Patient portal readiness among postpartum patients in a safety net setting
04 December 2016
21 April 2017
20 December 2017 (online)
Background: Maternity patients interact with the healthcare system over an approximately ten-month interval, requiring multiple visits, acquiring pregnancy-specific education, and sharing health information among providers. Many features of a web-based patient portal could help pregnant women manage their interactions with the healthcare system; however, it is unclear whether pregnant women in safety-net settings have the resources, skills or interest required for portal adoption.
Objectives: In this study of postpartum patients in a safety net hospital, we aimed to: (1) determine if patients have the technical resources and skills to access a portal, (2) gain insight into their interest in health information, and (3) identify the perceived utility of portal features and potential barriers to adoption.
Methods: We developed a structured questionnaire to collect demographics from postpartum patients and measure use of technology and the internet, self-reported literacy, interest in health information, awareness of portal functions, and perceived barriers to use. The questionnaire was administered in person to women in an inpatient setting.
Results: Of the 100 participants surveyed, 95% reported routine internet use and 56% used it to search for health information. Most participants had never heard of a patient portal, yet 92% believed that the portal functions were important. The two most appealing functions were to check results and manage appointments.
Conclusions: Most participants in this study have the required resources such as a device and familiarity with the internet to access a patient portal including an interest in interacting with a healthcare institution via electronic means. Pregnancy is a critical episode of care where active engagement with the healthcare system can influence outcomes. Healthcare systems and portal developers should consider ways to tailor a portal to address the specific health needs of a maternity population including those in a safety net setting.
Citation: Wieland D, Gibeau A, Dewey C, Roshto M, Frankel H. Patient portal readiness among postpartum patients in a safety net setting. Appl Clin Inform 2017; 8: 698–709 https://doi.org/10.4338/ACI-2016-12-RA-0204
KeywordsPatient portal - patient engagement - prenatal care - meaningful use - electronic medical records
Protection of Human Subjects
This study was approved by the Albert Einstein College of Medicine Institutional Review Board and given exempt status.
- 1 Hamilton BE, Martin JA, Osterman MJK. Births: Preliminary Data for 2015. National Vital Statistics Reports; 2016 65. (3). Hyattsville, MD: National Center for Healthcare Statistics. 2015. Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_03.pdf
- 2 American Academy of Pediatrics and American College of Obstetricians and Gynecologists. 2012 Guidelines for perinatal care. Elk Grove Village, IL:: American Academy of Pediatrics..
- 3 Fox S, Duggan M. Pew Research Center Health Online. 2013 Available at http://www.pewinternet.org/files/old-media//Files/Reports/PIP_HealthOnline.pdf
- 4 Kontos E, Blake KD, Chou WYS, Prestin A. Predictors of eHealth Usage: Insights on the Digital Divide from the Health Information Trends Survey 2012. J Med Internet Res 2014; 16 (07) e172.
- 5 “HITECH Ace Enforcement Interim Final Rule.” https://www.hhs.gov/hipaa/for-professionals/special-topics/HITECH-act-enforcement-interim-final-rule/ Accessed Dec 1, 2016.
- 6 Office of the National Coordinator. What is a patient portal? URL: http://www.healthit.gov/providers-professionals/faqs/what-patient-portal [accessed November 2016] [WebCite Cache].
- 7 Carrell D, Ralston JD. Variation in Adoption Rates of a Patient Web Portal with a Shared Medical Record by Age, Gender, and Morbidity Level. AMIA Annual Symposium Proceedings 2006; 2006: 871.
- 8 Zhou YY, Garrido T, Chin HL, Wiesenthal AM, Liang LL. Patient access to an electronic health record with secure messaging: impact on primary care utilization. Am J Manag Care 2007; 13 (07) 418-424.
- 9 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.
- 10 Griffin A, Skinner A, Thornhill J, Weinberger M. Patient portals: Who uses them? What features do they use? And do they reduce readmissions?. Appl Clin Inform 2016; 7: 489-501.
- 11 Sarkar U, Karter AJ, Liu JY, Adler NE, Nguyen R, Lopez A, Schillinger D. The Literacy Divide: Health Literacy and the Use of an Internet-Based Patient Portal in an Integrated Health System—Results from the Diabetes Study of Northern California (DISTANCE). J Health Comm 2010; 15 (02) 183-196.
- 12 Goel MS, Brown TL, Williams A, Hasnain-Wynia R, Thompson J, Baker DW. Disparities in Enrollment and Use of an Electronic Patient Portal. J Gen Intern Med 2011; 26 (10) 1112-1116.
- 13 Goldzweig CL, Orshansky G, Paige NM. Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review. Ann Intern Med 2013; 159 (10) 677-687.
- 14 Ancker JS, Barrón Y, Rockoff ML, Hauser D, Pichardo M, Szerencsy A, Calman N. Use of an Electronic Patient Portal Among Disadvantaged Populations. J Gen Intern Med 2011; 26 (10) 1117-1123.
- 15 Irizarry T, Dabbs AD, Curran CR. Patient Portals and Patient Engagement: A State of the Science Review. J Med Internet Res 2015; 17 (06) e148.
- 16 Hilton JF, Barkoff L, Chang O, Halperin L, Ratanawongsa N, Sarkar U, Leykin Y, Munoz RF, Thorn DH, Kahn JS. A Cross-Sectional Study of Barriers to Personal Health Record Use among Patients Attending a Safety-Net Clinic. PLoS ONE 2012; 7 (02) e31888.
- 17 Goel MS, Brown TL, Williams A, Cooper AJ, Hasnain-Wynia R, Baker DW. Patient reported barriers to enrolling in a patient portal. J Am Med Inform Assoc 2011; 18: i8-i12.
- 18 Dhanireddy S, Walker J, Reisch L, Oster N, Delbanco T, Elmore JG. The urban underserved: attitudes toward gaining full access to electronic medical records. Health Expect 2014; 17 (05) 725-732.
- 19 Chew LD, Bradley KA, Boyko EJ. Brief questions to identify patients with inadequate health literacy. Fam Med 2004; 36 (08) 588-594.
- 20 Nelson DE, Kreps GL, Hesse BW, Croyle RT, Willis G, Arora NK, Rimer B, Viswanath KV, Weinstein N, Alden S. The Health Information National Trends Survey (HINTS): development, design, and dissemination. J Health Commun 2004; 9 (05) 443-460.
- 21 Lyles C, Allen JY, Poole D, Tieu L, Kanter MH, Garrido T. I want to keep the personal relationship with my doctor: Understanding barriers to portal use among African Americans and Latinos. J Med Internet Res 2016; 18 (10) e263.
- 22 Schickedanz A, Huang D, Lopez A, Cheung E, Lyles CR, Bodenheimer T, Sarkar U. Access, interest, and attitudes toward electronic communication for health care among patients in the medical safety net. J Gen Intern Med 2013; 28 (07) 914-920.
- 23 Saunders MR, Winters P, Fortuna RJ, Mendoza M, Berliant M, Clark L, Fiscella K. Internet access and patient portal readiness among patients in a group of inner-city safety-net practices. J Ambulatory Care Manage 2013; 36 (03) 251-259.
- 24 Hawley G, Janamian T, Jackson C, Wilkinson SA. In a maternity shared-care environment, what do we know about the paper hand-held and electronic health record: a systematic literature review. BMC Pregnancy and Childbirth 2014; 14: 52.
- 25 Hawley G, Jackson C, Hepworth J, Wilkinson SA. Sharing of clinical data in a maternity setting: How do paper hand-held records and electronic health records compare for completeness?. BMC Health Services Research 2014; 14: 650.
- 26 Shaw E, Howard M, Chan D, Waters H, Kaczorowski J, Price D, Zazulak J. Access to Web-Based Personalized Antenatal Health Records for Pregnant Women: A Randomized Controlled Trial. J Obstet Gynaecol Can 2008; 30 (01) 38-43.
- 27 Forster M, Dennison K, Callen J, Georgiou A, Westbrook J. I. Maternity patients’ access to their electronic medical records: use and perspectives of a patient portal. Health Information Management Journal 2015; 44 (01) 4-11.
- 28 Wallace LS, Angier H, Huguet N, Gaudino JA, Krist A, Dearing M, Killerby M, Marino M, DeVoe JE. Patterns of Electronic Portal Use among Vulnerable Patients in a Nationwide Practice-based Research Network: From the OCHIN Practice-based Research Network (PBRN). Journal of the American Board of Family Medicine: JABFM 2016; 29 (05) 592-603.
- 29 Osborn CY, Rosenbloom ST, Stenner SP, Anders S, Muse S, Johnson KB, Jirjis J, Jackson GP. MyHealthAt-Vanderbilt: policies and procedures governing patient portal functionality. J Am Med Inform Assoc 2011; 18: i18-i23.
- 30 American Academy of Pediatrics. Recommendations for preventive pediatric healthcare. Available from https://www.aap.org/en-us/documents/periodicity_schedule.pdf Accessed March 19, 2017.