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DOI: 10.4338/ACI-2016-01-RA-0003
Patient Portals
Who uses them? What features do they use? And do they reduce hospital readmissions?Summary
Background
Patient portals have demonstrated numerous benefits including improved patientprovider communication, patient satisfaction with care, and patient engagement. Recent literature has begun to illustrate how patients use selected portal features and an association between portal usage and improved clinical outcomes.
Objectives
This study sought to: (1) identify patient characteristics associated with the use of a patient portal; (2) determine the frequency with which common patient portal features are used; and (3) examine whether the level of patient portal use (non-users, light users, active users) is associated with 30-day hospital readmission.
Methods
My UNC Chart is the patient portal for the UNC Health Care System. We identified adults discharged from three UNC Health Care hospitals with acute myocardial infarction, congestive heart failure, or pneumonia and classified them as active, light, or non-users of My UNC Chart.
Multivariable analyses were conducted to compare across user groups; logistic regression was used to predict whether patient portal use was associated with 30-day readmission.
Results
Of 2,975 eligible patients, 83.4% were non-users; 8.6% were light users; and 8.0% were active users of My UNC Chart. The messaging feature was used most often. For patients who were active users, the odds of being readmitted within 30 days was 66% greater than patients who were non-users (p<0.05). There was no difference in 30-day readmission between non-users and light users.
Conclusions
The vast majority of patients who were given an access code for My UNC Chart did not use it within 30 days of discharge. Of those who used the portal, active users had a higher odds of being readmitted within 30 days. Health care systems should consider strategies to: (1) increase overall use of patient portals and (2) target patients with the highest comorbidity scores to reduce hospital readmissions.
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Keywords
Electronic health records and systems - personal health records - patient-provider - patient portal - meaningful use
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Conflicts Of Interest
The authors report no conflicts of interests in the research.
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References
- 1 Wade-Vuturo AE, Mayberry LS, Osborn CY. Secure messaging and diabetes management: Experiences and perspectives of patient portal users. Journal of the American Medical Informatics Association. 2013 20. 519-525 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628058/.
- 2 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 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342639/.
- 3 Zhou YY, Kanter MH, Wang JJ, Garrido T. Improved quality at kaiser permanente through e-mail between physicians and patients. Health Affairs. 2010 29. 71370-71375 Available from: http://content.healthaff-airs.org/content/29/7/1370.abstract.
- 4 Goel MS, Brown TL, Williams A, Cooper AJ, Hasnain-Wynia R, Baker DW. Patient reported barriers to enrolling in a patient portal. Journal of the American Medical Informatics Association. 2011 18. i8-i12 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3241181/.
- 5 Krist AH, Woolf SH, Bello GA, Sabo TR, Longo DR, Kashiri P, Etz RS, Loomis J, Rothemich SF, Peele JE, Cohn J. Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record. Ann Fam Med. 2014 12. 418-426 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157978/.
- 6 Emont S. Measuring the Impact of Patient Portals: What the Literature Tells Us. California HealthCare Foundation. 2011 Available from: http://www.chcf.org/publications/2011/05/measuring-impact-patient-portals.
- 7 Wright A, Feblowitz J, Samal L, McCoy AB, Sittig DF. The Medicare Electronic Health Record Incentive Program: Provider Performance on Core and Menu Measures. Health Services Research. 2014 49. 325-346 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24359554.
- 8 Centers for Medicare & Medicaid Services. Stage 2 Eligible Professional Meaningful Use Core and Menu Measures. Available from: http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_MeaningfulUseSpecSheet_TableContents_EPs.pdf.
- 9 Office of the National Coordinator for Health Information Technology. U.S. Adoption of Patient Engagement Functionalities. Available from: http://dashboard.healthit.gov/quickstats/pages/FIG-Hospital-Adoption-of-Patient-Engagement-Functionalities.php.
- 10 Centers for Medicare & Medicaid Services. Electronic Health Record Incentive Program – Stage 3 and Modifications to Meaningful Use in 2015 through. 2017 Available from: https://www.federalregister.gov/articles/2015/10/16/2015–25595/medicare-and-medicaid-programs-electronic-health-record-incentive-program-stage-3-and-modifications#h-105.
- 11 James J. Health Policy Brief: Medicare Hospital Readmissions Reduction Program. Health Affairs. 2013 Available from: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=102.
- 12 Centers for Medicare & Medicaid Services [Internet]. Readmissions Reduction Program. Available from: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmis sions-Reduction-Program.html.
- 13 Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, D.C: National Academy Press; 2001 Available from: https://iom.nationalacademies.org/∼/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf.
- 14 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. e162 Available from: http://www.jmir.org/2012/6/e162/.
- 15 Otte-Trojel T, Bont A, Rundall TG, Klundert J. How outcomes are achieved through patient portals: a realist review. Journal of American Medical Informatics Association. 2013 21. 751-757 Available from: http://jamia.oxfordjournals.org/content/21/4/751.
- 16 Otte-Trojel T, Bont A, Klundert J, Rundall TG. Characteristics of Patient Portals Developed in the Context of Health Information Exchanges: Early Policy Effects of Incentives in the Meaningful Use Program in the United States. J Med Internet Res. 2014 16. e258 Available from: http://www.ncbi.nlm.nih.gov/pmc/ar ticles/PMC4260079/.
- 17 University of North Carolina Health System Annual Report. 2013 Available from: https://www.unchealth care.org/site/aboutus/annualreport2013.pdf.
- 18 Epic. Mobile Applications and Portals: Integrated Personal Health Record. Available from: http://www.epic.com/software-phr.php.
- 19 Charlson ME, Pompei P, Ales KL, MacKenzie RC. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Disease. 1987 40. 373-383 Available from: http://www.ncbi.nlm.nih.gov/pubmed/3558716.
- 20 Murray SB, Bates DW, Ngo L, Ufberg JW, Shapiro NI. Charlson index is associated with one-year mortality in emergency department patients with suspected infection. Journal of Academic Emergency Medicine. 2006 13. 530-536 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16551775.
- 21 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. e75 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961805/.
- 22 Weingart SN, Rind D, Tofias Z, Sands DZ. Who uses the patient internet portal? the PatientSite experience. Journal of the American Medical Informatics Association. 2006 13. 91-95 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380201/.
- 23 Silvestre A, Sue VM, Allen JY. If you build it, will they come? The Kaiser Permanente model of online health care. Health Affairs. 2009 28. 334-344 Available from: http://content.healthaffairs.org/con- tent/28/2/334.full.
- 24 Weinberger M, Oddone EZ, Henderson W. Does increased access to primary care reduce hospital readmissions?. New Engl J Med. 1996 334. 1441-1447 Available from: http://www.nejm.org/doi/full/10.1056/NEJM199605303342206.
- 25 Clemons SK, 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. e44 Available from: http://www.jmir.org/2015/2/e44/.
- 26 Irizarry T, DeVito ADabbs, Curran CR. Patient portals and patient engagement: a state of the science review. J Med Internet Res. 2015 17. e148 Available from: http://www.jmir.org/2015/6/e148/.
- 27 Lyles CR, Sarkar U, Schillinger D, Ralston JD, Allen JY, Nguyen R, Karter AJ. Refilling medications through an online patient portal: consistent improvements in adherence across racial/ethnic groups. J Am Med Inform Assoc. 2015 126. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26335983.
- 28 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. 194-201 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24374412.
- 29 Tenforde M, Nowacki A, Jain A, Hickner J. The association between personal health record use and diabetes quality measures. J Gen Intern Med. 2012 27. 420-424 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304034/.
- 30 Otte-Trojel T, de Bont A, Rundall TG, van de Klundert J. What do we know about developing patient portals? A systematic literature review. J Am Med Inform Assoc. 2015 114. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26335985.
- 31 Dhanireddy S, Walker J, Reisch L, Oster N, Delbanco T, Elmore JG. The urban underserved: attitudes towards gaining full access to electronic medical records. Health Expect. 2014 17. 724-732 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22738155.
- 32 Hassol A, Walker J, Kidder D, Rokita K, Young D, Pierdon S, Deitz D, Kuck S, Ortiz E. Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging. J Am Med Infor Assoc. 2004 11. 505-513 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC524631/.
- 33 Ludwin S, Greysen SR. Use of smartphones and mobile devices in hospitalized patients: Untapped opportunities for inpatient engagement. J Hosp Med. 2015 10. 459-461 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25872902.
Correspondence to:
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References
- 1 Wade-Vuturo AE, Mayberry LS, Osborn CY. Secure messaging and diabetes management: Experiences and perspectives of patient portal users. Journal of the American Medical Informatics Association. 2013 20. 519-525 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628058/.
- 2 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 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4342639/.
- 3 Zhou YY, Kanter MH, Wang JJ, Garrido T. Improved quality at kaiser permanente through e-mail between physicians and patients. Health Affairs. 2010 29. 71370-71375 Available from: http://content.healthaff-airs.org/content/29/7/1370.abstract.
- 4 Goel MS, Brown TL, Williams A, Cooper AJ, Hasnain-Wynia R, Baker DW. Patient reported barriers to enrolling in a patient portal. Journal of the American Medical Informatics Association. 2011 18. i8-i12 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3241181/.
- 5 Krist AH, Woolf SH, Bello GA, Sabo TR, Longo DR, Kashiri P, Etz RS, Loomis J, Rothemich SF, Peele JE, Cohn J. Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record. Ann Fam Med. 2014 12. 418-426 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4157978/.
- 6 Emont S. Measuring the Impact of Patient Portals: What the Literature Tells Us. California HealthCare Foundation. 2011 Available from: http://www.chcf.org/publications/2011/05/measuring-impact-patient-portals.
- 7 Wright A, Feblowitz J, Samal L, McCoy AB, Sittig DF. The Medicare Electronic Health Record Incentive Program: Provider Performance on Core and Menu Measures. Health Services Research. 2014 49. 325-346 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24359554.
- 8 Centers for Medicare & Medicaid Services. Stage 2 Eligible Professional Meaningful Use Core and Menu Measures. Available from: http://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_MeaningfulUseSpecSheet_TableContents_EPs.pdf.
- 9 Office of the National Coordinator for Health Information Technology. U.S. Adoption of Patient Engagement Functionalities. Available from: http://dashboard.healthit.gov/quickstats/pages/FIG-Hospital-Adoption-of-Patient-Engagement-Functionalities.php.
- 10 Centers for Medicare & Medicaid Services. Electronic Health Record Incentive Program – Stage 3 and Modifications to Meaningful Use in 2015 through. 2017 Available from: https://www.federalregister.gov/articles/2015/10/16/2015–25595/medicare-and-medicaid-programs-electronic-health-record-incentive-program-stage-3-and-modifications#h-105.
- 11 James J. Health Policy Brief: Medicare Hospital Readmissions Reduction Program. Health Affairs. 2013 Available from: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=102.
- 12 Centers for Medicare & Medicaid Services [Internet]. Readmissions Reduction Program. Available from: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmis sions-Reduction-Program.html.
- 13 Institute of Medicine, Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, D.C: National Academy Press; 2001 Available from: https://iom.nationalacademies.org/∼/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf.
- 14 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. e162 Available from: http://www.jmir.org/2012/6/e162/.
- 15 Otte-Trojel T, Bont A, Rundall TG, Klundert J. How outcomes are achieved through patient portals: a realist review. Journal of American Medical Informatics Association. 2013 21. 751-757 Available from: http://jamia.oxfordjournals.org/content/21/4/751.
- 16 Otte-Trojel T, Bont A, Klundert J, Rundall TG. Characteristics of Patient Portals Developed in the Context of Health Information Exchanges: Early Policy Effects of Incentives in the Meaningful Use Program in the United States. J Med Internet Res. 2014 16. e258 Available from: http://www.ncbi.nlm.nih.gov/pmc/ar ticles/PMC4260079/.
- 17 University of North Carolina Health System Annual Report. 2013 Available from: https://www.unchealth care.org/site/aboutus/annualreport2013.pdf.
- 18 Epic. Mobile Applications and Portals: Integrated Personal Health Record. Available from: http://www.epic.com/software-phr.php.
- 19 Charlson ME, Pompei P, Ales KL, MacKenzie RC. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Disease. 1987 40. 373-383 Available from: http://www.ncbi.nlm.nih.gov/pubmed/3558716.
- 20 Murray SB, Bates DW, Ngo L, Ufberg JW, Shapiro NI. Charlson index is associated with one-year mortality in emergency department patients with suspected infection. Journal of Academic Emergency Medicine. 2006 13. 530-536 Available from: http://www.ncbi.nlm.nih.gov/pubmed/16551775.
- 21 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. e75 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3961805/.
- 22 Weingart SN, Rind D, Tofias Z, Sands DZ. Who uses the patient internet portal? the PatientSite experience. Journal of the American Medical Informatics Association. 2006 13. 91-95 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380201/.
- 23 Silvestre A, Sue VM, Allen JY. If you build it, will they come? The Kaiser Permanente model of online health care. Health Affairs. 2009 28. 334-344 Available from: http://content.healthaffairs.org/con- tent/28/2/334.full.
- 24 Weinberger M, Oddone EZ, Henderson W. Does increased access to primary care reduce hospital readmissions?. New Engl J Med. 1996 334. 1441-1447 Available from: http://www.nejm.org/doi/full/10.1056/NEJM199605303342206.
- 25 Clemons SK, 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. e44 Available from: http://www.jmir.org/2015/2/e44/.
- 26 Irizarry T, DeVito ADabbs, Curran CR. Patient portals and patient engagement: a state of the science review. J Med Internet Res. 2015 17. e148 Available from: http://www.jmir.org/2015/6/e148/.
- 27 Lyles CR, Sarkar U, Schillinger D, Ralston JD, Allen JY, Nguyen R, Karter AJ. Refilling medications through an online patient portal: consistent improvements in adherence across racial/ethnic groups. J Am Med Inform Assoc. 2015 126. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26335983.
- 28 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. 194-201 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24374412.
- 29 Tenforde M, Nowacki A, Jain A, Hickner J. The association between personal health record use and diabetes quality measures. J Gen Intern Med. 2012 27. 420-424 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304034/.
- 30 Otte-Trojel T, de Bont A, Rundall TG, van de Klundert J. What do we know about developing patient portals? A systematic literature review. J Am Med Inform Assoc. 2015 114. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26335985.
- 31 Dhanireddy S, Walker J, Reisch L, Oster N, Delbanco T, Elmore JG. The urban underserved: attitudes towards gaining full access to electronic medical records. Health Expect. 2014 17. 724-732 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22738155.
- 32 Hassol A, Walker J, Kidder D, Rokita K, Young D, Pierdon S, Deitz D, Kuck S, Ortiz E. Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging. J Am Med Infor Assoc. 2004 11. 505-513 Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC524631/.
- 33 Ludwin S, Greysen SR. Use of smartphones and mobile devices in hospitalized patients: Untapped opportunities for inpatient engagement. J Hosp Med. 2015 10. 459-461 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25872902.