Accessing Patient Electronic Health Record Portals Safely Using Social Credentials: Case Study (Preprint)

2021 ◽  
Author(s):  
Spencer SooHoo ◽  
Michelle Keller ◽  
Harold Moyse ◽  
Benjamin Robbins ◽  
Matthew McLaughlin ◽  
...  
Keyword(s):  
Social Identity ◽  
Medical Center ◽  
Patient Portal ◽  
Patient Records ◽  
Patient Portals ◽  
Single Sign On ◽  
Single File ◽  
Electronic Health ◽  
The One ◽  
Federated Identity

BACKGROUND Patient portals for electronic health records are becoming increasingly prevalent and important, allowing users to communicate with clinicians, access labs and test results, schedule vaccination appointments, and track health conditions. Their use requires another set of logins and passwords, which can become increasingly unwieldy as patients have records at multiple institutions. Social credentials (e.g. Google, Facebook) are often used in the private sector to allow users to log into websites and can reduce password burden. OBJECTIVE The objective of the Single-FILE (Single Federated Identity Login for EHR) project was to test the feasibility and acceptability of implementing social credentials into a portal for patients with records at two institutions, Cedars-Sinai Medical Center (CSMC) and the California Rehabilitation Institute (CalRehab). METHODS We provided a portal that allowed patients to use a federated identity to access to multiple EHR patient portals with a single sign-on. The federated identity could be either a social identity (Google or Facebook) or one created and managed within Single-FILE. Binding the federated identity to the patient’s EHR identities was performed by confirming the patient had a valid EHR portal login and sending a one-time passcode to a telephone (SMS text or voice) that was stored in the EHR. This step reduced the risk that the binding was being performed with stolen EHR portal credentials since the one-time passcode was being sent a device that was already registered in the EHR. After the binding, the patient could use their federated identity to access their EHR portals at both CSMC and CalRehab. To evaluate the feasibility and acceptability, we recruited patients and/or their caregivers from CalRehab who were (1) 18 years and older, (2) had patient records at both CSMC and CalRehab. Next, we signed up patients onto the Single-FILE portal and connected their patient records. A short qualitative interview was conducted to assess interest and use of the patient portal. Thirty days after sign-up, we called the patients and reviewed use logs to measure use of the Single-FILE portal. RESULTS We enrolled 8 patients and/or their caregivers (spouses or siblings) into the study. Eight patients and/or their caregivers were interviewed at CalRehab, Patients enrolled were predominantly White (88%) and non-Hispanic (62%). Patients noted that they appreciated only having to remember one login as part of Single-FILE and being able to sign up through Facebook. However, we did not see use of Single-FILE by patients after they signed up. CONCLUSIONS The implementation of Single-FILE demonstrated that it is possible to safely bind a social identity to an EHR identity. The use of the one-time passcode sent to the patient’s EHR phone number provides a high degree of confidence that the binding is valid. However, we did not see use by patients of the Single-FILE portal after signup. We hypothesize that patients typically use the patient portal when they receive an email/text from the site that an appointment is upcoming, lab results are available, etc., which then takes them directly to the portal and not to Single-FILE. In other words, use of the patient portal is typically reactive rather than proactive, which limited the use of Single-FILE. Despite this limitation, we found that Single-FILE demonstrated a patient can use an identity they are comfortable with (i.e. social identity and associated credentials) to safely ease the friction associated with access to EHR data.

scholarly journals Analysis of Employee Patient Portal Use and Electronic Health Record Access at an Academic Medical Center

2020 ◽  
Vol 11 (03) ◽  
pp. 433-441 ◽  
Author(s):  
Lina Sulieman ◽  
Bryan Steitz ◽  
S. Trent Rosenbloom
Keyword(s):  
Electronic Health Record ◽  
Medical Center ◽  
Academic Medical Center ◽  
Health Data ◽  
Health Record ◽  
Patient Portal ◽  
Patient Portals ◽  
Clinical Notes ◽  
Usage Patterns ◽  
Electronic Health

Abstract Background Patient portals provide patients and their caregivers online access to limited health results. Health care employees with electronic health record (EHR) access may be able to view their health information not available in the patient portal by looking in the EHR. Objective In this study, we examine how employees use the patient portal when they also have access to the tethered EHR. Methods We obtained patient portal and EHR usage logs corresponding to all employees who viewed their health data at our institution between January 1, 2013 and November 1, 2017. We formed three cohorts based on the systems that employees used to view their health data: employees who used the patient portal only, employees who viewed health data in the EHR only, and employees who used both systems. We compared system accesses and usage patterns for each employee cohort. Results During the study period, 35,172 employees accessed the EHR as part of patients' treatment and 28,631 employees accessed their health data: 25,193 of them used the patient portal and 13,318 accessed their clinical data in EHR. All employees who accessed their records in the EHR viewed their clinical notes at least once. Among EHR accesses, clinical note accesses comprised more than 42% of all EHR accesses. Provider messaging and appointment scheduling were the most commonly used functions in the patient portal. Employees who had access to their health data in both systems were more likely to engage with providers through portal messages. Conclusion Employees at a large medical center accessed clinical notes in the EHR to obtain information about their health. Employees also viewed other health data not readily available in the patient portal.

scholarly journals Policies and procedures governing patient portal use at an Academic Medical Center

JAMIA Open ◽  
2019 ◽  
Vol 2 (4) ◽  
pp. 479-488
Author(s):  
Bryan D Steitz ◽  
Joseph Isaac S Wong ◽  
Jared G Cobb ◽  
Brian Carlson ◽  
Gaye Smith ◽  
...  
Keyword(s):  
Government Regulation ◽  
Medical Center ◽  
Academic Medical Center ◽  
Successful Implementation ◽  
Patient Portal ◽  
Patient Portals ◽  
Identity Verification ◽  
Policies And Procedures ◽  
Academic Medical ◽  
And Function

Abstract Background and Objective Patient portal use has increased over the last two decades in response to consumer demand and government regulation. Despite growing adoption, few guidelines exist to direct successful implementation and governance. We describe the policies and procedures that have governed over a decade of continuous My Health at Vanderbilt (MHAV) patient portal use. Methods We examined MHAV usage data between May 2007 and November 2017. We classified patient portal activity into eight functional categories: Appointment, Billing, Document Access, Genetics, Health Result, Immunization, Medication, and Messaging. We describe our operating policies and measure portal uptake, patient account activity, and function use over time. Results By the end of the study period, there were 375 517 registered accounts. Policies made MHAV available to competent adults and adolescents 13 and over. Patients signed up for a limited access account online, which could be upgraded to a full-access account after identity verification. Patients could assign proxy accounts to family and caregivers, which permitted nonpatient access to select MHAV functions. Laboratory and radiology results were accessible via MHAV. Results were classified into three groups based on sensitivity, which govern the length of delay before results appeared in MHAV. Discussion and Conclusion Patient portals offer significant opportunity to engage patients in their healthcare. However, there remains a need to understand how policies can promote uptake and use. We anticipate that other institutions can apply concepts from our policies to support meaningful patient portal engagement.

Electronic Health Record Patient Portals and the Blockchain Technology

2021 ◽  
pp. 218-227
Author(s):  
Jorge Tavares
Keyword(s):  
Medical Information ◽  
Healthcare Providers ◽  
Appointment Scheduling ◽  
Health Record ◽  
Patient Portal ◽  
Patient Portals ◽  
Blockchain Technology ◽  
Electronic Health ◽  
Implementation Of Ehr ◽  
E Mail

The electronic health records (EHR) patient portals are an integrated eHealth technology that combines an EHR system and a patient portal, giving patients access to their medical records, exam results, and services, such as appointment scheduling, notification systems, and e-mail access to their physician. EHR patient portals empower patients to carry out self-management activities and facilitate communication with healthcare providers, enabling the patient and healthcare provider to access the medical information quickly. Worldwide governmental initiatives have aimed to promote the use of EHR patient portals. The implementation of EHR patient portals encompasses several challenges, including security, confidentiality concerns, and interoperability between systems. New technological approaches like blockchain could address these issues and enable a successful worldwide implementation of EHR patient portals.

OP140 Adult Patient Access To Electronic Health Records

2019 ◽  
Vol 35 (S1) ◽  
pp. 32-32
Author(s):  
Petra Schnell-Inderst ◽  
Stefanie Neyer ◽  
Alexander Hörbst ◽  
Gerhard Müller ◽  
Uwe Siebert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cochrane Review ◽  
Patient Empowerment ◽  
Significant Risk ◽  
Study Groups ◽  
Composite Score ◽  
Patient Portal ◽  
Patient Portals ◽  
Health Related ◽  
Electronic Health

IntroductionIn order to facilitate patient information, patient involvement, and to support patient-centered care, healthcare organizations are increasingly offering access to patient data that are stored in the institution-specific electronic health record (EHR). Patients can access these data, read, and print them, or download and integrate them into any type of patient-held record. This EHR access is typically web-based and called “patient portal” allowing the independent access via the Internet from everywhere. A patient portal may also offer additional features such as prescription requests, appointment booking, messaging, personal health-related reminders, individual therapeutic recommendations, personal diaries, and social networking with other patients. In a Cochrane review, we assessed the effects of providing access to EHR for adult patients on patient empowerment and health-related outcomes compared to usual care.MethodsAccording to the methods of evidence-based medicine, we developed a protocol for a Cochrane review, which is published in the Cochrane database.ResultsWe identified ten randomized controlled trials (RCTs) including 6,668 randomized participants. Seven RCTs took place in the USA, two in Canada, and one in Japan. Additional functionalities of interventions and disease conditions were heterogeneous. Three studies (n = 601) reported on patient empowerment. The risk differences reported were neither statistically significant nor clinically relevant. Eight studies (n = 2,070) reported on nine different risk factors (blood pressure, blood glucose, poor asthma control, 10-year Framingham risk score, cholesterol, body mass index, composite score of eight variables, intraocular pressure, composite score of three variables). The results were heterogeneous. Mostly there were no statistically significant risk differences between study groups.ConclusionsOverall, there is no evidence for a clear positive effect of patient portals on patient empowerment and health related outcomes (mainly risk factors). However, we identified only a small number of studies. The usage of portals was often low and several studies were older.

scholarly journals Mental health care professionals’ appraisal of patients’ use of online access to their electronic health record: a qualitative study. (Preprint)

2021 ◽  
Author(s):  
Antonius Mattheus van Rijt ◽  
Pauline Hulter ◽  
Anne Marie Weggelaar-Jansen ◽  
Kees Ahaus ◽  
Bettine Pluut
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Qualitative Study ◽  
Mental Health Care ◽  
Health Care Professionals ◽  
Health Record ◽  
Patient Portal ◽  
Patient Access ◽  
Patient Portals ◽  
Electronic Health

BACKGROUND Patients, in a range of health care sectors, can access their medical health record using a patient portal. In mental health care, the use of patient portals among mental health care professionals (MHCPs) remains low. MHCPs worry that patient access to electronic health records will negatively affect the patient’s wellbeing and their own workload. This study explores the appraisal work carried out by MHCPs shortly after the introduction of online patient access and sheds light on the challenges MHCPs face when trying to make a patient portal work for them, the patient, and their relationship. OBJECTIVE This study aims to provide insights into the appraisal work of MHCPs to assess and understand patient access to their electronic health record (EHR) through a patient portal. METHODS We conducted a qualitative study including ten semi-structured interviews (N=11) and a focus group (N=10). Participants were MHCPs from different professional backgrounds and staff employees (e.g., team leaders, communication advisor). We collected data on their opinions and experiences with the recently implemented patient portal and their attempts to modify work practices. RESULTS Our study provides insights into MHCPs’ appraisal work to assess and understand patient access to the EHR through a patient portal. Four topics emerge from our data analysis: 1) appraising the effect on the patient-professional relationship, 2) appraising the challenge of sharing and registering delicate information, 3) appraising patient vulnerability, and 4) redefining consultation routines and registration practices. CONCLUSIONS MHCPs struggle with the effects of online patient access and are searching for the best ways to modify their registration and consultation practices. Our study suggests various solutions to the challenges faced by MHCPs. To optimize the effects of online patient access to EHRs, MHCPs need to be involved in the process of developing, implementing, and embedding patient portals.

scholarly journals Disparities in Pediatric Patient Portal Activation and Feature Use

JAMIA Open ◽  
2021 ◽  
Vol 4 (3) ◽  
Author(s):  
Jennifer H LeLaurin ◽  
Oliver T Nguyen ◽  
Lindsay A Thompson ◽  
Jaclyn Hall ◽  
Jiang Bian ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
White Female ◽  
Patient Portal ◽  
Patient Portals ◽  
Electronic Health Record Data ◽  
Factors Associated ◽  
Academic Medical ◽  
Vulnerable Individual ◽  
Records Access

Abstract Objective Disparities in adult patient portal adoption are well-documented; however, less is known about disparities in portal adoption in pediatrics. This study examines the prevalence and factors associated with patient portal activation and the use of specific portal features in general pediatrics. Materials and methods We analyzed electronic health record data from 2012 to 2020 in a large academic medical center that offers both parent and adolescent portals. We summarized portal activation and use of select portal features (messaging, records access and management, appointment management, visit/admissions summaries, and interactive feature use). We used logistic regression to model factors associated with patient portal activation among all patients along with feature use and frequent feature use among ever users (ie, ≥1 portal use). Results Among 52 713 unique patients, 39% had activated the patient portal, including 36% of patients aged 0–11, 41% of patients aged 12–17, and 62% of patients aged 18–21 years. Among activated accounts, ever use of specific features ranged from 28% for visit/admission summaries to 92% for records access and management. Adjusted analyses showed patients with activated accounts were more likely to be adolescents or young adults, white, female, privately insured, and less socioeconomically vulnerable. Individual feature use among ever users generally followed the same pattern. Conclusions Our findings demonstrate that important disparities persist in portal adoption in pediatric populations, highlighting the need for strategies to promote equitable access to patient portals.

scholarly journals Growth of Secure Messaging Through a Patient Portal as a Form of Outpatient Interaction across Clinical Specialties

2015 ◽  
Vol 06 (02) ◽  
pp. 288-304 ◽  
Author(s):  
S.E. Davis ◽  
J.A. Shenson ◽  
Q. Chen ◽  
S.T. Rosenbloom ◽  
G.P. Jackson ◽  
...  
Keyword(s):  
Health Care Providers ◽  
Medical Center ◽  
Patient Portal ◽  
Care Providers ◽  
Patient Portals ◽  
Healthcare Organizations ◽  
Secure Messaging ◽  
Medical Specialties ◽  
Face To Face ◽  
Clinic Visits

SummaryObjective: Patient portals are online applications that allow patients to interact with healthcare organizations. Portal adoption is increasing, and secure messaging between patients and health-care providers is an emerging form of outpatient interaction. Research about portals and messaging has focused on medical specialties. We characterized adoption of secure messaging and the contribution of messaging to outpatient interactions across diverse clinical specialties after broad portal deployment.Methods: This retrospective cohort study at Vanderbilt University Medical Center examined use of patient-initiated secure messages and clinic visits in the three years following full deployment of a patient portal across adult and pediatric specialties. We measured the proportion of outpatient interactions (i.e., messages plus clinic visits) conducted through secure messaging by specialty over time. Generalized estimating equations measured the likelihood of message-based versus clinic outpatient interaction across clinical specialties.Results: Over the study period, 2,422,114 clinic visits occurred, and 82,159 unique portal users initiated 948,428 messages to 1,924 recipients. Medicine participated in the most message exchanges (742,454 messages; 78.3% of all messages sent), followed by surgery (84,001; 8.9%) and obstetrics/gynecology (53,424; 5.6%). The proportion of outpatient interaction through messaging increased from 12.9% in 2008 to 33.0% in 2009 and 39.8% in 2010 (p<0.001). Medicine had the highest proportion of outpatient interaction conducted through messaging in 2008 (23.3% of out-patient interactions in medicine). By 2010, this proportion was highest for obstetrics/gynecology (83.4%), dermatology (71.6%), and medicine (56.7%). Growth in likelihood of message-based interaction was greater for anesthesiology, dermatology, obstetrics/gynecology, pediatrics, and psychiatry than for medicine (p<0.001).Conclusions: This study demonstrates rapid adoption of secure messaging across diverse clinical specialties, with messaging interactions exceeding face-to-face clinic visits for some specialties. As patient portal and secure messaging adoption increase beyond medicine and primary care, research is needed to understand the implications for provider workload and patient care.Citation: Cronin RM, Davis SE, Shenson JA, Chen Q, Rosenbloom ST, Jackson GP. Growth of secure messaging through a patient portal as a form of outpatient interaction across clinical specialties. Appl Clin Inf 2015; 6: 288–304http://dx.doi.org/10.4338/ACI-2014-12-RA-0117

Mobile device access to electronic patient portals in oncology: Potential implications for patient and practice experiences.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 179-179
Author(s):  
Kelvin Ky-Minh Pho ◽  
Rong Lu ◽  
Samantha Gates ◽  
Jennifer Cai ◽  
Donglu Xie ◽  
...  
Keyword(s):  
Mobile Devices ◽  
Mobile Device ◽  
Mobile Application ◽  
Underserved Populations ◽  
Patient Characteristics ◽  
Comprehensive Cancer Center ◽  
Patient Portal ◽  
Patient Portals ◽  
Mobile Access ◽  
Electronic Health

179 Background: Mobile devices provide individuals with rapid and frequent access to electronic patient portals. How patients use this growing and widespread technology to review test results and communicate with providers is not known. Methods: Retrospective study of patients enrolled in the MyChart electronic health portal associated with the EPIC electronic medical record in the Harold C. Simmons Comprehensive Cancer Center. We recorded type of portal access according to year and patient characteristics. Associations between patient characteristics and type of portal access were tested using Mann-Whitney test, Chi-square test, and linear Gaussian regression models. Results: Since the availability of mobile access in 2012, 2,524 patients accessed MyChart from a mobile device at least once, accounting for 291,526 mobile logins. The proportion of patients with mobile MyChart logins increased from 4% in 2012 to 13% in 2017 ( P= 0.004). Among these patients, the proportion of logins from mobile devices increased from 22% to 72% ( P< 0.001). Mobile access occurred more frequently among younger ( P< 0.001), black ( P= 0.002), and Hispanic ( P= 0.004) patients. In 2017, among patients who accessed MyChart from mobile devices at least once, those under age 40 years used the mobile application for over 90% of logins; those over age 60 years used the mobile application for 65% of logins. Black and Hispanic patients who used mobile MyChart access did so for approximately 80% of logins, compared to 70% of logins for non-Hispanic white patients. Before 2012, patients who went on to use mobile access averaged about five more logins per year than did mobile application never-users. While login frequency increased for both groups, the change was far greater for mobile application users. After 2012, total portal login frequency increased approximately 110% among patients who used mobile access, compared to 25% among non-users ( P< 0.001). Conclusions: Mobile access to electronic health portals has increased patient portal use, particularly among traditionally underserved populations. How this widely and immediately available technology impacts patient and practice experiences warrants further study.

scholarly journals Mobile Device Applications for Electronic Patient Portals in Oncology

2019 ◽  
pp. 1-8 ◽  
Author(s):  
Kelvin K. Pho ◽  
Rong Lu ◽  
Samantha Gates ◽  
Jennifer Cai ◽  
Donglu Xie ◽  
...  
Keyword(s):  
Mobile Device ◽  
Mobile Application ◽  
Underserved Populations ◽  
Patient Characteristics ◽  
Comprehensive Cancer Center ◽  
Patient Portal ◽  
Patient Portals ◽  
Mobile Access ◽  
Number Of Patients ◽  
Electronic Health

PURPOSE Mobile devices provide individuals with rapid and frequent access to electronic patient portals. We investigated how oncology patients use this technology to review test results and communicate with providers. PATIENTS AND METHODS We performed a retrospective study of patients enrolled in the MyChart electronic health portal associated with the Epic electronic medical record at the Harold C. Simmons Comprehensive Cancer Center from 2012 to 2017. We recorded type of portal access according to year and patient characteristics. Associations among patient characteristics and types of portal access were tested using Mann-Whitney U test, χ2 test, and linear Gaussian regression models. RESULTS Since the availability of a mobile device application in 2012, 2,524 patients with cancer accessed MyChart from a mobile device at least once, which accounted for 291,526 mobile log-ins. The number of patients with MyChart mobile application log-ins increased from 4% in 2012 to 13% in 2017 ( P = .004). Among these patients, the median proportion of log-ins that occurred through mobile device use increased from 22% to 72% during this time period ( P < .001). Mobile access occurred more frequently among younger ( P < .001), black ( P = .002), and Hispanic ( P = .004) patients. Since 2012, total portal log-in frequency increased approximately 110% among patients who used the mobile application compared with 25% among those who did not use the mobile application ( P < .001). CONCLUSION Mobile access to electronic health portals has increased patient portal use, particularly among traditionally underserved populations. How this widely and immediately available technology affects patient expectations and experiences warrants additional study.

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