Contextualizing numeric clinical test results for gist comprehension: Implications for EHR patient portals.

Patient portals to Electronic Health Record (EHR) systems are underused by older adults because of limited system usability and usefulness, including difficulty understanding numeric information. We investigated whether enhanced context for portal messages about test results improved responses to these messages, comparing verbally, graphically, and video-enhanced formats. Older adults viewed scenarios with fictitious patient profiles and messages describing results for these patients from cholesterol or diabetes screening tests indicating lower, borderline, or higher risk levels. These messages were conveyed by standard format (table of numerical test scores) or one of the enhanced formats. Verbatim and gist memory for test results, risk perception, affective response, attitude toward and intention to perform self-care behaviors, and satisfaction were measured. Verbally and video enhanced context improved older adults' gist but not verbatim memory compared to the standard format, suggesting we were successful in designing messages that highlight gist-based information. Little evidence was found for benefits related to the graphically enhanced format. Although verbally and video enhanced formats improved gist memory and message satisfaction, they had less impact on the other responses to the messages. However, these responses reflected level of risk: As risk associated with test results increased, positive affect decreased whereas negative affect, perceived risk, behavioral attitudes, and intentions increased, as predicted by behavioral change theories. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

A multidisciplinary approach to designing and evaluating Electronic Medical Record portal messages that support patient self-care.

We describe a project intended to improve the use of Electronic Medical Record (EMR) patient portal information by older adults with diverse numeracy and literacy abilities, so that portals can better support patient-centered care. Patient portals are intended to bridge patients and providers by ensuring patients have continuous access to their health information and services. However, they are underutilized, especially by older adults with low health literacy, because they often function more as information repositories than as tools to engage patients. We outline an interdisciplinary approach to designing and evaluating portal-based messages that convey clinical test results so as to support patient-centered care. We first describe a theory-based framework for designing effective messages for patients. This involves analyzing shortcomings of the standard portal message format (presenting numerical test results with little context to guide comprehension) and developing verbally, graphically, video- and computer agent-based formats that enhance context. The framework encompasses theories from cognitive and behavioral science (health literacy, fuzzy trace memory, behavior change) as well as computational/engineering approaches (e.g., image and speech processing models). We then describe an approach to evaluating whether the formats improve comprehension of and responses to the messages about test results, focusing on our methods. The approach combines quantitative (e.g., response accuracy, Likert scale responses) and qualitative (interview) measures, as well as experimental and individual difference methods in order to investigate which formats are more effective, and whether some formats benefit some types of patients more than others. We also report the results of two pilot studies conducted as part of developing the message formats.