Healthcare Team Perceptions of a Portal for Parents of Hospitalized Children Before and After ImplementationFunding This work was supported by a Department of Pediatrics’ Research and Development Grant at the University of Wisconsin School of Medicine and Public Health. This publication was also supported by the Clinical and Translational Science Award (CTSA) program through the National Center for Advancing Translational Sciences (NCATS), grant UL1TR000427. Dr. Hoonakker’s involvement in the study was also partially supported by NSF grant CMMI 1536987.
10 November 2016
Accepted: 09 January 2017
20 December 2017 (online)
Background. Patient electronic health record (EHR) portals can enhance patient and family engagement by providing information and a way to communicate with their healthcare team (HCT). However, portal implementation has been limited to ambulatory settings and met with resistance from HCTs.
Objective. We evaluated HCT perceptions before and 6-months after implementation of an inpatient EHR portal application on a tablet computer given to parents of hospitalized children. Methods. This repeated cross-sectional study was conducted with HCT members (nurses, physicians, ancillary staff) on a medical/surgical unit at a quaternary children’s hospital. From December 2014-June 2015, parents of children <12 years old were given a portal application on a tablet computer. It provided real-time vitals, medications, lab results, schedules, education, HCT information and a way to send the HCT messages/requests. HCT members completed surveys pre- and post-implementation regarding their portal perceptions. Pre-post differences in HCT perceptions were compared using chi-squared, Mann-Whitney and Kruskall Wallis tests.
Results. Pre-implementation, HCT respondents (N=94) were generally optimistic about the benefits of a portal for parents; however, all anticipated challenges to portal use. Over the next 6-months, 296 parents used the portal, sending 176 requests and 36 messages. Post-implementation, HCT respondent (N=70) perceptions of these challenges were significantly reduced (all p<0.001), including: parents (will) have too many questions (69 vs. 3%, pre-post), parents (will) know results before the HCT (65 vs. 1%), staff (would be/are) skeptical (43 vs. 21%) and there (will be/is) not enough technical support (28 vs. 1%).
Conclusions. All HCT respondents anticipated challenges in providing a portal to parents of hospitalized children; however, these concerns were minimized after implementation.
- 1 Stewart M, Brown JB, Donner A, McWhinney IR, Oates J, Weston WW, Jordan J. The impact of patient-centered care on outcomes. The Journal of Family Practice 2000; 49 (Suppl. 09) 796-804.
- 2 Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S. Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ 2001; 323 7318 908-911.
- 3 Maeng DD, Graf TR, Davis DE, Tomcavage J, Bloom Jr FJ. Can a Patient-Centered Medical Home Lead to Better Patient Outcomes? The Quality Implications of Geisinger’s ProvenHealth Navigator. American journal of medical quality : the official journal of the American College of Medical Quality 2012; 27 (Suppl. 03) 210-216.
- 4 Wanzer MB, Booth-Butterfield M, Gruber K. Perceptions of health care providers’ communication: relationships between patient-centered communication and satisfaction. Health Communication 2004; 16 (Suppl. 03) 363-383.
- 5 Wolf DM, Lehman L, Quinlin R, Zullo T, Hoffman L. Effect of patient-centered care on patient satisfaction and quality of care. Journal of Nursing Care Quality 2008; 23 (Suppl. 04) 316-321.
- 6 Committee on Patient Safety and Health Information Technology.. Health IT and Patient Safety: Building Safer Systems for Better Care.. Washington (DC): National Academies Press (US); 2011. Nov.
- 7 Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. Journal of the American Medical Informatics Association: JAMIA 2006; 13 (Suppl. 02) 121-126.
- 8 Schnipper JL, Gandhi TK, Wald JS, Grant RW, Poon EG, Volk LA, Businger A, Siteman E, Buckel L, Middleton B. Design and implementation of a web-based patient portal linked to an electronic health record designed to improve medication safety: the Patient Gateway medications module. Informatics in Primary Care 2008; 16 (Suppl. 02) 147-155.
- 9 Ammenwerth E, Schnell-Inderst P, Hoerbst A. The impact of electronic patient portals on patient care: a systematic review of controlled trials. Journal of Medical Internet Research 2012; 14 (Suppl. 06) e162.
- 10 Goldzweig CL, Orshansky G, Paige NM, Towfigh AA, Haggstrom DA, Miake-Lye I, Beroes JM, Shekelle PG. Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review. Ann Intern Med 2013; 159 (Suppl. 10) 677-687.
- 11 Davis Giardina T, Menon S, Parrish DE, Sittig DF, Singh H. Patient access to medical records and health-care outcomes: a systematic review. Journal of the American Medical Informatics Association: JAMIA 2014; 21 (Suppl. 04) 737-741.
- 12 Kalra D, Fernando B. A review of the empirical evidence of the healthcare benefits of personal health records. Yearbook of Medical Informatics 2013; 8 (Suppl. 01) 93-102.
- 13 Kruse CS, Bolton K, Freriks G. The effect of patient portals on quality outcomes and its implications to meaningful use: a systematic review. Journal of Medical Internet Research 2015; 17 (Suppl. 02) e44.
- 14 Prey JE, Woollen J, Wilcox L, Sackeim AD, Hripcsak G, Bakken S, Restaino S, Feiner S, Vawdrey DK. Patient engagement in the inpatient setting: a systematic review. Journal of the American Medical Informatics Association: JAMIA 2014; 21 (Suppl. 04) 742-750.
- 15 Greysen SR, Khanna RR, Jacolbia R, Lee HM, Auerbach AD. Tablet computers for hospitalized patients: a pilot study to improve inpatient engagement. J Hosp Med 2014; 9 (Suppl. 06) 396-399.
- 16 Vawdrey DK, Wilcox LG, Collins SA, Bakken S, Feiner S, Boyer A, Restaino SW. A tablet computer application for patients to participate in their hospital care. AMIA Annual Symposium Proceedings 2011; 1428-1435.
- 17 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. Journal of the American Medical Informatics Association: JAMIA 2016; 23 (Suppl. 01) 159-165.
- 18 Pell JM, Mancuso M, Limon S, Oman K, Lin CT. Patient access to electronic health records during hospitalization. JAMA Internal Medicine 2015; 175 (Suppl. 05) 856-858.
- 19 Kelly MM, Hoonakker PL, Dean SM. Using an inpatient portal to engage families in pediatric hospital care. Journal of the American Medical Informatics Association: JAMIA 2017; 24 (Suppl. 01) 153-161.
- 20 Miller Jr. DP, Latulipe C, Melius KA, Quandt SA, Arcury TA. Primary Care Providers’ Views of Patient Portals: Interview Study of Perceived Benefits and Consequences. Journal of Medical Internet Research 2016; 18 (Suppl. 01) e8.
- 21 Keplinger LE, Koopman RJ, Mehr DR, Kruse RL, Wakefield DS, Wakefield BJ, Canfield SM. Patient portal implementation: resident and attending physician attitudes. Fam Med 2013; 45 (Suppl. 05) 335-340.
- 22 Wakefield DS, Mehr D, Keplinger L, Canfield S, Gopidi R, Wakefield BJ, Koopman RJ, Belden JL, Kruse R, Kochendorfer KM. Issues and questions to consider in implementing secure electronic patient-provider web portal communications systems. International Journal of Medical Informatics 2010; 79 (Suppl. 07) 469-477.
- 23 Kittler AF, Carlson GL, Harris C, Lippincott M, Pizziferri L, Volk LA, Jagannath Y, Wald JS, Bates DW. Primary care physician attitudes towards using a secure web-based portal designed to facilitate electronic communication with patients. Informatics in Primary Care 2004; 12 (Suppl. 03) 129-138.
- 24 Carayon P, Hoonakker PLT, Cartmill R, Hassol A. Using Health Information Technology (IT) in Practice Redesign: Impact of Health IT on Workflow.. Patient-Reported Health Information Technology and Work-flow. (Prepared by Abt Associates under Contract No. 290-2010-00031I). AHRQ Publication No. 15-0043-EF. Rockville, MD: Agency for Healthcare Research and Quality; May 2015
- 25 Carayon P, Hundt AS, Wetterneck TB. Nurses’ acceptance of Smart IV pump technology. International Journal of Medical Informatics 2010; 79 (Suppl. 06) 401-411.
- 26 Carayon P, Cartmill R, Blosky MA, Brown R, Hackenberg M, Hoonakker P, Hundt AS, Norfolk E, Wetter-neck TB, Walker JM. ICU nurses’ acceptance of electronic health records. Journal of the American Medical Informatics Association: JAMIA 2011; 18 (Suppl. 06) 812-819.
- 27 Hoonakker PL, Carayon P, Brown RL, Cartmill RS, Wetterneck TB, Walker JM. Changes in end-user satisfaction with Computerized Provider Order Entry over time among nurses and providers in intensive care units. Journal of the American Medical Informatics Association: JAMIA 2013; 20 (Suppl. 02) 252-259.
- 28 Karsh BT. Beyond usability: designing effective technology implementation systems to promote patient safety. Quality & Safety in Health Care 2004; 13 (Suppl. 05) 388-394.
- 29 Holden RJ, Karsh BT. The technology acceptance model: its past and its future in health care. Journal of Biomedical Informatics 2010; 43 (Suppl. 01) 159-172.
- 30 Hu PJ, Chau PY. Physician acceptance of telemedicine technology: an empirical investigation. Topics in Health Information Management 1999; 19 (Suppl. 04) 20-35.
- 31 Gagnon MP, Ngangue P, Payne-Gagnon J, Desmartis M. m-Health adoption by healthcare professionals: a systematic review. Journal of the American Medical Informatics Association: JAMIA 2016; 23 (Suppl. 01) 212-220.
- 32 Hoonakker PL, Cartmill RS, Carayon P, Walker JM. Development and Psychometric Qualities of the SEIPS Survey to Evaluate CPOE/EHR Implementation in ICUs. International Journal of Healthcare Information Systems and Informatics 2011; 6 (Suppl. 01) 51-69.
- 33 Cox ED, Carayon P, Hansen KW, Rajamanickam VP, Brown RL, Rathouz PJ, DuBenske LL, Kelly MM, Buel LA. Parent perceptions of children’s hospital safety climate. BMJ Quality & Safety 2013; 22 (Suppl. 08) 664-671.
- 34 Leveille SG, Walker J, Ralston JD, Ross SE, Elmore JG, Delbanco T. Evaluating the impact of patients’ online access to doctors’ visit notes: designing and executing the OpenNotes project. BMC Medical Informatics and Decision Making 2012; 12: 32.
- 35 Delbanco T, Walker J, Darer JD, Elmore JG, Feldman HJ, Leveille SG, Ralston JD, Ross SE, Vodicka E, Weber VD. Open notes: doctors and patients signing on. Ann Intern Med 2010; 153 (Suppl. 02) 121-125.
- 36 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. Applied Clinical Informatics 2015; 6 (Suppl. 02) 288-304.
- 37 Shenson JA, Cronin RM, Davis SE, Chen Q, Jackson GP. Rapid growth in surgeons’ use of secure messaging in a patient portal. Surgical Endoscopy 2016; 30 (Suppl. 04) 1432-1440.
- 38 Kaushal R, Barker KN, Bates DW. How can information technology improve patient safety and reduce medication errors in children’s health care?. Archives of Pediatrics & Adolescent Medicine 2001; 155 (Suppl. 09) 1002-1007.