Long-term Patterns of Patient Portal Use for Pediatric Patients at an Academic Medical Center
17 January 2017
18 May 2017
20 December 2017 (online)
Background: Patient portal adoption has increased over the last two decades. Most research about patient portals has focused on adult populations in the primary care and medical specialty settings.
Objective: We describe initial and long-term portal use by pediatric patients and their caregivers in a broadly deployed patient portal at an academic medical center.
Methods: We analyzed portal usage for pediatric patients and their caregivers from 2008 to 2014. We recorded usage events with time stamps; user role defined as self, surrogate (i.e., parent or guardian), or delegate; and functions accessed. Usage events were grouped into sessions to calculate descriptive statistics by patient age, user role, and active use over time.
Results: From 2008 to 2014, the number of portal accounts increased from 633 to 17,128. 15.9% of pediatric patients had their own account; 93.6%, a surrogate account; and 2.2% a delegate account. During the study period, 15,711 unique users initiated 493,753 sessions and accessed 1,491,237 functions. Most commonly used functions were secure messaging (accessed in 309,204 sessions; 62.6%); test results (174,239; 35.3%) and appointments (104,830; 21.2%). Function usage was greatest for patients ages 0-2 years (136,245 functions accessed; 23.1%) and 15-17 years (109,241;18.5%). Surrogate users conducted 83.2% of logins for adolescent patients. Portal accounts were actively used for < 1 year for 9,551 patients (55.8%), 1-2 years for 2,826 patients (16.5%), 2–3 years for 1,968 patients (11.5%) and over 3 years for 2,783 patients (16.3%).
Conclusion: Pediatric patients and caregivers have avidly used messaging, test result, and appointment functions. The majority of access was done by surrogates. Adolescent portal usage increased with age. Most accounts for pediatric patients were only used actively for a few years, with peak usage for patients in early childhood and late adolescence.
Citation: Steitz BD, Cronin RM, Davis SE, Yan Z, Jackson GP. Long-term Patterns of Patient Portal Use for Pediatric Patients at an Academic Medical Center. Appl Clin Inform 2017; 8: 779–793 https://doi.org/10.4338/ACI-2017-01-RA-0005
KeywordsPatient portal - Patient engagement - Consumer health informatics - Pediatrics - Electronic health records and systems - Internet Portal
Protection of Human and Animal Subjects
The VUMC IRB approved this study. The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects. Waiver of consent was granted by the IRB for this study involving no more than minimal risk and not adversely affecting the rights and the welfare of relevant individuals.
- 1 Archer N, Fevrier-Thomas U, Lokker C, McKibbon KA, Straus SE. Personal health records: a scoping review. AMIA 2011; 18 (04) 515-22.
- 2 HealthIT.gov: What is a patient portal? [Internet]. 2014 Available from: healthit.gov
- 3 Tang PC, Ash JS, Bates DW, Overhage JM, Sands DZ. Personal Health Records: Definitions, Benefits, and Strategies for Overcoming Barriers to Adoption. AMIA 2006; 13 (02) 121-6.
- 4 Weingart SN, Rind D, Tofias Z, Sands DZ. Who uses the patient internet portal? The PatientSite experience. AMIA 2006; 13 (01) 91-5.
- 5 Nazi KM, Woods SS, Woods SS. MyHealtheVet PHR: a description of users and patient portal use. AMIA Annu Symp Proc; 2008: 1182.
- 6 Kaelber D, Pan EC. The value of personal health record (PHR) systems. AMIA Annu Symp Proc 2008; 343-7.
- 7 Detmer D, Bloomrosen M, Raymond B, Tang P. Integrated personal health records: transformative tools for consumer-centric care. BMC Med Inform Decis Mak. BioMed Central Ltd 2008; 8 (01) 45-14.
- 8 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; 1070-1.
- 9 Goldzweig CL, Towfigh AA, Paige NM, Orshansky G, Haggstrom DA, Beroes JM. 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. Jul 1-63.
- 10 Davis SE, Osborn CY, Kripalani S, Goggins KM, Jackson GP. Health Literacy, Education Levels, and Patient Portal Usage During Hospitalizations. AMIA Annu Symp Proc 2015; 1-10.
- 11 Ross SE, Moore LA, Earnest MA, Wittevrongel L, Lin C-T. 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.
- 12 Lin C-T, 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.
- 13 Krist AH, Woolf SH, Rothemich SF, Johnson RE, Peele JE, Cunningham TD. et al. Interactive Preventive Health Record to Enhance Delivery of Recommended Care: A Randomized Trial. The Annals of Family Medicine 2012; 10 (04) 312-9.
- 14 Wright A, Poon EG, Wald J, Feblowitz J, Pang JE, Schnipper JL. et al. Randomized Controlled Trial of Health Maintenance Reminders Provided Directly to Patients Through an Electronic PHR. J GEN INTERN MED. Springer-Verlag 2011; 27 (01) 85-92.
- 15 Green BB. Effectiveness of Home Blood Pressure Monitoring, Web Communication, and Pharmacist Care on Hypertension Control. JAMA 2008; 299 (24) 2857-20.
- 16 Ralston JD, Hirsch IB, Hoath J, Mullen M, Cheadle A, Goldberg HI. Web-Based Collaborative Care for Type 2 Diabetes: A pilot randomized trial. Diabetes Care 2009; 32 (02) 234-9.
- 17 Tang PC, Overhage JM, Chan AS, Brown NL, Aghighi B, Entwistle MP. et al. Online disease management of diabetes: Engaging and Motivating Patients Online With Enhanced Resources-Diabetes (EM-POWER-D), a randomized controlled trial. AMIA 2013; 20 (03) 526-34.
- 18 Simon GE, Ralston JD, Savarino J, Pabiniak C, Wentzel C, Operskalski BH. Randomized Trial of Depression Follow-Up Care by Online Messaging. J GEN INTERN MED 2011; 26 (07) 698-704.
- 19 Goldzweig CL, Orshansky G, Paige NM, Towfigh AA, Haggstrom DA, Miake-Lye I. et al. Electronic Patient Portals: Evidence on Health Outcomes, Satisfaction, Efficiency, and Attitudes. Ann Intern Med. American College of Physicians 2013; 159 (10) 677-25.
- 20 deLusignan S, Mold F, Sheikh A, Majeed A, Wyatt JC, Quinn T. et al. Patients’ online access to their electronic health records and linked online services: a systematic interpretative review. BMJ Open 2014; 4 (Suppl. 09) e006021-11.
- 21 Thompson LA, Novak M, Schentrup AM. Adolescent Health and the Electronic Health Record: Can it be a social media tool for quality adolescent care?. Adolesc Med State Art Rev 2014; 25 (03) 698-710.
- 22 Bourgeois FC, Taylor PL, Emans SJ, Nigrin DJ, Mandl KD. Whose personal control? Creating private, personally controlled health records for pediatric and adolescent patients. AMIA 2008; 15 (06) 737-743.
- 23 Bush RA, Connelly CD, Fuller M, Pérez A. Implementation of the Integrated Electronic Patient Portal in the Pediatric Population: A Systematic Review. Telemedicine and e-Health. 2015; Aug 10 150810084832003-9.
- 24 Ahlers-Schmidt CR, Nguyen M. Parent intention to use a patient portal as related to their children following a facilitated demonstration. Telemed J E Health 2013; 19 (12) 979-981.
- 25 Bergman DA, Brown NL, Wilson S. Teen Use of a Patient Portal: A Qualitative Study of Parent and Teen Attitudes. Perspectives in Health Information Management / AHIMA, American Health Information Management Association 2008; 5: 13.
- 26 Britto MT, Jimison HB, Munafo JK, Wissman J, Rogers ML, Hersh W. Usability Testing Finds Problems for Novice Users of Pediatric Portals. Journal of the American Medical Informatics Association 2009; 16 (05) 660-669.
- 27 Britto MT, Hesse EA, Kamdar OJ, Munafo JK. Parents’ perceptions of a patient portal for managing their child‘s chronic illness. The Journal of pediatrics 2013; 163 (01) 280-281. e281–282.
- 28 Byczkowski TL, Munafo JK, Britto MT. Family perceptions of the usability and value of chronic disease web-based patient portals. Health informatics journal. 2014; 20 (02) 151-162.
- 29 Fiks AG, Mayne S, Karavite DJ, DeBartolo E, Grundmeier RW. A shared e-decision support portal for pediatric asthma. The Journal of ambulatory care management 2014; 37 (02) 120-126.
- 30 Thompson LA, Martinko T, Budd P, Mercado R, Schentrup AM. Meaningful Use of a Confidential Adolescent Patient Portal. Journal of Adolescent Health 2016; 58 (02) 134-140.
- 31 Hannan A. Providing patients online access to their primary care computerised medical records: a case study of sharing and caring. Inform Prim Care 2010; 18 (01) 41-49.
- 32 Ketterer T, West DW, Sanders VP, Hossain J, Kondo MC, Sharif I. Correlates of patient portal enrollment and activation in primary care pediatrics. Academic pediatrics 2013; 13 (03) 264-271.
- 33 Shaw RJ, Ferranti J. Patient-provider internet portals –patient outcomes and use. Computers, informatics, nursing 2011; 29 (Suppl. 12) 714-718. quiz 719–720.
- 34 Tom JO, Mangione-Smith R, Solomon C, Grossman DC. Integrated personal health record use: association with parent-reported care experiences. Pediatrics 2012; 130 (01) e183-190.
- 35 Byczkowski TL, Munafo JK, Britto MT. Variation in use of Internet-based patient portals by parents of children with chronic disease. Archives of pediatrics & adolescent medicine 2011; 165 (05) 405-411.
- 36 Patient Volumes | Children’s Hospital Vanderbilt [Internet]. Available from: http://www.childrenshospital.vanderbilt.org/guide.php?mid=3101
- 37 Osborn CY, Rosenbloom ST, Stenner SP, Anders S, Muse S, Johnson KB. et al. MyHealthAtVanderbilt: policies and procedures governing patient portal functionality. AMIA 2011; 18 (Suppl. 01) i18-i23.
- 38 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.
- 39 R: A language and environment for statistical computing. 2015. Vienna, Austria.
- 40 Crotty BH, Tamrat Y, Mostaghimi A, Safran C, Landon BE. Patient-to-physician messaging: volume nearly tripled as more patients joined system, but per capita rate plateaued. Health Aff (Millwood) 2014; 33 (10) 1817-1822.
- 41 Tennessee Population Demographics 2017, 2016 [Internet]. Available from: https://suburbanstats.org/population/how-many-people-live-in-tennessee
- 42 Kentucky Population Demographics 2017, 2016 [Internet]. Available from: https://suburbanstats.org/population/how-many-people-live-in-kentucky
- 43 Fiks AG, DuRivage N, Mayne SL, Finch S, Ross ME, Giacomini K. et al. Adoption of a Portal for the Primary Care Management of Pediatric Asthma: A Mixed-Methods Implementation Study. J Med Internet Res 2016; 18 (06) e172
- 44 Wade-Vuturo AE, Mayberry LS, Osborn CY. Secure messaging and diabetes management: experiences and perspectives of patient portal users. AMIA 2013; 20 (03) 519-525.
- 45 Palen TE, Ross C, Powers JD, Xu S. Association of Online Patient Access to Clinicians and Medical Records With Use of Clinical Services. JAMA 2012; 308 (19) 2012-2018.
- 46 Women: Health Care Decision Makers [Internet]. Washington, DC; [cited 2016 Oct 9]. Available from: http://www.nationalpartnership.org/research-library/health-care/aca-enrollment-event-toolkit.pdf
- 47 Masterman M, Cronin RM, Davis SA, Shenson JA, Jackson GP. Adoption of secure messaging in a patient portal across pediatric specialties. Proceedings of the AMIA 2016 Annual Symposium 2016: 1930-39.
- 48 Cronin RM, Fabbri D, Denny JC, Jackson GP. Automated Classification of Consumer Health Information Needs in Patient Portal Messages. AMIA Annu Symp Proc 2015; 2015: 1861-70.
- 49 Robinson JR, Valentine A, Carney C, Fabbri D, Jackson GP. Complexity of medical decision-making in care provided by surgeons through patient portals. Journal of Surgical Research 2017; 214: 93-101.
- 50 Robinson J, Davis SA, Cronin RM, Jackson GP. Use of a patient portal during hospital admissions to surgical services. Proceedings of the AMIA 2016 Annual Symposium 2016: 1967-76.
- 51 American Academy of P, American Academy of Family P, American College of P. Transitions Clinical Report Authoring G, Cooley WC, Sagerman PJ. Supporting the health care transition from adolescence to adulthood in the medical home. Pediatrics 2011; 128 (01) 182-200.