Bridging the Digital Health Divide: Characterizing Patient Portal Users and Nonusers in the U.S.

OBJECTIVE: The objectives of this study were to (1) examine demographic differences between patient portal users and nonusers; and (2) examine health literacy, patient self-efficacy, and technology usage and attitudes between patient portal users and nonusers. METHODS: Data were collected from Amazon Mechanical Turk (MTurk) workers from December 2021 to January 2022. MTurk workers completed an online survey, which asked about their health, access to technology, health literacy, patient self-efficacy, media and technology attitudes, and patient portal use for those with an account. A total of 489 MTurk workers completed the survey. Data were analyzed using latent class analysis (LCA) and multivariate logistic regression models. RESULTS: Latent class analysis models revealed some qualitative differences between users and nonusers of patient portals in relation to neighborhood type, education, income, disability status, comorbidity of any type, insurance type, and the presence or absence of primary care providers. These results were partially confirmed by logistic regression models, which showed that participants with insurance, a primary care provider, or a disability or comorbid condition were more likely to have a patient portal account. CONCLUSIONS: Our study findings suggest that access to health care, along with ongoing patient health needs, influence the usage of patient portal platforms. Patients with health insurance have the opportunity to access health care services, including establishing a relationship with a primary care provider. This relationship can be critical to a patient ever creating a patient portal account and actively engaging in their care, including communicating with their care team.

Identifying Electronic Medication Administration Record (eMAR) Usability Issues from Patient Safety Event Reports.

BACKGROUND: Improving our understanding of the association between medication errors and health information technology (health IT) usability has the potential to reduce errors and improve patient safety. This study used patient safety event reports (PSEs) to investigate the contribution of usability challenges associated with the electronic medication administration record (eMAR) to medication errors. METHODS: Free-text descriptions of 849 medication-related PSEs selected from 2.3 million reports were analyzed. Coders identified the specific health IT components, usability challenge categories, and nuanced usability themes that contributed to each PSE. Thematic analysis was conducted to refine categorizations and identify emerging themes. Final analysis was limited to PSEs involving a contribution from eMAR, either as the point of origin or as a downstream contributor to error. RESULTS: eMAR contributed to 473 PSEs. eMAR was the point of origin for 84 (17.8% of 473) PSEs. Usability challenge categories included Workflow support (n = 52, 11.0%) and Display/Visual clutter (n = 30, 6.3%). eMAR contributed downstream from the point of origin in 389 (82.2% of 473) PSEs, with errors stemming primarily from Pharmacy IT and computerized provider order entry (CPOE). Prominent secondary eMAR-associated usability challenges included Display/Visual clutter (n = 327, 69.1%) and Alerting (n = 32, 6.8%). CONCLUSION: This study identified several eMAR usability challenges, through the analysis of PSEs, that contribute to medication errors. Findings highlight the critical need for improving the eMAR user interface. Improved interface design, better vendor usability testing, eMAR-focused certification testing, consideration of work system factors, and eMAR-focused usability and safety testing by health care facilities can improve eMAR technology and patient safety.