Understanding cancer patients’ use and perceptions of inpatient portal: A case study at a tertiary hospital in Saudi Arabia
Introduction
The patient-centred hospital care model aims to involve patients in the care delivery process, to inform and empower them to ask questions and make critical decisions, and to gain ownership of their hospital care [1]. Digital health information technologies, including inpatient portals, provide promise for the implementation of this model in a cost-effective and convenient manner [2].
An inpatient portal is a secure, web-based application that can be linked to a patient’s electronic medical record (EMR), which is documented and managed by a health care institution [3]. It allows patients to access clinical information in real-time, to communicate directly with healthcare providers, and to perform self-management activities during hospitalisation [4]. The major functions include viewing, downloading, and sharing clinical data (including lab results, clinical summaries, and medication lists), browsing trustworthy educational resources, sending secure messages and preparing for discharge [2,3]. Other functions, such as preventive care services, specific administrative services, or entertainment services, can also be integrated into the portal or be offered as a stand-alone platform [5].
There has been growing evidence for the positive impact of an inpatient portal on patient adherence to medications [6], and on patient safety during hospitalisation [6,7]. Two studies found that the inpatient portals in hospitals brought many benefits for patient care such as addressing patients’ care needs, supporting daily health management and ultimately improving patient experience with hospitalisation [8,9]. However, a systematic review by Dendere et al. [6] reported that there were mixed findings about the impact of inpatient portals on improvement of patient engagement in their care. Other studies that evaluated patients, caregivers, and team care members perspectives about the enhancement of patient-provider communication after using the inpatient portal reported a mix of positive and negative perspectives [8,10,11]. The positive perspectives were mainly related to the improvement of patients’ health outcomes after using the portal [12]. While, the negative perspectives were mainly because of an increase on the providers’ workload [12]. Prior studies also found that some inpatients had concerns about privacy and security of their personal and clinical information in electronic format using the portal inside the hospital [6] and were anxious of their inability to understand medical results [6,8].
To date, there is little knowledge about the adoption of inpatient portals by hospitalised cancer patients. An earlier study explored the information and communication needs for an interactive patient portal proposed for an oncology setting in the Netherlands [13]. Thirty-five cancer survivors and 31 health professionals suggested that the most important clinical information needed by cancer patients was diagnosis, treatment, medication side-effects, and discharge information. They expected the portal to offer patients instant access to their own electronic medical record (EMR) and treatment care plan. They suggested that the portal should be linked with the hospital appointment system, providing online rehabilitation programs and tele-monitoring programs, and allowing patients to self-report their clinical outcomes.
A two-year retrospective study found that 51.2 % of 4594 hospitalised cancer patients successfully registered with the inpatient portal prior to their admission to the Mayo Clinic in the United States [14]. Most registered patients were young, female, married, with higher income and more frequent hospitalizations. Only 26.8 % of them continued to use the portal during their hospital stay. A literature review on the use of web-based portals by cancer patients found that the use of the portal in outpatient and intensive care settings was associated with patient characteristics including younger age, white race, and higher socioeconomic status [15]. Alpert et al. [16] found that the use of a portal in oncology primary care centres enabled cancer patients to improve preparation for their consultation, to better exchange their clinical information with other health providers, to take better control of their conditions, and to make them more acceptable and comfortable in communicating risk information.
Although there is growing interest to implement inpatient portals to improve the overall experience of cancer patients during hospitalisation, most studies were performed in academic medical centres in developed countries, e.g. the US and Canada, with limited generalizability of the findings to other hospitals with different demographics, culture, and medical practices [6,15]. There is a lack of information about their use and perceptions of inpatient portals in developing countries such as Saudi Arabia. Therefore, this study aimed to understand hospitalised cancer patients’ use and perceptions of an inpatient portal in a tertiary hospital in Saudi Arabia.
The research questions were: 1) Did the cancer patients use the inpatient portal during their hospitalisation? 2) Which functions did they use more, less, or not at all? 3) What were their perceptions about the inpatient portal? and 4) Were there differences in usage and perceptions between patients with different characteristics such as age, sex, or education level?
Section snippets
Study design and setting
We conducted a cross-sectional, qualitative study. The data collection method was interviews with hospitalised patients in King Faisal Specialist Hospital & Research Centre (KFSHRC). The study was approved by the research ethics committees of KFSHRC and the University of Wollongong.
The hospital introduced an inpatient portal called Infotainment to hospitalised patients at the King Abdullah Centre for Oncology and Liver Diseases (KACOLD) in 2017. The portal was presented in 55-inch
Results
Twenty-two cancer patients participated in the interviews, 50 % were male (see Table 2). The average age was 38.8 years.
Level of use
Despite being the first time for sixteen (72.7 %) of the interviewed cancer patients to use it, almost all these patients achieved a modest level of using the portal. This finding was consistent with earlier findings in the US about the level of use of web-based portals by cancer patients who visited a cancer centre affiliated to an academic medical centre [25] or were hospitalised at a tertiary hospital [14]. Furthermore, our study found that the male participants accessed the portal more
Conclusion
Introduction of the portal to hospitalised cancer patients offers the opportunity to provide an online access to key clinical information and to enhance patient-provider communication, leading to better self-management and clinical outcomes. The cancer patients perceived the portal to be useful and easy to use. Most of them used the portal for entertainment, checking information about patient safety, viewing medication lists, and ordering meals. The difficulties encountered in using the portal
Authors’ contributions
Bader designed and conducted the interviews, made data analysis and writing of the manuscript. Ping conceptualized and designed the study, reviewed the data and writing of the manuscript. David reviewed the data and made critical revisions to the paper. Fahad, Salman and Shaleh have participated in conducting interviews with patients and interpretation of the data, and approved the final version of the paper.
Summary Points
What was already known on the topic?
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Inpatient portals have potential to
Declaration of Competing Interest
The authors declare no conflict of interest.
Acknowledgements
This work was a part of a research project to achieve a doctoral degree at the University of Wollongong. It was completely supported by the University of Wollongong, Australia, and the University of Hail, Saudi Arabia, and partly supported by the King Faisal Specialized Hospital and Research Center.
References (31)
- et al.
Promise of and potential for patient-facing technologies to enable meaningful use
Am. J. Prev. Med.
(2011) - et al.
Health IT acceptance factors in long-term care facilities: a cross-sectional survey
Int. J. Med. Inform.
(2009) - et al.
Internet-based technologies to improve cancer care coordination: current use and attitudes among cancer patients
Eur. J. Cancer
(2015) - et al.
Using technology to engage hospitalised patients in their care: a realist review
BMC Health Serv. Res.
(2017) - et al.
Inpatient portals for hospitalized patients and caregivers: a systematic review
J. Hosp. Med.
(2017) What Is a Patient Portal?
(2015)Patient portals
Encycl. Gerontol. Popul. Aging
(2019)- et al.
Patient portals facilitating engagement with inpatient electronic medical records: a systematic review
J. Med. Internet Res.
(2019) - et al.
The impact of patient interactive systems on the management of pain in an inpatient hospital setting: a systematic review
Appl. Clin. Inform.
(2019) - et al.
Patients’ perceptions of portal use across care settings: qualitative study
J. Med. Internet Res.
(2019)
Improving acceptance of inpatient portals: patients’ and care team members’ perspectives
Telemed. J. E.
Helping Patients Be Better Patients: A Qualitative Study of Perceptions About Inpatient Portal Use
Telemed. J. E.
Empowering patients during hospitalization: perspectives on inpatient portal use
Appl. Clin. Inform.
Healthcare professionals’ experiences of patient-professional communication over patient portals: a systematic review of qualitative studies (Preprint)
J. Med. Internet Res.
An interactive portal to empower cancer survivors: a qualitative study on user expectations
Support. Care Cancer
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2022, Saudi Pharmaceutical JournalCitation Excerpt :In addition, three non-RCTs showed improvement in adherence (Delbanco et al., 2012; Oster et al., 2015; Wright et al., 2015). Studies that addressed patient-reported experience were all non-interventional studies (Alshoumr et al., 2021; Bhavnani et al., 2011; DesRoches et al., 2019; Esch et al., 2016; Haggstrom et al., 2011; Lehnbom et al., 2012; Turvey et al., 2014; White et al., 2016; Wolff et al., 2016), except for one study that was a RCT (Chrischilles et al., 2014). Through accessing electronic records, patients were more likely to: (a) take their medications as prescribed, (b) better understand why they needed to take their medications, (c) correct their medication regimen, (d) report if they were having side effects and (e) learn more about their medications.