Patient Portal Messaging for Asynchronous Virtual Care During the COVID-19 Pandemic: Retrospective Analysis

Huang, Ming; Khurana, Aditya; Mastorakos, George; Wen, Andrew; He, Huan; Wang, Liwei; Liu, Sijia; Wang, Yanshan; Zong, Nansu; Prigge, Julie; Costello, Brian A.; Shah, Nilay D.; Ting, Henry H.; Fan, Jungwei; Patten, Christi A.; Liu, Hongfang

doi:10.2196/35187

Cited by 20 publications

(23 citation statements)

References 36 publications

(39 reference statements)

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“…20 Nearly half of the articles in this review were published between 2020 and 2022, perhaps reflecting increased interest and use of the patient portal during the pandemic. 74,75 However, we found no temporal difference in care partners' use of the patient portal in more recent years. Our results suggest that, despite expanded functionality and use of the patient portal, shared and proxy portal registration and use remain limited.…”

Section: Discussioncontrasting

confidence: 58%

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Patient Portals to Support Care Partner Engagement in Adolescent and Adult Populations

et al. 2022

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ImportanceFamily and other unpaid care partners may bridge accessibility challenges in interacting with the patient portal, but the extent and nature of this involvement is not well understood.ObjectiveTo inform an emerging research agenda directed at more purposeful inclusion of care partners within the context of digital health equity by (1) quantifying care partners’ uptake and use of the patient portal in adolescent and adult patients, (2) identifying factors involving care partners’ portal use across domains of the System Engineering Initiative for Patient Safety model, and (3) assessing evidence of perceived or actual outcomes of care partners’ portal use.Evidence ReviewFollowing Arksey and O’Malley’s methodologic framework, a scoping review of manuscripts published February 1 and March 22, 2022, was conducted by hand and a systematic search of PubMed, PsycInfo, Embase, and Web of Science. The search yielded 278 articles; 125 were selected for full-text review and 41 were included.FindingsFew adult patient portal accounts had 1 or more formally registered care partners (&lt;3% in 7 of 7 articles), but care partners commonly used the portal (8 of 13 contributing articles reported &gt;30% use). Care partners less often authored portal messages with their own identity credentials (&lt;3% of portal messages in 3 of 3 articles) than with patient credentials (20%-60% of portal messages in 3 of 5 articles). Facilitators of care partner portal use included markers of patient vulnerability (13 articles), care partner characteristics (15 articles; being female, family, and competent in health system navigation), and task-based factors pertaining to ease of information access and care coordination. Environmental (26 articles) and process factors (19 articles, eg, organizational portal registration procedures, protection of privacy, and functionality) were identified as influential to care partner portal use, but findings were nuanced and precluded reporting on effects. Care partner portal use was identified as contributing to both patient and care partner insight into patient health (9 articles), activation (7 articles), continuity of care (8 articles), and convenience (6 articles).Conclusions and RelevanceIn this scoping review, care partners were found to be infrequently registered for the patient portal and more often engaged in portal use with patient identity credentials. Formally registering care partners for the portal was identified as conferring potential benefits for patients, care partners, and care quality.

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Section: Discussioncontrasting

confidence: 58%

“…Nearly half of the articles in this review were published between 2020 and 2022, perhaps reflecting increased interest and use of the patient portal during the pandemic . However, we found no temporal difference in care partners’ use of the patient portal in more recent years.…”

Section: Discussionmentioning

confidence: 57%

Patient Portals to Support Care Partner Engagement in Adolescent and Adult Populations

et al. 2022

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“…Many patients report positive SARS-CoV-2 test results to clinicians via patient-initiated EHR messages. When message responses are delayed due to increased EHR message burden, treatment windows may be missed . Oral antiviral therapies may decrease hospitalization, long-term sequelae, and death but have only been studied and authorized for use within 5 days of symptom onset .…”

Section: Introductionmentioning

confidence: 99%

Use of Natural Language Processing of Patient-Initiated Electronic Health Record Messages to Identify Patients With COVID-19 Infection

Mermin-Bunnell,

Zhu,

Hornback

et al. 2023

JAMA Netw Open

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ImportanceNatural language processing (NLP) has the potential to enable faster treatment access by reducing clinician response time and improving electronic health record (EHR) efficiency.ObjectiveTo develop an NLP model that can accurately classify patient-initiated EHR messages and triage COVID-19 cases to reduce clinician response time and improve access to antiviral treatment.Design, Setting, and ParticipantsThis retrospective cohort study assessed development of a novel NLP framework to classify patient-initiated EHR messages and subsequently evaluate the model’s accuracy. Included patients sent messages via the EHR patient portal from 5 Atlanta, Georgia, hospitals between March 30 and September 1, 2022. Assessment of the model’s accuracy consisted of manual review of message contents to confirm the classification label by a team of physicians, nurses, and medical students, followed by retrospective propensity score–matched clinical outcomes analysis.ExposurePrescription of antiviral treatment for COVID-19.Main Outcomes and MeasuresThe 2 primary outcomes were (1) physician-validated evaluation of the NLP model’s message classification accuracy and (2) analysis of the model’s potential clinical effect via increased patient access to treatment. The model classified messages into COVID-19–other (pertaining to COVID-19 but not reporting a positive test), COVID-19-positive (reporting a positive at-home COVID-19 test result), and non–COVID-19 (not pertaining to COVID-19).ResultsAmong 10 172 patients whose messages were included in analyses, the mean (SD) age was 58 (17) years; 6509 patients (64.0%) were women and 3663 (36.0%) were men. In terms of race and ethnicity, 2544 patients (25.0%) were African American or Black, 20 (0.2%) were American Indian or Alaska Native, 1508 (14.8%) were Asian, 28 (0.3%) were Native Hawaiian or other Pacific Islander, 5980 (58.8%) were White, 91 (0.9%) were more than 1 race or ethnicity, and 1 (0.01%) chose not to answer. The NLP model had high accuracy and sensitivity, with a macro F1 score of 94% and sensitivity of 85% for COVID-19–other, 96% for COVID-19–positive, and 100% for non–COVID-19 messages. Among the 3048 patient-generated messages reporting positive SARS-CoV-2 test results, 2982 (97.8%) were not documented in structured EHR data. Mean (SD) message response time for COVID-19–positive patients who received treatment (364.10 [784.47] minutes) was faster than for those who did not (490.38 [1132.14] minutes; P = .03). Likelihood of antiviral prescription was inversely correlated with message response time (odds ratio, 0.99 [95% CI, 0.98-1.00]; P = .003).Conclusions and RelevanceIn this cohort study of 2982 COVID-19–positive patients, a novel NLP model classified patient-initiated EHR messages reporting positive COVID-19 test results with high sensitivity. Furthermore, when responses to patient messages occurred faster, patients were more likely to receive antiviral medical prescription within the 5-day treatment window. Although additional analysis on the effect on clinical outcomes is needed, these findings represent a possible use case for integration of NLP algorithms into clinical care.

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“…A person's ability to use digital tools has emerged as a critical determinant of the quality of health care received, yet clinicians lack accessible and standardized digital health assessment tools. Existing tools assess mobile phone adoption and internet access [6] and digital literacy [7] and the use of patient electronic health record messaging systems (or patient portal) has also been used as a proxy for digital access and fluency/facility [1,8]. Census tract-level data can also determine residential broadband connections [9].…”

Section: Introductionmentioning

confidence: 99%

Development and initial cognitive testing of the Digital Equity Screening Tool (DEST): Community participatory approach to assessing digital inequality

Sharma¹,

Patten²,

Tilburt³

et al. 2022

J. Clin. Trans. Sci.

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Patient Portal Messaging for Asynchronous Virtual Care During the COVID-19 Pandemic: Retrospective Analysis

Cited by 20 publications

References 36 publications

Patient Portals to Support Care Partner Engagement in Adolescent and Adult Populations

Patient Portals to Support Care Partner Engagement in Adolescent and Adult Populations

Use of Natural Language Processing of Patient-Initiated Electronic Health Record Messages to Identify Patients With COVID-19 Infection

Development and initial cognitive testing of the Digital Equity Screening Tool (DEST): Community participatory approach to assessing digital inequality

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