Communication matters: Exploring older adults’ current use of patient portals

https://doi.org/10.1016/j.ijmedinf.2018.10.004Get rights and content

Highlights

  • The primary purpose of using a patient portal among older adults is to engage in healthcare through effective communications with providers.

  • Key feaures that older adults use a patient portal for include Medications, Lab results, and Messaging, all to better communicate with providers.

  • Older adults' perceptions of the provider’s use of a patient portal are a crucial factor that determines their decision to use a patient portal.

  • Concrete design implications are suggested to tailor a patient portal to the ageing population’s needs through conceptual sketches.

Abstract

Objectives

Patient portals have the potential to increase patient engagement. Older patients are of particular interest as they are likely to suffer from multiple chronic conditions. Yet, questions remain about how patient portals are perceived and deemed useful by older adults. This study explored attitudes toward, perceived utility of, and requirements of a patient portal from the perspective of older adults.

Methods

We used a mixed-method approach integrating online surveys, a review of existing portals, and participatory design workshops with 17 people who were 65 years old and over.

Results

The findings demonstrate that the participants used a patient portal primarily as one of the communication channels to interact with their providers, rather than as a tool for accessing and managing personal health information. Consequently, the perception of whether or not a provider would use the patient portal was a primary factor that older adults considered in determining the adoption and use of a portal.

Conclusions

It is important to understand that older adults would perceive a patient portal as one part of a larger communication system to interact with a provider. This finding will help researchers and practitioners to advance the design and use of a patient portal to effectively incorporate it into older adults’ health care and better serve the unique needs of the ageing population.

Introduction

Growing evidence that patient engagement improves health outcomes and reduces healthcare cost has drawn attention to the potential of patient portals [7,35]. Patient portal is a secure online system to support a wide range of patients' needs relating to personal health information management, including viewing lab results and medications, refilling prescriptions, scheduling appointments, downloading and completing forms, and reading educational materials. Thanks to the potential of portals to promote patient engagement and improve self-management, the adoption of patient portals is becoming increasingly important for quality care.

Older adults are of particular interest in improving patient engagement, as they are likely to suffer from multiple chronic conditions and consequently face an increasing amount of health information to manage as they age [13,38]. Thus, effective use of a patient portal is important for this population. However, studies have shown that older adults are less likely to use available patient portals [9,31]. Efforts have been made to enhance older adults’ portal use, but mostly by elucidating barriers, such as accessibility, preference, literacy, and security concerns [8,16,23,39]. Few studies to date have reported on the current and expected use of patient portals from the perspective of older adults themselves. A better understanding of how older adults perceive and use patient portals would help identify the unique needs of the ageing population. Therefore, the goal of this study is to investigate attitudes and perspectives toward a patient portal and its perceived utility and requirements among older adults with varying degrees of prior experiences with patient portal use.

In what follows, we first provide a literature review of older adults and patient portals. Next, we describe our data collection and analysis methods. Then, we present key findings and conclude by discussing key implications for the design of patient portals tailored to older adults.

Section snippets

Literature review

Research relating to adoption issues around patient portals has surged, likely because of the federal mandate of Meaningful Use [1]. Ruland et al. studied patient portal use and discussed various user experience issues, including tradeoffs between data security and user friendliness, that relate to adopting patient portals [29]. Wilson et al. demonstrated that Technology Acceptance Models (TAM) could predict whether patients would adopt systems such as patient portals [44]. In a survey of

Methods

We used a mixed-methods approach consisting of online surveys, a review of existing portals, and participatory design studies to gain a broad, triangulated understanding of older adults’ current use of and perspectives on patient portals. Below, we describe each method, participants we recruited, and the techniques for analyzing the data we collected. All studies were reviewed by university-based research ethics boards.

Findings

From the review of existing portals emerged 20 features or contents that portals currently provide or older adults consider needing portals to provide in 4 categories, including medication, lab results, communication, and other (See Table 4). Among those, the participants of a participatory design study rated the following seven features as most important in card sorting activities (by the order of ratings).

  • 1

    Medication > Photos, instructions, and effects and possible side effects of medication

  • 2

Discussion: communication matters

Engaging patients to actively participate in their care is an effective means to improve health outcomes [11]. Patient portals have become an important pillar of patient-centered care and engagement primarily by a two-pronged approach: Providing patients with easy access to personal health data, including lab results, health histories, discharge summaries, and immunizations, to help them better understand and self-manage their conditions [40]; and improving communication with providers through

Limitations

The findings must be evaluated within the context of several limitations of the study. First, our sample of older adults was small (N = 17) and we used a method of convenience sampling for recruitment. One disadvantage of convenience sampling is that it runs the risk of compiling a non-representative study sample. Selection bias or unmeasured factors (e.g., relationship among people in a group, group dynamics of participatory design workshops) could have influenced the responses during the

Conclusion

This study used a mixed-methods approach to understand how older adults perceive and use patient portals. Our findings illustrate that the participants perceive patient portals primarily as one of their communication channels through which they interact with their providers. This conceptualization extends beyond a conventional notion of communication such as face-to-face communication or exchanging messages with providers; the participants considered most features that the portals offer,

Authors’ contributions

Kim and Fadem were involved in the conception of the work. Kim and Fadem designed the study. Kim provided methodological expertise. Fadem undertook the data collection. Kim and Fadem performed the analysis and interpretation. Kim and Fadem drafted the article. Kim did critical revision of the article and has given final approval of the version to be submitted.

Funding

This study was funded by the Rutgers School of Communication and Information.

Conflicts of interest

There are no known conflicts of interest associated with this work and there has been no significant financial support for this work that could have influenced its outcome.

Summary points

What was already known on the topic?

  • Patient portals have potential to increase patient engagement but these technologies depend on user engagement for their success

  • Older patents are of particular interest as they are likely to suffer from multiple chronic conditions, but questions remain about how patient

References (44)

  • Liz Forbat et al.

    Engaging patients in health care: an empirical study of the role of engagement on attitudes and action

    Patient Educ. Couns.

    (2009)
  • Calvin K.L. Or et al.

    A systematic review of patient acceptance of consumer health inf ormation technology

    Journal of the American Medical Inf ormatics Association

    (2009)
  • Sachin D. Shah et al.

    It takes two to tango: engaging patients and providers with portals

    PMR

    (2017)
  • David Blumenthal et al.

    The “meaningful use” regulation for electronic health records

    N. Engl. J. Med.

    (2010)
  • C.M. Campenelli

    American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults

    J. Am. Geriatr. Soc.

    (2012)
  • M.Kay Cresci et al.

    Information technologies as health management tools: urban elders’ interest and ability in using’the internet

    Educ. Gerontol.

    (2012)
  • Jennifer L. Davidson et al.

    What health topics older adults want to track: a participatory design study

    Proceedings of the 15th International ACM SIGACCESS Conference on Computers and Accessibility

    (2013)
  • Guy Dewsbury et al.

    Designing technology with older people

    Universal Access in the Information Society

    (2007)
  • Nancy P. Gordon et al.

    Differences in access to and preferences for using patient portals and other eHealth technologies based on race, ethnicity, and age: a database and survey study of seniors in a large health plan

    J. Med. Internet Res.

    (2016)
  • Ilana Graetz et al.

    The digital divide and patient portals: internet access explained differences in patient portal use for secure messaging by age, race, and income

    Med. Care

    (2016)
  • Jessica Greene et al.

    How Much Do Health Literacy and Patient Activation Contribute to Older Adults’ Ability to Manage Their Health?

    (2005)
  • Jessica Greene et al.

    Why does patient activation matter? An examination of the relationships between patient activation and health-related outcomes

    J. Gen. Intern. Med.

    (2012)
  • Judith H. Hibbard et al.

    What the evidence shows about patient activation: better health outcomes and care experiences; fewer data on costs

    Health Aff.

    (2013)
  • Taya Irizarry et al.

    Patient portals and patient engagement: a state of the science review

    J. Med. Internet Res.

    (2015)
  • Holly Jimison et al.

    Barriers and drivers of health information technology use for the elderly, chronically ill, and underserved

    Evid. Rep. Assess. (Full Rep)

    (2008)
  • Celine Latulipe et al.

    Design considerations for patient portal adoption by low-income, older adults

    In Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems

    (2015)
  • Stephen Lindsay et al.

    Engaging older people using participatory design

    In Proceedings of the SIGCHI Conference on Human Factors in Computing Systems

    (2012)
  • Leslie S. Liu et al.

    Barriers to the adoption and use of personal health record systems

    In Proceedings of the 2011 Iconference

    (2011)
  • Laurie T. Martin et al.

    Developing predictive models of health literacy

    J. Gen. Intern. Med.

    (2009)
  • Michael Massimi et al.

    Participatory design process with older users

    In Proc. UbiCoomp2006 Workshop on Future media

    (2006)
  • Miller Jr et al.

    Primary care providers’ views of patient portals: interview study of perceived benefits and consequences

    J. Med. Internet Res.

    (2016)
  • E.S. Nahm et al.

    Use of patient portals in older adults: a comparison of three samples

    Stud. Health Technol. Inform.

    (2016)
  • Cited by (0)

    View full text