Su salud a la mano (your health at hand): patient perceptions about a bilingual patient portal in the Los Angeles safety net

Abstract

Objectives Driven by beneficial patient-centered outcomes associated with patient portal use and the Affordable Care Act, portal implementation has expanded into safety nets—health systems that offer access to care to a large share of uninsured, Medicaid, and other vulnerable populations. However, little attention has been paid to the factors that affect portal accessibility by the vulnerable patients served by these health systems—including those who are limited English proficient (LEP). Materials and Methods The Los Angeles County Department of Health Services (LAC DHS), the second-largest safety net system in the nation, launched its first patient portal, and one of the few bilingual English-Spanish interfaces in existence, in March of 2015. To explore portal awareness and perceptions, we conducted focus groups with LAC DHS patients, in English and Spanish (LEP). The Technology Acceptance Model was used to guide thematic analysis of focus group data. Results Of the 46 participants, 37 were patients and 9 were caretakers; 23 were English-speaking and 23 Spanish-speaking LEP. All patients had diabetes or hypertension. Over half had an annual household income <$10 000, yet 78% of English-speaking and 65% of Spanish-speaking LEP participants reported at-home Internet access. Participants’ discussion centered around 3 major thematic narratives: (1) participants’ awareness or attitudes about the LAC DHS portal; (2) role of culture, language, or community with regard to portal accessibility and utility; and (3) perceived needs for successful portal implementation. Conclusions Safety net participants identified concrete benefits to the portal and emphasized the need for portal engagement that offered accessible education, support, and resources in clinical and community settings. The portal offers an additional opportunity to engage the patient and family with trusted and validated health information, and should be further developed in this capacity. This study provides a better understanding of preferred improvements of patient portal engagement that guide broader health technology efforts to address electronic health disparities.

Patients, clinicians and open notes: information blocking as a case of epistemic injustice

“…Such designs should encompass notes in multiple languages, and interfaces that allow manually impaired and sight-impaired patients to access and contribute to their clinical notes. 82 The use of tooltips or other design modifications embedded in clinical notes may also facilitate patient understanding of medical or psychotherapy terminology without further compromising the clinician's time and workload. 60 83 Finally, clinical education can play a role in improving practitioners' education about open notes, and the justifications for sharing notes with patients.…”

Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations

“…We conducted focus groups in the summer of 2017 among LAC DHS patients with chronic conditions to better understand perceptions of the portal and to obtain patient-centered recommendations for implementation [ 41 ]. Important themes from these focus groups were that we needed to provide dedicated patient guidance for both portal enrollment and portal navigation.…”

Patient Portal Functionalities and Uptake: Systematic Review Protocol

“…The benefits are often explained through the use of specific functionalities of the portal. For example, patients’ access to the health record with visit notes gives them ability to revisit their notes, which in turn improves their compliance with the care plan set out by the doctor [ 15 , 16 ] and also increases their confidence [ 17 , 18 ]. At the same time, access to the health record or test results gives the patients the chance to instantly and continuously review their record, increasing their knowledge about their condition [ 15 ] and improving their communication with the health care provider through increased ability to discuss their health care condition [ 15 , 16 , 18 ].…”

“…Other functionalities of patient portals such as e-messaging or secure messaging and patient education can improve patients’ involvement in their care [ 15 ] and their knowledge about their disease [ 19 ], respectively. Patients’ ability to refill medication through the portal allows them to efficiently refill medication, reducing the time they spend without medication, and as a consequence may improve their adherence and compliance with medication regime [ 17 , 20 ].…”

“…Research reporting patient portal outcomes can provide valuable evidence if the context and the patient portal functionalities are clearly described and specified [ 6 ], because the context could contribute to the success of the technology. In addition, because patient portal adoption can generally be higher among patients with chronic diseases [ 28 ], the literature focused on studying the patient portal mostly by patient subpopulations such as those with diabetes or hypertension [ 17 ]. It is, therefore, essential to report user characteristics and contextual factors when considering patient portals.…”