Patient Engagement Using a Patient Portal in a Clinical Research Hospital

Abstract

United States spending on healthcare is astronomical. Nearly 66% of the costs are attributable to patients with multiple chronic conditions (U.S. Department of Health and Human Services, 2014) and the estimated costs of cancer may reach $158 billion by 2020 (Mariotto, Yabroff, Shao, Feuer & Brown, 2011). It is vital to address any avenue that can decrease these costs and improve outcomes. Meanwhile, growth of adult internet usage from 2000 to 2015 increased from 52% to 84% (Perrin & Duggan, 2015). According to Fox and Duggan (2013) from the Pew Research Center, 59% of adults use the internet to find health information with 53% actually talking to their providers to validate their online findings. Furthermore, 41% of adults are using the internet as a diagnostic tool to self-diagnose and getting confirmation from their provider. This is not surprising considering two-thirds of Americans have a smartphone and the less-advantaged are more likely to be dependent on their smartphone with 62% using their phones to look up health information (Smith, 2015). In 2009, the American Recovery and Reinvestment Act (ARRA) was signed and part of this act was the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act authorized the Meaningful Use (MU) program which encourages the widespread adoption EHRs by offering financial incentives and technical assistance to healthcare org that use EHR “meaningfully” (Meaningful Use [MU]) —that is, the use of certified EHR technology. The goal of MU is to improve quality, safety, efficiency, and reduce health disparities; engage patients and families; improve care coordination, population and public health; and maintain the privacy and security of patient health information (Conway, 2013, paragraph 4). One way patients can access their health information and engage with healthcare providers is through the patient portal (The Office of the National Coordinator, 2015). Patient portals have evolved from simple online tools to access clinical documentation to more robust applications where the patients and caregivers can interact using a secure communication channel (eMessaging) and send requests for medical appointments and medication refills. Many healthcare organizations are using portals as an additional means to engage their patients and deliver quality care. The Centers for Medicare & Medicaid Services (CMS, 2016) describe patient engagement as a collaborative partnership between the patient and care team that may improve outcomes. According to the Agency for Healthcare Research and Quality (AHRQ, 2013), patient satisfaction and outcomes are influenced by patient engagement. The purpose of this scholarly project was to implement and evaluate the impact of an updated patient portal on the patient experience and portal utilization in a clinical research hospital. The project took place in a medium-sized academic medical center dedicated to clinical investigation. This clinical research hospital treats a relatively high number of patients with chronic disease and cancer. There was a patient portal that was implemented in 2013, but it had very limited functionality that allowed patients to only view visit summaries, discharge instructions, and some lab results. There were 14,833 registered portal participants who used the original portal, however, only 3,881 were active users. The hospital implemented a new, more robust portal in 2017. Besides the ability to access multiple organizational portals from one portal, the new portal offers a mobile application and more importantly, secure health messaging and improved visit not usability. The potential significance with this implementation is improved engagement, communication, and patient satisfaction.