Direct Release of Test Results to Patients Increases Patient Engagement and Utilization of Care.

An important focus for meaningful use criteria is to engage patients in their care by allowing them online access to their health information, including test results. There has been little evaluation of such initiatives. Using a mixed methods analysis of electronic health record data, surveys, and qualitative interviews, we examined the impact of allowing patients to view their test results via patient portal in one large health system. Quantitative data were collected for new users and all users of the patient portal. Qualitative interviews occurred with patients who had received an HbA1c or abnormal Pap result. Survey participants were active patient portal users. Our main measures were patient portal usage, factors associated with viewing test results and utilizing care, and patient and provider experiences with patient portal and direct release. Usage data show 80% of all patient portal users viewed test results during the year. Of survey respondents, 82.7% noted test results to be a very useful feature and 70% agreed that patient portal has made their provider more accessible to them. Interviewed patients reported feeling they should have direct access to test results and identified the ability to monitor results over time and prepare prior to communicating with a provider as benefits. In interviews, both patients and physicians reported instances of test results leading to unnecessary patient anxiety. Both groups noted the benefits of results released with provider interpretation. Quantitative data showed patient utilization to increase with viewing test results online, but this effect is mitigated when results are manually released by physicians. Our findings demonstrate that patient portal access to test results was highly valued by patients and appeared to increase patient engagement. However, it may lead to patient anxiety and increase rates of patient visits. We discuss how such unintended consequences can be addressed and larger implications for meaningful use criteria.

Characteristics of patients who seek care via eVisits instead of office visits.

PURPOSE: There is growing recognition that many physician-patient encounters do not require face-to-face contact. The availability of secure Internet portals creates the opportunity for online eVisits. Increasing numbers of health systems provide eVisits, and many health plans reimburse for eVisits. However, little is known on who chooses to seek care via an eVisit. MATERIALS AND METHODS: At four primary care practices, we used the electronic medical record to identify all eVisits and office visits for sinusitis and urinary tract infections (UTIs) between January 2010 and May 2011. From the electronic medical record we abstracted the necessary information on patient demographics. The population studied included 5,165 sinusitis visits (9% of which were eVisits) and 2,954 UTI visits (3% eVisits). RESULTS: In multivariate models controlling for other patient factors, the variables most strongly associated with a patient initiating an eVisit versus an office visit were age (18-44 years of age versus 65 years of age and older: sinusitis, odds ratio 1.65 [0.97-2.81]; UTI, 2.97 [1.03-8.62]) and longer travel distance to clinic (>10 miles from patient home to clinic versus 0-5 miles: sinusitis, odds ratio 6.54 [4.68-9.16]; UTI, odds ratio 3.25 [1.74-6.07]). Higher income was not associated with higher eVisit use. CONCLUSIONS: At these four primary care practices, eVisits accounted for almost 7% of visits for sinusitis and UTI. eVisits attract a younger patient population who might use eVisits for convenience reasons.

Internet-based medical visit and diagnosis for common medical problems: experience of first user cohort.

OBJECTIVE: Internet-based medical visits, or "structured e-Visits," allow patients to report symptoms and seek diagnosis and treatment from their doctor over a secure Web site, without calling or visiting the physician's office. While acceptability of e-Visits has been investigated, outcomes associated with e-Visits, that is, whether patients receiving diagnoses receive appropriate care or need to return to the doctor, remain unexplored. MATERIALS AND METHODS: The first 156 e-Visit users from a large family medicine practice were surveyed regarding their experience with the e-Visit and e-Visit outcomes. In addition, medical records for patients making e-Visits were reviewed to examine need for follow-up care within 7 days. RESULTS: Interviews were completed with 121 patients (77.6% participation). The most common type of e-Visit was for "other" symptoms or concerns (37%), followed by sinus/cold symptoms (35%). Back pain, urinary symptoms, cough, diarrhea, conjunctivitis, and vaginal irritation were each less frequent (<10%). A majority, 61% completed e-Visits with their own physician. The majority of patients (57.0%) reported receipt of a diagnosis without need for follow-up beyond a prescription; 75% of patients thought the e-Visit was as good as or better than an in-person visit, and only 11.6% felt that their concerns or questions were incompletely addressed. In a review of medical records, 16.9% had a follow-up visit within 7 days, mostly for the same condition. Four of these were on the same day as the e-Visit, including one emergency department visit. CONCLUSIONS: Outcomes for the e-Visit suggest that it is an appropriate and potentially cost-saving addition to in-person delivery of primary care.

eVisit: a pilot study of a new kind of healthcare delivery.

Patient online eVisits are gaining momentum due to increasing consumer demand for improved access to clinical services, availability of new technologies to deploy such services and development of reimbursement initiatives by major payers. The eVisit service provides patients with an online consultation through a series of structured, secure message exchanges with a physician, providing an alternative for onsite office visits and non-reimbursed phone-based care. In this study, we evaluate a pilot deployment of eVisits in a primary care clinic providing online consultation service for 7 simple health conditions at its three locations. We examine usage data over 3 months and survey and interview results for trends in adoption, demographic and temporal patterns of usage, clinician and patient expectations and experiences, and challenges to sustainability of the service. Based on our analysis, we conclude that the eVisit pilot was a success. Patients valued the new service being offered as demonstrated by a rapid increase in usage. The quality of service was good with fast turnaround times and few exchanges to resolve a request. These positive outcomes combined with a reimbursement model are promising indications of sustainability but several challenges remain.

Exploring challenges and potentials of personal health records in diabetes self-management: implementation and initial assessment.

The University of Pittsburgh Medical Center (UPMC) has implemented a personal health record grounded in the Chronic Care Model, UPMC HealthTrak, to assist patients with diabetes self-management. UPMC HealthTrak is based in the physician office and connects the patient, physician, and electronic medical record (EMR). Its functionalities include secure, electronic communication with the physician's office, along with preventive healthcare reminders, and disease-specific tools and information. In this paper, we describe challenges to office-based implementation of and initial patient reaction to the technology in the context of diabetes care. UPMC has deployed a secure Web-based patient portal, UPMC HealthTrak. We implemented UPMC HealthTrak in the ambulatory setting and assessed its impact on patient-practice communication. We conducted 10 90-minute focus groups (five pre- and five postimplementation) to assess patient reaction to UPMC HealthTrak. Focus groups were analyzed using grounded theory techniques. During the period September 2004-January 2007, there was no significant change in number of patient encounters or telephone calls received in our office, but the number of HealthTrak messages increased. Our 39 pre- and postimplementation focus group participants felt that the system would enhance communication with the office, and that the reminder system would be helpful. They also liked having access to laboratory tests remotely. They were frustrated when tests were not released and messages not answered. A Web-based patient portal can be integrated into a clinical office, although patients may not quickly change communication patterns. Patients are responsive to technology. Future work should focus on diabetes-related outcomes assessment and intensifying interventions.