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Benefits and Challenges of Patient Portal Implementation

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Literature Review

Electronic health records have been in existence for more than a decade. Over the years, they have been used as tools to enhance patient outcomes in conditions that demand consistent patient follow up. Recent advancements have increased the applications of electronic health data to provide online access to data for patients and doctors. For instance, patient portals have the ability to complete the circle of care by linking patients to their caregivers directly. A number of studies have been done to support the impact of patient portals in diabetes care. This literature review aims to analyze data from various researches to determine the impact of patient portals on patients suffering from diabetes.

Most research papers on the impact of patient portal systems have managed to highlight several advantages of using the systems. For instance, the research by Lau, Campbell, Tang, Thompson, and Elliott (2014) undertook a retrospective observational study with a hospital set up in British Columbia.  The research used an electronic health recording system supported by a patient portal that was coupled with staff support. Access to the patient portal was free and was aimed at providing a question and answer system for doctors and patients; updated laboratory data and a journal. The results of the study revealed that the management of diabetes has significantly improved once the patients were provided with medical information support through the patient portals. Moreover, better health outcomes were also identified in patients who made more use of the patient portal systems to seek knowledge on diabetes and self-care capabilities. Lau et al. (2014) also managed to show how the results on patient outcome were independent of the type of diabetes since both type one and type two showcased similar results in the value of patient care.

Additionally, Or, Calvin and Da Tao (2014) also undertook a study that sought out to evaluate the impact of consumer health information on the outcomes of self-managed diabetes care. The main hypothesis of the study was that CHITs have the potential to significantly improve the patient outcomes in diabetes patients. In comparison to EHR, CHITs are tailored to the general public rather than to individual patients. They represent information that is available for all to view and utilizes.  Patients who made a self-concerted effort to seek CHITs showed changes in their behaviors and self-monitoring frequencies. Consequently, the use of the CHITs showed a positive increased in the medical outcomes. The results indicated a 64 % increase in diabetes outcomes measures. In this way, it also supports the ability of patient portals in increasing patient outcomes.

Kruse, Clemens Scott, Katy Bolton, and Greg Freriks (2015) add to the discussion by evaluating the concept of meaning full use and how it impacts the applications of patient portals. The health and information technology for economic and clinical health compels health organizations to be aware of the meaning full use qualification. The requirement is seen to increase the participation of the patients in medical decision making but the implications on the patient outcomes had not been evaluated. Kruse et al. (2015) purposed to review the results from other patient portal quality use and evaluate how meaningful use has impacted the patient outcomes. They used data-driven research papers and related them back to the criteria of meaning full use. The results indicated that the use of patient portals resulted in improvements in awareness of the disease improved medical treatment adherence, and decreased hospital visits, increased self-management capabilities. Additionally, the study also showed an increase in satisfaction and quality of health care provided. Consequently, more organizations are making use of the patient portal to increase patient outcomes.

Challenges of implementing patient portals identified in various research papers revolve around various factors associated with the patient side. Ketterer, West, Sanders, Hossain, Kondo, Sharif (2013) identified the socio-economic barriers that exist in the success of patient portal enrollments. The study assessed predictors of enrollments such as demographics and clinical perspectives in pediatric primary care population. It used a cross-sectional analysis of a children’s hospital database composing of 84,015 children over a duration of 4 years. The results indicated that only 38% of the children enrolled and even a lower percentage managed to activate their accounts. The statistics indicated lower levels for low-income families, adolescents, recipients of Medicaid and patients of minority ethnicity. The results of this study are significant as they evaluate the sociodemographic disparities that are available in patient portal outcomes. The impact of patient portals can be decreased in cases where there exist such socio-economic disparities.

Irizarry, DeVito, and Curran (2015) also supported the potential for patient portals to improve care by promoting engagement between patients and their health providers. The research aimed at reporting the findings from literature reviews on diabetes patients making use of a patient portal. Through an electronic literature search, the researchers were able to identify controlled practices that had defined outcomes. The results indicated that patients had registered for accounts and had a record of using their portals had improved outcomes when compared to their peers.

Another key issue that affects the impact of patient portals in diabetes patient outcomes is the motivational factors. There are various factors that affect the motivation of patients in feeling self-empowered to follow the guidelines provided either through EHR or CHITs. These factors have been argued out to have significant impacts on the value of patient portals in institutions. For patients who make voluntary use of the systems, have greater potential to witness improved outcomes. Additionally, the patient outcomes are also affected by the literacy levels and the ability to make appropriate use of technology provided. Using an online portal and the level of improvement witnessed are factors of the literacy and motivation of the individual patients.

In light of the need for patient motivation and adequate literacy, the importance of Internet-based patient portals have been underscored by a number of researches.  Kruse, C.S, Bolton, K. &, Freriks G. (2015) argue out that the ineffectiveness of the patient portal systems is visible in the way self-management is not always a sufficient mechanism of improving care. Other factors identified were such as the knowledge of diabetes versus the information given, the choice of technology, the need for confidentiality together with social concerns associated with the surrounding community. These factors are poised to decrease the significance of patient portals in instigating significant change in diabetes patient care outcomes.

Sun, Korytkowski, Sereika, Saul, Li, and Burke (2018) highlight the various uses of patient portals in managing diabetes patient care. For instance, patients can comfortably perform medical tasks such as look at their summaries, view their lab results, communicate with their care providers and manage future appointments. The portals are advancing to be capable of recording patient symptoms and self-care results such as the blood pressure and glucose readings. The increased effectiveness of care delivery is the main reason for the adoption of the patient portals by organizations.

The impact of portal systems has also been evaluated by considering the perceptions of patients. For instance, the research by Irizarry et al (2015) outlined the way in which patients were more satisfied with the portal features offered. The results of the study indicated that the patients were more aware of their health status and more willing to make deliberate attempts at improvement.  However, while patients made extensive use of features such as the recording blood pressure Irizarry et al (2015) noted that they made limited use of other features.  It was also noted that different patients had a varied frequency of use that declined for all patients over time.  Patients highlighted issues such as the difficulties in navigating the portal together with the lack of user-friendly design that is simple and captivating. These issues raise the concern of the need for focus on the design aspect in the impact of patient portals.

 

In light of the literature analysis, it is evident that patient care is enhanced through the application of patient portals. Various research papers have indicated an increase in the positive outcomes for patients suffering from diabetes and other conditions. However, the patient perspectives raise significant concerns about the application of patient portals. The decrease in the use of EHR over time by patients and the barriers are potential limiting factors that affect the long-term viability of patient portals. The question raised is what the resulting patient outcomes are in the long run. How do patient portals influence the long-term outcomes of patients suffering from diabetes? This paper seeks to answer these questions and add on to the research provided by other researchers.

References

Lau, M., Campbell, H., Tang, T., Thompson, D., & Elliott, T. (2014). Impact of Patient Use of an Online Patient Portal on Diabetes Outcomes. Canadian Journal of Diabetes, 38(1), 17-21. Doi: 10.1016/j.jcjd.2013.10.005

Irizarry T., DeVito D.A., & Curran C.R. (2015) Patient portals and patient engagement: a state of the science review. J Med Internet Res; 17(6):e148 [doi: 10.2196/jmir.4255] [Medline: 26104044]

Or, Calvin, K.L., & Da, T. (2014). Does the use of consumer health information technology improve outcomes in the patient self-management of diabetes?  A meta-analysis and narrative     review     of randomized controlled   trials."   International   Journal of Medical Informatics 83.5: 320-329.

Ketterer T., West D.W., Sanders V.P., Hossain J., Kondo M.C, Sharif I.K., Clemens S., Katy B., and Greg, F. (2013) "Correlates of patient portal enrollment and activation in primary care pediatrics." Academic Pediatrics 13.3 264-271. 10.1016/j.acap.2013.02.002  

Kruse, C.S, Bolton, K. &, Freriks G. (2015) "The effect of patient portals on quality outcomes and its implications to meaningful use: a systematic review." Journal of Medical Internet Research 17.2 e44.

Sun, R., Korytkowski, M., Sereika, S., Saul, M., Li, D., & Burke, L. (2018). Patient Portal Use in Diabetes Management: Literature Review. JMIR Diabetes, 3(4), e11199. doi: 10.2196/11199

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