Download PDF
Appl Clin Inform 2015; 06(02): 288-304
DOI: 10.4338/ACI-2014-12-RA-0117
Research Article
Schattauer GmbH

Growth of Secure Messaging Through a Patient Portal as a Form of Outpatient Interaction across Clinical Specialties

R.M. Cronin
1   Vanderbilt University Medical Center Department of Biomedical Informatics, Nashville, Tennessee
2   Vanderbilt University Medical Center Department of Medicine, Nashville, Tennessee
3   Vanderbilt University Medical Center Department of Pediatrics, Nashville, Tennessee
,
S.E. Davis
1   Vanderbilt University Medical Center Department of Biomedical Informatics, Nashville, Tennessee
,
J.A. Shenson
4   Vanderbilt University Medical Center School of Medicine, Nashville, Tennessee
,
Q. Chen
1   Vanderbilt University Medical Center Department of Biomedical Informatics, Nashville, Tennessee
5   Vanderbilt University Medical Center Department of Biostatistics, Nashville, Tennessee
,
S.T. Rosenbloom
1   Vanderbilt University Medical Center Department of Biomedical Informatics, Nashville, Tennessee
2   Vanderbilt University Medical Center Department of Medicine, Nashville, Tennessee
3   Vanderbilt University Medical Center Department of Pediatrics, Nashville, Tennessee
,
G.P. Jackson
1   Vanderbilt University Medical Center Department of Biomedical Informatics, Nashville, Tennessee
3   Vanderbilt University Medical Center Department of Pediatrics, Nashville, Tennessee
6   Vanderbilt University Medical Center Department of Pediatric Surgery, Nashville, Tennessee
› Author Affiliations
Further Information

Publication History

received: 19 December 2014

accepted: 03 March 2015

Publication Date:
19 December 2017 (online)

Also available at
   Permissions and Reprints

Summary

Objective: Patient portals are online applications that allow patients to interact with healthcare organizations. Portal adoption is increasing, and secure messaging between patients and health-care providers is an emerging form of outpatient interaction. Research about portals and messaging has focused on medical specialties. We characterized adoption of secure messaging and the contribution of messaging to outpatient interactions across diverse clinical specialties after broad portal deployment.

Methods: This retrospective cohort study at Vanderbilt University Medical Center examined use of patient-initiated secure messages and clinic visits in the three years following full deployment of a patient portal across adult and pediatric specialties. We measured the proportion of outpatient interactions (i.e., messages plus clinic visits) conducted through secure messaging by specialty over time. Generalized estimating equations measured the likelihood of message-based versus clinic outpatient interaction across clinical specialties.

Results: Over the study period, 2,422,114 clinic visits occurred, and 82,159 unique portal users initiated 948,428 messages to 1,924 recipients. Medicine participated in the most message exchanges (742,454 messages; 78.3% of all messages sent), followed by surgery (84,001; 8.9%) and obstetrics/gynecology (53,424; 5.6%). The proportion of outpatient interaction through messaging increased from 12.9% in 2008 to 33.0% in 2009 and 39.8% in 2010 (p<0.001). Medicine had the highest proportion of outpatient interaction conducted through messaging in 2008 (23.3% of out-patient interactions in medicine). By 2010, this proportion was highest for obstetrics/gynecology (83.4%), dermatology (71.6%), and medicine (56.7%). Growth in likelihood of message-based interaction was greater for anesthesiology, dermatology, obstetrics/gynecology, pediatrics, and psychiatry than for medicine (p<0.001).

Conclusions: This study demonstrates rapid adoption of secure messaging across diverse clinical specialties, with messaging interactions exceeding face-to-face clinic visits for some specialties. As patient portal and secure messaging adoption increase beyond medicine and primary care, research is needed to understand the implications for provider workload and patient care.

Citation: 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 Inf 2015; 6: 288–304

http://dx.doi.org/10.4338/ACI-2014-12-RA-0117

Keywords

Patient portal - secure messaging - patient engagement - consumer health informatics
 

  • References

  • 1 Patient portal –Wikipedia, the free encyclopedia.. [cited 2014 Sep 4]. Available from: http://en.wikipedia.org/wiki/Patient_portal
    PubMed
  • 2 Archer N, Fevrier-Thomas U, Lokker C, McKibbon KA, Straus SE. Personal health records: a scoping review. J Am Med Inform Assoc JAMIA 2011; 18 (04) 515-522.
    CrossrefPubMedSearch in Google Scholar
  • 3 HealthIT.gov. What is a patient portal? | FAQs | Providers & Professionals | HealthIT.gov. 2014 [cited 2015 Feb 10]. Available from: http://www.healthit.gov/providers-professionals/faqs/what-patient-portal
    PubMed
  • 4 Masys DR, Baker DB. Patient-Centered Access to Secure Systems Online (PCASSO): a secure approach to clinical data access via the World Wide Web. Proc Conf Am Med Inform Assoc AMIA Annu Fall Symp AMIA Fall Symp 1997; 340-343.
    PubMedSearch in Google Scholar
  • 5 Gann B. Giving patients choice and control: health informatics on the patient journey. Yearb Med Inform 2012; 7 (01) 70-73.
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 De Lusignan S, Mold F, Sheikh A, Majeed A, Wyatt JC, Quinn T, Cavill M, Gronlund TA, Franco C, Chauhan U, Blakey H, Kataria N, Barker F, Ellis B, Koczan P, Arvanitis TN, McCarthy M, Jones S, Rafi I. Patients’ online access to their electronic health records and linked online services: a systematic interpretative review. BMJ Open 2014; 4 (09) e006021.
    CrossrefPubMedSearch in Google Scholar
  • 7 Phelps RG, Taylor J, Simpson K, Samuel J, Turner AN. Patients’ continuing use of an online health record: a quantitative evaluation of 14,000 patient years of access data. J Med Internet Res 2014; 16 (10) e241.
    CrossrefPubMedSearch in Google Scholar
  • 8 Woywodt A, Vythelingum K, Rayner S, Anderton J, Ahmed A. Single-centre experience with Renal PatientView, a web-based system that provides patients with access to their laboratory results. J Nephrol 2014; 27 (05) 521-527.
    CrossrefPubMedSearch in Google Scholar
  • 9 Murray J, Majeed A, Khan MS, Lee JT, Nelson P. Use of the NHS Choices website for primary care consultations: results from online and general practice surveys. JRSM Short Rep 2011; 2 (07) 56.
    PubMedSearch in Google Scholar
  • 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 (10) 677-687.
    CrossrefPubMedSearch in Google Scholar
  • 11 Baer D. Patient-physician e-mail communication: the kaiser permanente experience. J Oncol Pract Am Soc Clin Oncol 2011; 7 (04) 230-233.
    PubMedSearch in Google Scholar
  • 12 Chen C, Garrido T, Chock D, Okawa G, Liang L. The Kaiser Permanente Electronic Health Record: transforming and streamlining modalities of care. Health Aff Proj Hope 2009; 28 (02) 323-333.
    PubMedSearch in Google Scholar
  • 13 Cimino JJ, Patel VL, Kushniruk AW. The patient clinical information system (PatCIS): technical solutions for and experience with giving patients access to their electronic medical records. Int J Med Inf 2002; 68 1–3 113-127.
    CrossrefPubMedSearch in Google Scholar
  • 14 Earnest MA, Ross SE, Wittevrongel L, Moore LA, Lin C-T. Use of a patient-accessible electronic medical record in a practice for congestive heart failure: patient and physician experiences. J Am Med Inform Assoc 2004; 11 (05) 410-417.
    CrossrefPubMedSearch in Google Scholar
  • 15 Goldzweig CL, Towfigh AA, Paige NM, Orshansky G, Haggstrom DA, Beroes JM, Miake-Lye I, Shekelle PG. 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 [cited 2015 Feb 13]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK100359
    PubMed
  • 16 Grant RW, Wald JS, Schnipper JL, Gandhi TK, Poon EG, Orav EJ, Williams DH, Volk LA, Middleton B. Practice-linked online personal health records for type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med 2008; 168 (16) 1776-1782.
    CrossrefPubMedSearch in Google Scholar
  • 17 Green BB, Cook AJ, Ralston JD, Fishman PA, Catz SL, Carlson J, Carrell D, Tyll L, Larson EB, Thompson RS. Effectiveness of home blood pressure monitoring, Web communication, and pharmacist care on hypertension control: a randomized controlled trial. JAMA 2008; 299 (24) 2857-2867.
    CrossrefPubMedSearch in Google Scholar
  • 18 Liederman EM, Lee JC, Baquero VH, Seites PG. Patient-physician web messaging. The impact on message volume and satisfaction. J Gen Intern Med 2005; 20 (01) 52-57.
    CrossrefPubMedSearch in Google Scholar
  • 19 Shapochka A. Providers Turn to Portals to Meet Patient Demand, Meaningful Use | Journal of AHIMA. [cited 2014 Sep 30]. Available from: http://journal.ahima.org/2012/08/23/providers-turn-to-portals-to-meet-patient-demand-meaningful-use
    PubMed
  • 20 RCGP-Road-Map.. [cited 2014 Nov 12]. Available from: http://www.rcgp.org.uk/~/media/Files/CIRC/POA/RCGP-Road-Map.ashx
    PubMed
  • 21 The power of information: Putting all of us in control of the health and care information we need.. [cited 2014 Nov 12]. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/213689/dh_134205.pdf
    PubMed
  • 22 Equity and excellence: Liberating the NHS.. [cited 2014 Dec 2]. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/216664/dh_129580.pdf
    PubMed
  • 23 Tang CH, Li CC, Chang GH, Chang P. Implementing a personalized portal combined with workflow management tools used in diabetes care. AMIA Annu Symp Proc 2003; 1026.
    PubMedSearch in Google Scholar
  • 24 Quinn CC, Clough SS, Minor JM, Lender D, Okafor MC, Gruber-Baldini A. WellDoc mobile diabetes management randomized controlled trial: change in clinical and behavioral outcomes and patient and physician satisfaction. Diabetes Technol Ther 2008; 10 (03) 160-168.
    CrossrefPubMedSearch in Google Scholar
  • 25 Nordqvist C, Hanberger L, Timpka T, Nordfeldt S. Health professionals’ attitudes towards using a Web 2.0 portal for child and adolescent diabetes care: qualitative study. J Med Internet Res 2009; 11 (02) e12.
    CrossrefPubMedSearch in Google Scholar
  • 26 Ma C, Warren J, Phillips P, Stanek J. Empowering patients with essential information and communication support in the context of diabetes. Int J Med Inf 2006; 75 (08) 577-596.
    CrossrefPubMedSearch in Google Scholar
  • 27 Bryce CL, Zickmund S, Hess R, McTigue KM, Olshansky E, Fitzgerald K, Fischer G. Value versus user fees: perspectives of patients before and after using a web-based portal for management of diabetes. Telemed J E-Health Off J Am Telemed Assoc 2008; 14 (10) 1035-1043.
    PubMedSearch in Google Scholar
  • 28 Hess R, Bryce CL, Paone S, Fischer G, McTigue KM, Olshansky E, Zickmund S, Fitzgerald K, Siminerio L. Exploring challenges and potentials of personal health records in diabetes self-management: implementation and initial assessment. Telemed J E-Health Off J Am Telemed Assoc 2007; 13 (05) 509-517.
    PubMedSearch in Google Scholar
  • 29 Agrawal A, Mayo-Smith MF. Adherence to computerized clinical reminders in a large healthcare delivery network. Stud Health Technol Inform 2004; 107 Pt 1 111-114.
    PubMedSearch in Google Scholar
  • 30 Grant RW, Wald JS, Poon EG, Schnipper JL, Gandhi TK, Volk LA, Middleton B. Design and implementation of a web-based patient portal linked to an ambulatory care electronic health record: patient gateway for diabetes collaborative care. Diabetes Technol Ther 2006; 8 (05) 576-586.
    CrossrefPubMedSearch in Google Scholar
  • 31 McCarrier KP, Ralston JD, Hirsch IB, Lewis G, Martin DP, Zimmerman FJ, Goldberg HI. Web-based collaborative care for type 1 diabetes: a pilot randomized trial. Diabetes Technol Ther 2009; 11 (04) 211-217.
    CrossrefPubMedSearch in Google Scholar
  • 32 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) 234-239.
    CrossrefPubMedSearch in Google Scholar
  • 33 Sarkar U, Lyles CR, Parker MM, Allen J, Nguyen R, Moffet HH, Schillinger D, Karter AJ. Use of the Refill Function Through an Online Patient Portal is Associated With Improved Adherence to Statins in an Integrated Health System. Med Care 2014; 52 (03) 194-201.
    CrossrefPubMedSearch in Google Scholar
  • 34 Grant RW, Wald JS, Schnipper JL, Gandhi TK, Poon EG, Orav EJ, Williams DH, Volk LA, Middleton B. Practice-linked online personal health records for type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med 2008; 168 (16) 1776-1782.
    CrossrefPubMedSearch in Google Scholar
  • 35 Earnest MA, Ross SE, Wittevrongel L, Moore LA, Lin C-T. Use of a patient-accessible electronic medical record in a practice for congestive heart failure: patient and physician experiences. J Am Med Inform Assoc 2004; 11 (05) 410-417.
    CrossrefPubMedSearch in Google Scholar
  • 36 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.
    CrossrefPubMedSearch in Google Scholar
  • 37 Epstein JN, Langberg JM, Lichtenstein PK, Kolb R, Simon JO. The myADHDportal.com Improvement Program: An innovative quality improvement intervention for improving the quality of ADHD care among community-based pediatricians. Clin Pract Pediatr Psychol 2013; 1 (01) 55-67.
    PubMedSearch in Google Scholar
  • 38 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.
    CrossrefPubMedSearch in Google Scholar
  • 39 Grant RW, Wald JS, Poon EG, Schnipper JL, Gandhi TK, Volk LA, Middleton B. Design and implementation of a web-based patient portal linked to an ambulatory care electronic health record: patient gateway for diabetes collaborative care. Diabetes Technol Ther 2006; 8 (05) 576-586.
    CrossrefPubMedSearch in Google Scholar
  • 40 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. Inform Prim Care 2008; 16 (Suppl. 02) 147-155.
    PubMedSearch in Google Scholar
  • 41 Collmann J, Cooper T. Breaching the security of the Kaiser Permanente Internet patient portal: the organizational foundations of information security. J Am Med Inform Assoc 2007; 14 (02) 239-243.
    CrossrefPubMedSearch in Google Scholar
  • 42 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. American Medical Informatics Association 2006: 871.
    PubMedSearch in Google Scholar
  • 43 Nazi KM, Woods SS. MyHealtheVet PHR: a description of users and patient portal use. AMIA. Annual Symposium proceedings/AMIA Symposium AMIA Symposium 2007: 1182-1182.
    PubMed
  • 44 Epstein JN, Langberg JM, Lichtenstein PK, Kolb R, Altaye M, Simon JO. Use of an Internet portal to improve community-based pediatric ADHD care: a cluster randomized trial. Pediatrics 2011; 128 (05) e1201-e1208.
    CrossrefPubMedSearch in Google Scholar
  • 45 Ketterer T, West DW, Sanders VP, Hossain J, Kondo MC, Sharif I. Correlates of patient portal enrollment and activation in primary care pediatrics. Acad Pediatr 2013; 13 (03) 264-271.
    CrossrefPubMedSearch in Google Scholar
  • 46 North F, Crane SJ, Chaudhry R, Ebbert JO, Ytterberg K, Tulledge-Scheitel SM, Stroebel RJ. Impact of patient portal secure messages and electronic visits on adult primary care office visits. Telemed J E-Health Off J Am Telemed Assoc 2014; 20 (03) 192-198.
    PubMedSearch in Google Scholar
  • 47 Jung C, Padman R, Shevchik G, Paone S. Who are portal users vs. early e-Visit adopters? A preliminary analysis. AMIA Annu Symp Proc AMIA Symp 2011; 2011: 1070-1079.
    PubMedSearch in Google Scholar
  • 48 Hanberger L, Ludvigsson J, Nordfeldt S. Use of a web 2.0 portal to improve education and communication in young patients with families: randomized controlled trial. J Med Internet Res 2013; 15 (08) e175.
    CrossrefPubMedSearch in Google Scholar
  • 49 Cho AH, Arar NH, Edelman DE, Hartwell PH, Oddone EZ, Yancy Jr. WS. Do diabetic veterans use the Internet? Self-reported usage, skills, and interest in using My HealtheVet Web portal. Telemed J E-Health Off J Am Telemed Assoc 2010; 16 (05) 595-602.
    PubMedSearch in Google Scholar
  • 50 Tsai J, Rosenheck RA. Use of the internet and an online personal health record system by US veterans: comparison of Veterans Affairs mental health service users and other veterans nationally. J Am Med Inform Assoc JAMIA 2012; 19 (06) 1089-1094.
    CrossrefPubMedSearch in Google Scholar
  • 51 Burke RP, Rossi AF, Wilner BR, Hannan RL, Zabinsky JA, White JA. Transforming patient and family access to medical information: utilisation patterns of a patient-accessible electronic health record. Cardiol Young 2010; 20 (05) 477-484.
    CrossrefPubMedSearch in Google Scholar
  • 52 Tuil WS, Verhaak CM, Braat DDM, de Vries Robbé PF, Kremer JAM. Empowering patients undergoing in vitro fertilization by providing Internet access to medical data. Fertil Steril 2007; 88 (02) 361-368.
    CrossrefPubMedSearch in Google Scholar
  • 53 Weingart SN, Rind D, Tofias Z, Sands DZ. Who uses the patient internet portal? The PatientSite experience. J Am Med Inform Assoc 2006; 13 (01) 91-95.
    CrossrefPubMedSearch in Google Scholar
  • 54 Haun JN, Lind JD, Shimada SL, Martin TL, Gosline RM, Antinori N, Stewart M, Simon SR. Evaluating user experiences of the secure messaging tool on the Veterans Affairs’ patient portal system. J Med Internet Res 2014; 16 (03) e75.
    CrossrefPubMedSearch in Google Scholar
  • 55 Barnett TE, Chumbler NR, Vogel WB, Beyth RJ, Qin H, Kobb R. The effectiveness of a care coordination home telehealth program for veterans with diabetes mellitus: a 2-year follow-up. Am J Manag Care 2006; 12 (08) 467-474.
    PubMedSearch in Google Scholar
  • 56 Stiles RA, Deppen SA, Figaro MK, Gregg WM, Jirjis JN, Rothman RL, Johnston PE, Miller RA, Dittus RS, Speroff T. Behind-the-scenes of patient-centered care: content analysis of electronic messaging among primary care clinic providers and staff. Med Care 2007; 45 (12) 1205-1209.
    CrossrefPubMedSearch in Google Scholar
  • 57 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 (Suppl. 01) i18-i23.
    CrossrefPubMedSearch in Google Scholar
  • 58 Allphin M. Patient Portals 2013: On Track for Meaningful Use?. KLAS research; 2013 Aug [cited 2004 Sep 17]. Available from: https://www.klasresearch.com/store/ReportDetail.aspx?Productid=844
    PubMed
  • 59 White CB, Moyer CA, Stern DT, Katz SJ. A content analysis of e-mail communication between patients and their providers: patients get the message. J Am Med Inform Assoc 2004; 11 (04) 260-267.
    CrossrefPubMedSearch in Google Scholar
  • 60 Hobbs J, Wald J, Jagannath YS, Kittler A, Pizziferri L, Volk LA, Middleton B, Bates DW. Opportunities to enhance patient and physician e-mail contact. Int J Med Inf 2003; 70 (01) 1-9.
    CrossrefPubMedSearch in Google Scholar
  • 61 McDaniel LS, Henderson NC, Rathouz PJ. Fast Pure R Implementation of GEE: Application of the Matrix Package. R J 2013; 5 (01) 181-187.
    PubMedSearch in Google Scholar
  • 62 Wallwiener M, Wallwiener CW, Kansy JK, Seeger H, Rajab TK. Impact of electronic messaging on the patient-physician interaction. J Telemed Telecare 2009; 15 (05) 243-250.
    CrossrefPubMedSearch in Google Scholar
  • 63 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.
    CrossrefPubMedSearch in Google Scholar
  • 64 Stage2_MeaningfulUseSpecSheet_TableContents_EPs. [cited 2014 Nov 12]. Available from: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_MeaningfulUseSpecSheet_TableContents_EPs.pdf
    PubMed
  • 65 Blumenthal D, Tavenner M. The “meaningful use” regulation for electronic health records. N Engl J Med 2010; 363 (06) 501-504.
    CrossrefPubMedSearch in Google Scholar
  • 66 Roter DL, Larson S, Sands DZ, Ford DE, Houston T. Can e-mail messages between patients and physicians be patient-centered?. Health Commun 2008; 23 (01) 80-86.
    CrossrefPubMedSearch in Google Scholar
  • 67 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.
    PubMedSearch in Google Scholar
  • 68 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) 2012-2019.
    CrossrefPubMedSearch in Google Scholar
  • 69 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.
    CrossrefPubMedSearch in Google Scholar
  • 70 Katz SJ, Moyer CA, Cox DT, Stern DT. Effect of a triage-based E-mail system on clinic resource use and patient and physician satisfaction in primary care: a randomized controlled trial. J Gen Intern Med 2003; 18 (09) 736-744.
    CrossrefPubMedSearch in Google Scholar
  • 71 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.
    CrossrefPubMedSearch in Google Scholar
  • 72 2014 proposed Medicare Physician Fee Schedule –American Academy of Family Physicians (AAFP). [cited 2014 Sep 4]. Available from: http://www.aafp.org/dam/AAFP/documents/advocacy/payment/medi/care/ES-2014ProposedFeeSchedule-071913.pdf
    PubMed
  • 73 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.
    CrossrefPubMedSearch in Google Scholar