an Academic Medical Center

Lina Sulieman
1   Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
Bryan Steitz
1   Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
,
S. Trent Rosenbloom
1   Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
› Institutsangaben
Weitere Informationen

Publikationsverlauf

19. Dezember 2019

14. Mai 2020

Publikationsdatum:
17. Juni 2020 (online)

Abstract

Background Patient portals provide patients and their caregivers online access to limited health results. Health care employees with electronic health record (EHR) access may be able to view their health information not available in the patient portal by looking in the EHR.

Objective In this study, we examine how employees use the patient portal when they also have access to the tethered EHR.

Methods We obtained patient portal and EHR usage logs corresponding to all employees who viewed their health data at our institution between January 1, 2013 and November 1, 2017. We formed three cohorts based on the systems that employees used to view their health data: employees who used the patient portal only, employees who viewed health data in the EHR only, and employees who used both systems. We compared system accesses and usage patterns for each employee cohort.

Results During the study period, 35,172 employees accessed the EHR as part of patients' treatment and 28,631 employees accessed their health data: 25,193 of them used the patient portal and 13,318 accessed their clinical data in EHR. All employees who accessed their records in the EHR viewed their clinical notes at least once. Among EHR accesses, clinical note accesses comprised more than 42% of all EHR accesses. Provider messaging and appointment scheduling were the most commonly used functions in the patient portal. Employees who had access to their health data in both systems were more likely to engage with providers through portal messages.

Conclusion Employees at a large medical center accessed clinical notes in the EHR to obtain information about their health. Employees also viewed other health data not readily available in the patient portal.

Protection of Human and Animal Subjects

This study was submitted to the Institutional Review Board (IRB) Office and did not involve any human subjects. As such, it was exempt from IRB review.


Supplementary Material

 
  • References

  • 1 Nazi KM, Woods SS, Woods SS. MyHealtheVet PHR: a description of users and patient portal use. AMIA Annu Symp Proc 2008; 1182
  • 2 Koonce TY, Giuse DA, Beauregard JM, Giuse NB. Toward a more informed patient: bridging health care information through an interactive communication portal. J Med Libr Assoc 2007; 95 (01) 77-81
  • 3 Detmer D, Bloomrosen M, Raymond B, Tang P. Integrated personal health records: transformative tools for consumer-centric care. BMC Med Inform Decis Mak 2008; 8: 45
  • 4 Kaelber D, Pan EC. The value of personal health record (PHR) systems. AMIA Annu Symp Proc 2008; 343-347
  • 5 Tsai R, Bell III EJ, Woo H, Baldwin K, Pfeffer MA. How patients use a patient portal: an institutional case study of demographics and usage patterns. Appl Clin Inform 2019; 10 (01) 96-102
  • 6 Grossman LV, Masterson Creber RM, Ancker JS. , et al. Technology access, technical assistance, and disparities in inpatient portal use. Appl Clin Inform 2019; 10 (01) 40-50
  • 7 Cronin RM, Davis SE, Shenson JA, Chen Q, Rosenbloom ST, Jackson GP. Growth of secure messaging through a patient portal as a form of outpatient interaction across clinical specialties. Appl Clin Inform 2015; 6 (02) 288-304
  • 8 Goldzweig CL, Towfigh AA, Paige NM, et al. Systematic Review: Secure Messaging Between Providers and Patients, and Patients’ Access to Their Own Medical Record: Evidence on Health Outcomes, Satisfaction, Efficiency and Attitudes. Washington (DC): Department of Veterans Affairs (US); 2012
  • 9 Masterman M, Cronin RM, Davis SE, Shenson JA, Jackson GP. Adoption of secure messaging in a patient portal across pediatric specialties. AMIA Annu Symp Proc 2017; 2016: 1930-1939
  • 10 Shenson JA, Cronin RM, Davis SE, Chen Q, Jackson GP. Rapid growth in surgeons' use of secure messaging in a patient portal. Surg Endosc 2016; 30 (04) 1432-1440
  • 11 Walker DM, Gaughan A, Fareed N, Moffatt-Bruce S, McAlearney AS. Facilitating organizational change to accommodate an inpatient portal. Appl Clin Inform 2019; 10 (05) 898-908
  • 12 Zhao JY, Song B, Anand E. , et al. Barriers, facilitators, and solutions to optimal patient portal and personal health record use: a systematic review of the literature. AMIA Annu Symp Proc 2018; 2017: 1913-1922
  • 13 Ancker JS, Mauer E, Kalish RB, Vest JR, Gossey JT. Early adopters of patient-generated health data upload in an electronic patient portal. Appl Clin Inform 2019; 10 (02) 254-260
  • 14 Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc 2006; 13 (02) 121-126
  • 15 Neuner J, Fedders M, Caravella M, Bradford L, Schapira M. Meaningful use and the patient portal: patient enrollment, use, and satisfaction with patient portals at a later-adopting center. Am J Med Qual 2015; 30 (02) 105-113
  • 16 Osborn CY, Rosenbloom ST, Stenner SP. , et al. MyHealthAtVanderbilt: policies and procedures governing patient portal functionality. J Am Med Inform Assoc 2011; 18 (Suppl. 01) i18-i23
  • 17 Steitz B, Cronin RM, Davis SE, Yan E, Jackson GP. Long-term patterns of patient portal use for pediatric patients at an academic medical center. Appl Clin Inform 2017; 8 (03) 779-793
  • 18 Dalal AK, Dykes P, Samal L. , et al. Potential of an electronic health record-integrated patient portal for improving care plan concordance during acute care. Appl Clin Inform 2019; 10 (03) 358-366
  • 19 Carroll JG. Crossing the quality chasm: A new health system for the 21st century. Quality Management in Healthcare 2002;10(04):60–61
  • 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 Kruse CS, Argueta DA, Lopez L, Nair A. Patient and provider attitudes toward the use of patient portals for the management of chronic disease: a systematic review. J Med Internet Res 2015; 17 (02) e40
  • 22 Irizarry T, Shoemake J, Nilsen ML, Czaja S, Beach S, DeVito Dabbs A. Patient portals as a tool for health care engagement: a mixed-method study of older adults with varying levels of health literacy and prior patient portal use. J Med Internet Res 2017; 19 (03) e99
  • 23 Woolf SH, Krist AH, Lafata JE. , et al. Engaging patients in decisions about cancer screening: exploring the decision journey through the use of a patient portal. Am J Prev Med 2018; 54 (02) 237-247
  • 24 Bush RA, Vemulakonda VM, Richardson AC, Deakyne Davies SJ, Chiang GJ. Providing access: differences in pediatric portal activation begin at patient check-in. Appl Clin Inform 2019; 10 (04) 670-678
  • 25 Stein JN, Klein JW, Payne TH. , et al. Communicating with vulnerable patient populations: a randomized intervention to teach inpatients to use the electronic patient portal. Appl Clin Inform 2018; 9 (04) 875-883
  • 26 McAlearney AS, Fareed N, Gaughan A, MacEwan SR, Volney J, Sieck CJ. Empowering patients during hospitalization: perspectives on inpatient portal use. Appl Clin Inform 2019; 10 (01) 103-112
  • 27 Ali SB, Romero J, Morrison K, Hafeez B, Ancker JS. Focus section health IT usability: applying a task-technology fit model to adapt an electronic patient portal for patient work. Appl Clin Inform 2018; 9 (01) 174-184
  • 28 Osborn CY, Mayberry LS, Wallston KA, Johnson KB, Elasy TA. Understanding patient portal use: implications for medication management. J Med Internet Res 2013; 15 (07) e133
  • 29 Lin CT, Wittevrongel L, Moore L, Beaty BL, Ross SE. An Internet-based patient-provider communication system: randomized controlled trial. J Med Internet Res 2005; 7 (04) e47
  • 30 Ross SE, Moore LA, Earnest MA, Wittevrongel L, Lin CT. Providing a web-based online medical record with electronic communication capabilities to patients with congestive heart failure: randomized trial. J Med Internet Res 2004; 6 (02) e12
  • 31 Krist AH, Woolf SH, Rothemich SF. , et al. Interactive preventive health record to enhance delivery of recommended care: a randomized trial. Ann Fam Med 2012; 10 (04) 312-319
  • 32 Wright A, Poon EG, Wald J. , et al. Randomized controlled trial of health maintenance reminders provided directly to patients through an electronic PHR. J Gen Intern Med 2012; 27 (01) 85-92
  • 33 Green BB, Cook AJ, Ralston JD. , et al. Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. JAMA 2008; 299 (24) 2857-2867
  • 34 Ralston JD, Hereford J, Carrell D. Use and satisfaction of a patient Web portal with a shared medical record between patients and providers. AMIA Annu Symp Proc 2006; 1070
  • 35 Tang PC, Overhage JM, Chan AS. , et al. Online disease management of diabetes: engaging and motivating patients online with enhanced resources-diabetes (EMPOWER-D), a randomized controlled trial. J Am Med Inform Assoc 2013; 20 (03) 526-534
  • 36 ONC Office of the National Coordinator for Health Information Technology (ONC). ONC's Cures Act Final Rule supports seamless and secure access, exchange, and use of electronic health information. Available at: https://www.healthit.gov/curesrule/ . Accessed April 11, 2020
  • 37 The Office of the National Coordinator for Health Information Technology (ONC). United States Core Data for Interoperability (USCDI). Available at: https://www.healthit.gov/isa/united-states-core-data-interoperability-uscdi . Accessed April, 11, 2020
  • 38 U.S. Food and Drug Administration (FDA). 21st Century Cures Act. Available at: https://www.fda.gov/regulatory-information/selected-amendments-fdc-act/21st-century-cures-act . Accessed April 11, 2020
  • 39 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
  • 40 Walker J, Darer JD, Elmore JG, Delbanco T. The road toward fully transparent medical records. N Engl J Med 2014; 370 (01) 6-8
  • 41 Klein JW, Peacock S, Tsui JI, O'Neill SF, DesRoches CM, Elmore JG. Perceptions of primary care notes by patients with mental health diagnoses. Ann Fam Med 2018; 16 (04) 343-345
  • 42 Gerard M, Chimowitz H, Fossa A, Bourgeois F, Fernandez L, Bell SK. The importance of visit notes on patient portals for engaging less educated or nonwhite patients: survey study. J Med Internet Res 2018; 20 (05) e191
  • 43 Walker J, Leveille S, Bell S. , et al. OpenNotes after 7 years: patient experiences with ongoing access to their clinicians' outpatient visit notes. J Med Internet Res 2019; 21 (05) e13876
  • 44 Fossa AJ, Bell SK, DesRoches C. OpenNotes and shared decision making: a growing practice in clinical transparency and how it can support patient-centered care. J Am Med Inform Assoc 2018; 25 (09) 1153-1159
  • 45 Walker J, Meltsner M, Delbanco T. US experience with doctors and patients sharing clinical notes. BMJ 2015; 350: g7785
  • 46 Krasowski MD, Grieme CV, Cassady B. , et al. Variation in results release and patient portal access to diagnostic test results at an academic medical center. J Pathol Inform 2017; 8: 45
  • 47 Vanderbilt University Medical Center. Information Privacy and Security. Available at: https://ww2.mc.vanderbilt.edu/InfoPrivacySecurity/17073 . Accessed June 21, 2019
  • 48 University of Iowa Medical Center. May I access my own medical record? Available at: https://medcom.uiowa.edu/theloop/announcements/quest-newsletter-may-i-access-my-own-medical-record . Accessed June 21, 2019
  • 49 Washington U of. Workforce Members Privacy, Confidentiality, and Information Security Agreement For Patient, Confidential, Restricted and Proprietary Information. Available at: http://depts.washington.edu/comply/docs/002_F1.pdf . Accessed June 21, 2019
  • 50 University of Chicago. Summary of HIPAA Privacy & Security Rules. Available at: http://hipaa.bsd.uchicago.edu/SummaryofHIPAAPrivacyandSecurityRules.pdf . Accessed June 21, 2019
  • 51 University of Pittsburgh Medical Center. Privacy and security obligation. Available at: http://www.chp.edu/~/media/chp/about-us/documents/privacy-and-security-obligations.ashx?la=en . Accessed June 21, 2019
  • 52 Care New England. Accessing Your Own EMR. Available at: https://www.brown.edu/academics/medical/about/departments/psychiatry-and-human-behavior/training/sites/brown.edu.academics.medical.about.departments.psychiatry-and-human-behavior.training/files/uploads/CNE-PRIV-009AccessingYourOwnEMR.pdf . Accessed June 21, 2019
  • 53 Detroit Medical Center. Employee condfidentiality form. Available at: https://www.dmc.org/for-health-professionals/employee-confidentiality-form . Accessed June 21, 2019
  • 54 R. Available at: https://www.r-project.org/ . Accessed May 27, 2020
  • 55 Patel V, Johnson C. Individuals’ use of online medical records and technology for health needs. ONC Data Brief. 2018 Apr;40.