No abstract

The University of Pittsburgh Medical Center (UPMC) has implemented a personal health record grounded in the Chronic Care Model, UPMC HealthTrak, to assist patients with diabetes self-management. UPMC HealthTrak is based in the physician office and connects the patient, physician, and electronic medical record (EMR). Its functionalities include secure, electronic communication with the physician's office, along with preventive healthcare reminders, and disease-specific tools and information. In this paper, we describe challenges to office-based implementation of and initial patient reaction to the technology in the context of diabetes care. UPMC has deployed a secure Web-based patient portal, UPMC HealthTrak. We implemented UPMC HealthTrak in the ambulatory setting and assessed its impact on patient-practice communication. We conducted 10 90-minute focus groups (five pre- and five postimplementation) to assess patient reaction to UPMC HealthTrak. Focus groups were analyzed using grounded theory techniques. During the period September 2004-January 2007, there was no significant change in number of patient encounters or telephone calls received in our office, but the number of HealthTrak messages increased. Our 39 pre- and postimplementation focus group participants felt that the system would enhance communication with the office, and that the reminder system would be helpful. They also liked having access to laboratory tests remotely. They were frustrated when tests were not released and messages not answered. A Web-based patient portal can be integrated into a clinical office, although patients may not quickly change communication patterns. Patients are responsive to technology. Future work should focus on diabetes-related outcomes assessment and intensifying interventions.

An important focus for meaningful use criteria is to engage patients in their care by allowing them online access to their health information, including test results. There has been little evaluation of such initiatives. Using a mixed methods analysis of electronic health record data, surveys, and qualitative interviews, we examined the impact of allowing patients to view their test results via patient portal in one large health system. Quantitative data were collected for new users and all users of the patient portal. Qualitative interviews occurred with patients who had received an HbA1c or abnormal Pap result. Survey participants were active patient portal users. Our main measures were patient portal usage, factors associated with viewing test results and utilizing care, and patient and provider experiences with patient portal and direct release. Usage data show 80% of all patient portal users viewed test results during the year. Of survey respondents, 82.7% noted test results to be a very useful feature and 70% agreed that patient portal has made their provider more accessible to them. Interviewed patients reported feeling they should have direct access to test results and identified the ability to monitor results over time and prepare prior to communicating with a provider as benefits. In interviews, both patients and physicians reported instances of test results leading to unnecessary patient anxiety. Both groups noted the benefits of results released with provider interpretation. Quantitative data showed patient utilization to increase with viewing test results online, but this effect is mitigated when results are manually released by physicians. Our findings demonstrate that patient portal access to test results was highly valued by patients and appeared to increase patient engagement. However, it may lead to patient anxiety and increase rates of patient visits. We discuss how such unintended consequences can be addressed and larger implications for meaningful use criteria.

Purpose: There is growing recognition that many physician-patient encounters do not require face-to-face contact. The availability of secure Internet portals creates the opportunity for online eVisits. Increasing numbers of health systems provide eVisits, and many health plans reimburse for eVisits. However, little is known on who chooses to seek care via an eVisit. Materials and Methods: At four primary care practices, we used the electronic medical record to identify all eVisits and office visits for sinusitis and urinary tract infections (UTIs) between January 2010 and May 2011. From the electronic medical record we abstracted the necessary information on patient demographics. The population studied included 5,165 sinusitis visits (9% of which were eVisits) and 2,954 UTI visits (3% eVisits). Results: In multivariate models controlling for other patient factors, the variables most strongly associated with a patient initiating an eVisit versus an office visit were age (18-44 years of age versus 65 years of age and older: sinusitis, odds ratio 1.65 [0.97-2.81]; UTI, 2.97 [1.03-8.62]) and longer travel distance to clinic ( >10 miles from patient home to clinic versus 0-5 miles: sinusitis, odds ratio 6.54 [4.68-9.16]; UTI, odds ratio 3.25 [1.74-6.07]). Higher income was not associated with higher eVisit use. Conclusions: At these four primary care practices, eVisits accounted for almost 7% of visits for sinusitis and UTI. eVisits attract a younger patient population who might use eVisits for convenience reasons.