scholarly journals Assessment of Patients’ Ability to Review Electronic Health Record Information to Identify Potential Errors: Cross-sectional Web-Based Survey

10.2196/19074 ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. e19074
Author(s):  
Lisa Freise ◽  
Ana Luisa Neves ◽  
Kelsey Flott ◽  
Paul Harrison ◽  
John Kelly ◽  
...  
Keyword(s):  
Information Exchange ◽  
Personal Health Information ◽  
Free Text ◽  
Patient Portal ◽  
Medical Terminology ◽  
Framework Analysis ◽  
Cross Sectional ◽  
Web Based ◽  
Patient Reported ◽  
Electronic Health

Background Sharing personal health information positively impacts quality of care across several domains, and particularly, safety and patient-centeredness. Patients may identify and flag up inconsistencies in their electronic health records (EHRs), leading to improved information quality and patient safety. However, in order to identify potential errors, patients need to be able to understand the information contained in their EHRs. Objective The aim of this study was to assess patients’ perceptions of their ability to understand the information contained in their EHRs and to analyze the main barriers to their understanding. Additionally, the main types of patient-reported errors were characterized. Methods A cross-sectional web-based survey was undertaken between March 2017 and September 2017. A total of 682 registered users of the Care Information Exchange, a patient portal, with at least one access during the time of the study were invited to complete the survey containing both structured (multiple choice) and unstructured (free text) questions. The survey contained questions on patients’ perceived ability to understand their EHR information and therefore, to identify errors. Free-text questions allowed respondents to expand on the reasoning for their structured responses and provide more detail about their perceptions of EHRs and identifying errors within them. Qualitative data were systematically reviewed by 2 independent researchers using the framework analysis method in order to identify emerging themes. Results A total of 210 responses were obtained. The majority of the responses (123/210, 58.6%) reported understanding of the information. The main barriers identified were information-related (medical terminology and knowledge and interpretation of test results) and technology-related (user-friendliness of the portal, information display). Inconsistencies relating to incomplete and incorrect information were reported in 12.4% (26/210) of the responses. Conclusions While the majority of the responses affirmed the understanding of the information contained within the EHRs, both technology and information-based barriers persist. There is a potential to improve the system design to better support opportunities for patients to identify errors. This is with the aim of improving the accuracy, quality, and timeliness of the information held in the EHRs and a mechanism to further engage patients in their health care.

scholarly journals Patients’ Ability to Review Electronic Health Record Information to Identify Potential Errors: A Pilot Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Lisa Freise ◽  
Ana Luisa Neves ◽  
Kelsey Flott ◽  
Paul Harrison ◽  
John Kelly ◽  
...  
Keyword(s):  
Information Exchange ◽  
Online Survey ◽  
Personal Health Information ◽  
Free Text ◽  
Patient Portal ◽  
Medical Terminology ◽  
Framework Analysis ◽  
User Friendliness ◽  
Cross Sectional ◽  
Electronic Health

BACKGROUND Sharing personal health information positively impacts quality of care across several domains, and particularly safety and patient-centeredness. Patients when reading their electronic health records (EHRs) may identify and flag up inconsistencies, leading to improved information quality and patient safety. However, in order to identify potential errors, patients need to be able to understand the information contained in their electronic records. OBJECTIVE This study assesses patients’ ability to identify errors present in their EHRs. Specifically, it evaluates the degree to which patients comprehend the information in their EHRs, what barriers exist to their understanding, and what, if any, errors patients can identify when given access to their EHRs. METHODS A cross-sectional online survey was undertaken between March 2017 and September 2017. A total of 682 registered users of the Care Information Exchange patient portal, with at least one access during the time of the study, were invited to complete the survey containing both structured (multiple choice) and unstructured (free-text) questions. The survey contained questions on patients’ perceived ability to understand their EHR information and therefore to identify errors. Free-text questions allowed respondents to expand on the reasoning behind their structured responses and provide more detail about their perceptions of EHRs and identifying errors within them. Qualitative data was systematically reviewed by two independent researchers using the framework analysis method, in order to identify emerging themes. RESULTS A total of 160 participants completed the survey (response rate=23.5%). The majority of participants (68.7%) reported they understood the information. The main barriers identified were information-related (medical terminology and knowledge, and interpretation of test results) and technology-related (user-friendliness of the portal, information display). Participants identified inconsistencies relating to incomplete and incorrect information in 14% of their records. CONCLUSIONS While the majority of patients reportedly understand the information contained within their EHRs, both technology and information-based barriers persist. There is a potential to improve system design to better support opportunities for patients to identify errors. This is with the aim of improving the accuracy, quality and timeliness of the information held in the EHRs and also a mechanism to further engage patients in their heath and healthcare. CLINICALTRIAL Not applicable

scholarly journals Patient-Reported Use of the After Visit Summary in a Primary Care Internal Medicine Practice

2019 ◽  
Vol 7 (5) ◽  
pp. 703-707
Author(s):  
Sarita Pathak ◽  
Gregory Summerville ◽  
Celia P Kaplan ◽  
Sarah S Nouri ◽  
Leah S Karliner
Keyword(s):  
Primary Care ◽  
Multivariable Analysis ◽  
Free Text ◽  
Primary Care Visit ◽  
Communication Tool ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Visit ◽  
Patient Reported ◽  
Communication Errors

Participants completed a cross-sectional survey about their use of the after visit summary (AVS) at a previous primary care visit. Of 355 participants, 294 (82.8%) recalled receiving it, 67.4% consulted it, 45.9% consulted it more than once, and 31.6% shared the AVS. In multivariable analysis, higher education and older age were associated with AVS consultation. Among the subset of 133 patients recalling personalized free-text instructions, 96% found them easy to understand and 94.4% found them useful. Our findings suggest that the AVS is a useful communication tool and improvement efforts should emphasize clarity for those most vulnerable to communication errors.

scholarly journals Assessing the Content Validity of a New Patient-Reported Measure of Barriers to Antiretroviral Therapy Adherence for Electronic Administration in Routine HIV Care: Proposal for a Web-Based Delphi Study (Preprint)

2018 ◽  
Author(s):  
Kim Engler ◽  
Sara Ahmed ◽  
David Lessard ◽  
Serge Vicente ◽  
Bertrand Lebouché
Keyword(s):  
Antiretroviral Therapy ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Free Text ◽  
Art Adherence ◽  
Web Based ◽  
Specific Patient ◽  
Patient Reported ◽  
Electronic Administration ◽  
Oriented Research

BACKGROUND Adherence to lifesaving antiretroviral therapy (ART) for HIV infection remains a challenge for many patients. Routine screening for barriers to ART adherence could help make HIV care more patient-centered and prevent virologic rebound or failure. Our team is currently developing a new HIV-specific patient-reported outcome measure (PROM) of these barriers for use in Canada and France along with a digital app for its electronic administration. In our previous work, we developed the PROM’s multidimensional conceptual framework and generated 100 English items, which have been translated to French. OBJECTIVE This study aims to use a Web-based Delphi to help validate and select the content of this new HIV-specific PROM, based on the perspective of anglophone and francophone patients and providers in Canada and France. Here, we present the proposal for this Delphi. METHODS This modified Delphi will involve a diverse panel of patients (n=32) and providers (n=52) recruited especially from the 9 sites of the PROM development study (site locations in Canada: Montreal, Toronto, Vancouver; in France: Paris, Nantes, Clermont-Ferrand, Saint-Martin, Cayenne). Overall, 2 rounds of Web-based questionnaires will be conducted. The threshold for consensus is set at 60% and will determine which items are carried forward to the second round. Per item, 3 aspects will be rated: importance as a barrier to ART adherence, relevance for HIV care, and clarity. In both rounds, space will be available for free text comments. Overall comprehensiveness will be assessed in the second round. RESULTS This study has undergone a methodological review by experts in patient-oriented research. It has received approval from a research ethics board of the McGill University Health Centre. It is financially supported, in part, by the Canadian Institutes of Health Research’s Strategy for Patient-Oriented Research-Quebec Support Unit (M006). As of May 21, 2019, 15 people living with HIV and 25 providers completed the first round of the Delphi (24 from Canada and 16 from France). CONCLUSIONS To our knowledge, this is the first Delphi to seek consensus on the most relevant and clinically actionable barriers to ART adherence, collecting opinions on an extensive list of barriers. Drawing on a relatively large and diverse panel of HIV patients and providers, it essentially engages key stakeholders in decision making about the PROM’s final content, helping to ensure its utility and adoption. INTERNATIONAL REGISTERED REPOR PRR1-10.2196/12836

scholarly journals Evaluating the Structural Reform of Outpatient Psychotherapy in Germany (ES-Rip Trial) - A Qualitative Study of Provider Perspectives

2021 ◽  
Author(s):  
Poß-Doering Regina ◽  
Hegelow Martin ◽  
Borchers Milena ◽  
Hartmann Mechthild ◽  
Kruse Johannes ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Intrinsic Motivation ◽  
Rural Areas ◽  
Information Exchange ◽  
Structural Reform ◽  
Framework Analysis ◽  
Outpatient Psychotherapy ◽  
Psychotherapeutic Treatment ◽  
Cross Sectional ◽  
Provider Perspectives

Abstract Background: Access to outpatient mental healthcare can be challenging for patients. In Germany, a national structural reform was implemented in 2017 to accelerate and enhance access to outpatient psychotherapy and reduce waiting times. During the first phase of the study ’Evaluation of a structural reform of the outpatient psychotherapy guideline (ES-RiP)’ and embedded into a process evaluation, the implementation was to be evaluated through assessing general practitioners’ (GPs) and psychotherapists’ (PTs) perspectives regarding utilization of provided new measures, and perceived potential for optimization. Particular focus was on patients with a comorbidity of mental disorders and chronic physical conditions (cMPs). Methods: This exploratory cross-sectional qualitative study used on-site and online focus group discussions and semi-structured open-ended telephone interviews with GPs and outpatient PTs. Generated data were analyzed using thematic framework analysis. Descriptive statistics were used to analyze participant characteristics collected via a socio-demographic questionnaire. Results: Perspectives on the structural reform were heterogenous. GPs and PTs considered the component of timely initial psychotherapeutic assessment consultations beneficial. GPs disapproved of their deficits in detailed information about the structural reform and exchange with outpatient PTs. Improvement suggestions included structured short information exchange and joint quality circles. The overall number of available outpatient PTs in rural areas was perceived as insufficient. For patients with cMPs, GPs saw patient barriers for therapy access and continuity in low intrinsic motivation, physical impediments and older age. PTs also saw patient challenges regarding low intrinsic motivation and keeping scheduled appointments. They considered post-reform administrative efforts to be high and reported that the regulations (conformity) lead to planning difficulties and financial losses. Reform elements were tailored to fit in with PTs key therapy areas. Stronger networking and joint lectures were suggested as remedy for the currently still limited exchange with GPs. Unlike the GPs, PTs emphasized that accepting patients into psychotherapeutic treatment was independent of a possibly present chronic physical disease.Conclusions: The findings contribute to understanding the integration of the delivered structural reform into daily care processes and provides an indication about reached targets and potential improvements. Further phases of the ES-RiP study can build on the findings and broaden insights. Trial registration: Registration-ID DRKS00020344 (DRKS German Register of Clinical Trials; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020344)

scholarly journals Understanding of and Barriers to Electronic Health Record Patient Portal Access in a Culturally Diverse Pediatric Population (Preprint)

2018 ◽  
Author(s):  
Daniel J Miklin ◽  
Sameera S Vangara ◽  
Alan M Delamater ◽  
Kenneth W Goodman
Keyword(s):  
Culturally Diverse ◽  
Parental Education ◽  
Pediatric Population ◽  
Patient Portal ◽  
Cross Sectional Survey ◽  
Adult Care ◽  
Cross Sectional ◽  
Parental Education Level ◽  
Doctor Patient Communication ◽  
Electronic Health

BACKGROUND Electronic health records (EHRs) have become a standard in the health care setting. In an effort to improve health literacy, foster doctor-patient communication, and ease the transition from adolescent to adult care, our institution created a policy that allows patients aged between 13 and 17 years to have EHR portal access. A literature review revealed predictable differences in portal registration among different ethnicities and socioeconomic statuses. Consequently, a cross-sectional survey was developed to investigate barriers to EHR portal access in a sample of culturally diverse adolescents. OBJECTIVE The aim of this study was to assess for barriers to EHR portal access in a culturally diverse adolescent population. METHODS A 42-item anonymous survey was completed by 97 adolescents aged between 13 and 18 years, attending general pediatrics clinics. The results were analyzed using descriptive statistics and t tests. RESULTS The average participant age was 15.5 (SD 1.5) years with 60% (58/97) male and 40% (39/97) female. Participants were 44% (43/97) black, 41% (40/97) Hispanic, 9% (9/97) Caucasian, 3% (3/97) Asian, and 2% (2/97) others. There were statistically significant differences in perceptions of confidentiality in age (13 to 15 years vs 16 to 18 years; P=.001) and insurance status (government vs private; P=.012) but not in gender, ethnicity, or parental education level. Younger adolescents with governmental insurance were more confident in the level of confidentiality with their physician. A total of 94% of participants had heard of the term EHR, but only 55% were familiar with its function. Furthermore, 77% of patients primarily accessed the internet through phones, and 50% of participants knew that patients aged under 18 years could obtain care for mental health, substance abuse, sexual health, and pregnancy. CONCLUSIONS This research has identified gaps in EHR technology with regard to the pediatric patient population. The results of our survey show that adolescents may have misconceptions regarding the doctor-patient relationship, their ability to obtain care, and the modalities present in an EHR. As technology progresses, it is essential to have a deeper understanding of adolescents’ perceptions of confidentiality, technology, and available resources to design an EHR system that encourages patient education and communication while limiting barriers to care.

scholarly journals Capturing a Patient-Reported Measure of Physical Function Through an Online Electronic Health Record Patient Portal in an Ambulatory Clinic: Implementation Study (Preprint)

2017 ◽  
Author(s):  
Jing Li ◽  
Jinoos Yazdany ◽  
Laura Trupin ◽  
Zara Izadi ◽  
Milena Gianfrancesco ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Physical Function ◽  
Patient Reported Outcomes ◽  
Health Record ◽  
Patient Portal ◽  
Rheumatology Clinic ◽  
Patient Reported ◽  
Physical Function Score ◽  
Electronic Health ◽  
White Patients

BACKGROUND Despite significant interest in the collection of patient-reported outcomes to make care more patient-centered, few studies have evaluated implementation efforts to collect patient-reported outcomes from diverse patient populations OBJECTIVE We assessed the collection of patient-reported outcomes from rheumatoid arthritis patients in an academic rheumatology clinic, using a paper and an online form through the electronic health record patient portal. METHODS We identified patients seen between 2012-2016 with ≥2 face-to-face encounters with a rheumatology provider and International Classification of Diseases codes for RA, ≥30 days apart. In 2013, our clinic implemented a paper version of the Patient Reported Outcome Measurement Information System (PROMIS) physical function form that was administered to patients upon their check-in at the clinic. In 2015, an online version of the form became available by way of the electronic health record patient portal to patients with active portal accounts. We compared the proportion of visits with documented PROMIS scores across age, race and ethnicity, and language and examined trends over time using a control chart. RESULTS We included 1078 patients with rheumatoid arthritis with 7049 in-person encounters at the rheumatology clinic over 4 years, with an average of 168 visits per month. Of the included patients, 80.4% of patients (867/1078) were female and the mean age was 58 (SD 16) years. The overall PROMIS physical function score documentation increased from 60.4% (1081/1791) of visits in 2013 to 74.4% (905/1217) of visits in 2016. Online score documentation increased from 10.0% (148/1473) in 2015 to 19.3% (235/1217) in 2016. African American patients were least likely to have a PROMIS physical function score recorded (55/88, 62.5% compared to 792/990, 80.0% for other racial or ethnic groups; P<.001). Compared with white patients, both African American and Hispanic patients were less likely to have active online electronic health record portal accounts (44/88, 50% and 90/157, 57.3% respectively, compared to 437/521, 83.9% of white patients; P<.001) and, once activated, less likely to use the online survey (6/44, 13.6% and 16/90, 17.8% respectively, compared to 135/437, 30.9% of white patients; P=.02). There was no significant difference in the proportion of any PROMIS physical function forms recorded between non-English vs English preferred patients. No significant differences were found across age or gender. CONCLUSIONS PROMIS physical function form completion improved overall from 2012-2016 but lagged among racial and ethnic minorities and non-English preferred patients. Future studies should address issues of portal access, enrollment, satisfaction, and persistence and focus on developing PRO implementation strategies that accommodate the needs and preferences of diverse populations.

scholarly journals Computer-assisted textual analysis of free-text comments in the Swiss Cancer Patient Experiences (SCAPE) survey

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chantal Arditi ◽  
Diana Walther ◽  
Ingrid Gilles ◽  
Saphir Lesage ◽  
Anne-Claude Griesser ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Cancer Care ◽  
Textual Analysis ◽  
Questionnaire Development ◽  
Patient Experiences ◽  
Computer Assisted ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Patient Reported

Abstract Background Patient experience surveys are increasingly conducted in cancer care as they provide important results to consider in future development of cancer care and health policymaking. These surveys usually include closed-ended questions (patient-reported experience measures (PREMs)) and space for free-text comments, but published results are mostly based on PREMs. We aimed to identify the underlying themes of patients’ experiences as shared in their own words in the Swiss Cancer Patient Experiences (SCAPE) survey and compare these themes with those assessed with PREMs to investigate how the textual analysis of free-text comments contributes to the understanding of patients’ experiences of care. Methods SCAPE is a multicenter cross-sectional survey that was conducted between October 2018 and March 2019 in French-speaking parts of Switzerland. Patients were invited to rate their care in 65 closed-ended questions (PREMs) and to add free-text comments regarding their cancer-related experiences at the end of the survey. We conducted computer-assisted textual analysis using the IRaMuTeQ software on the comments provided by 31% (n = 844) of SCAPE survey respondents (n = 2755). Results We identified five main thematic classes, two of which consisting of a detailed description of ‘cancer care pathways’. The remaining three classes were related to ‘medical care’, ‘gratitude and praise’, and the way patients lived with cancer (‘cancer and me’). Further analysis of this last class showed that patients’ comments related to the following themes: ‘initial shock’, ‘loneliness’, ‘understanding and acceptance’, ‘cancer repercussions’, and ‘information and communication’. While closed-ended questions related mainly to factual aspects of experiences of care, free-text comments related primarily to the personal and emotional experiences and consequences of having cancer and receiving care. Conclusions A computer-assisted textual analysis of free-text in our patient survey allowed a time-efficient classification of free-text data that provided insights on the personal experience of living with cancer and additional information on patient experiences that had not been collected with the closed-ended questions, underlining the importance of offering space for comments. Such results can be useful to inform questionnaire development, provide feedback to professional teams, and guide patient-centered initiatives to improve the quality and safety of cancer care.

scholarly journals Using the Computer-based Health Evaluation System (CHES) to support self-management of symptoms and functional health: Evaluation of hematological patients’ usage of a web-based patient portal (Preprint)

2020 ◽  
Author(s):  
Jens Lehmann ◽  
Petra Buhl ◽  
Johannes M Giesinger ◽  
Lisa M Wintner ◽  
Monika Sztankay ◽  
...  
Keyword(s):  
Evaluation System ◽  
Functional Health ◽  
Self Management ◽  
Health Evaluation ◽  
Patient Portal ◽  
Structured Interviews ◽  
Patient Portals ◽  
Web Based ◽  
Patient Reported ◽  
Hospital Visits

BACKGROUND Patient portals offer the possibility to assess patient-reported outcome measures (PROMs) remotely and first evidence has demonstrated their potential benefits. OBJECTIVE In this study, we evaluated patients’ use of a web-based patient portal where patients can complete PROMs. The portal was developed to supplement routine monitoring at the Department of Internal Medicine V in Innsbruck. METHODS We included patients with cancer who were already participating in the monitoring at the hospital for usage of the patient portal. Patients were introduced to the portal and asked to complete questionnaires prior to their next hospital visits. We used system access logs and three consecutive semi-structured interviews to analyze patients’ usage and evaluation of the portal. RESULTS Between July 2017 and August 2020, we approached N=122 patients for participation in the study, of whom n=102 (83.6%) consented to use the patient portal. Patients were on average 60 (SD 10.4) years old. Of n=71 patients providing data at all study time points, n=26 (36.6%) patients consistently used the portal prior to their hospital visits. During an average session, patients viewed 5.3 different pages and spent 9.4 minutes logged on to the portal. Feedback from interviews was largely positive with no patients reporting difficulties navigating the survey and 50% of patients valuing the self-management tools provided in the portal. CONCLUSIONS Our study demonstrates how a patient portal can complement a routine PROM implementation at the hospital by reducing the burden of administration for the clinical team and offering an additional way for patients to engage with PROMs.

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