Electronic Health Record (EHR)-Based Patient Portals for Patient-Provider Advance Care Planning Communication: Harnessing Innovation, Handling Disparities
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Abstract
Title: Electronic Health Record (EHR)-Based Patient Portals for Patient-Provider Advance Care Planning Communication: Harnessing Innovation, Handling Disparities
Background: Advance Care Planning (ACP) is the process of assisting patients in making future healthcare decisions. ACP delivery has been linked to improved patient satisfaction, decreased caregiver stress, and improved grieving. However, it often receives low priority due to provider time limitations related to increasing patient volume, disease complexity, and paperwork burden.
Increasing use of health information technology (HIT) for documentation and patient care, including electronic health records (EHR) and EHR-tethered patient portals, provides opportunities for innovation in ACP delivery.
Objective: The study objective is to assess patient willingness to use EHR-tethered patient portals for ACP provider-patient communication.
Methods: Patients in primary care clinics at the Ohio State University Medical Center over the age of 50 were surveyed, as part of an ongoing study, using convenience sampling. This survey is the initial phase of a multi-phase project to develop an EHR-based patient-provider ACP communication framework.
Results: 48 patients have been surveyed to date. Of all patients surveyed, 25/48 (52%) are willing to have ACP discussions with their provider using the EHR-tethered patient portal (OSUMyChart); 23/48 patients were unwilling to have these discussions using OSUMyChart. Thirty of the 48 surveyed patients have home internet access. Of patients with home internet, 19/30 (63%) were willing to have an ACP discussion with their provider using OSUMyChart. Fourteen of the 48 surveyed patients have activated OSUMyChart accounts. Of these 10/14 (73%) patients with activated OSUMyChart accounts report willingness to have an electronic ACP discussion with a provider. A majority of patients who are unwilling to use the EHR-tethered patient portal for ACP discussions report limited computer access as the barrier to its use. Less reported concerns involved security of electronic ACP documentation and a desire to have printed documentation. Patient reported benefits for OSUMyChart communication include convenience and accessibility to providers.
Conclusions: EHR-tethered patient portals can be used for patient-provider ACP communication to promote compatibility with busy practice workflows. About half of all surveyed patients are willing to use these portals for patient/ provider ACP communication. Although larger sample size is needed, current data suggests that patients with home internet and activated EHR-tethered patient portals may be more willing to have electronic patient-provider ACP communication. Lack of home internet and computer access, barriers to electronic ACP communication, are more likely in patients who are older and economically challenged. Electronic ACP communication does present unique opportunities for ACP communication. However, in order to prevent economic and age related health disparities, implementation of an electronic ACP communication tool must include usability testing, technology assistance, and accessible, internet-connected devices. Practical approaches could include on-site tech support, patient education areas providing internet connected devices, clinic based computer kiosks, and public-private partnerships with internet providers to improve home connectivity. Patient focus groups, including minority focus groups, are currently underway to develop additional patient-centered strategies that could promote success of EHR-tethered patient portal based ACP communication while addressing health disparities.
Table: Patient Willingness to Use OSUMyChart for ACP Communication
OSUMyChart Response Positive Negative
Total Patients (n = 48) 25 (52.1%) 23 (47.9%)
Male (n = 17) 8 (47.1%) 9 (52.9%)
Female (n = 31) 17 (54.8%) 14 (45.2%)
Internet Access (n = 30) 19 (63.3%) 11 (36.7%)
Has OSUMyChart (n = 14) 10 (71.4%) 4 (28.6%)
Median Age Range (n = 48) 65-70 65-70
Background: Advance Care Planning (ACP) is the process of assisting patients in making future healthcare decisions. ACP delivery has been linked to improved patient satisfaction, decreased caregiver stress, and improved grieving. However, it often receives low priority due to provider time limitations related to increasing patient volume, disease complexity, and paperwork burden.
Increasing use of health information technology (HIT) for documentation and patient care, including electronic health records (EHR) and EHR-tethered patient portals, provides opportunities for innovation in ACP delivery.
Objective: The study objective is to assess patient willingness to use EHR-tethered patient portals for ACP provider-patient communication.
Methods: Patients in primary care clinics at the Ohio State University Medical Center over the age of 50 were surveyed, as part of an ongoing study, using convenience sampling. This survey is the initial phase of a multi-phase project to develop an EHR-based patient-provider ACP communication framework.
Results: 48 patients have been surveyed to date. Of all patients surveyed, 25/48 (52%) are willing to have ACP discussions with their provider using the EHR-tethered patient portal (OSUMyChart); 23/48 patients were unwilling to have these discussions using OSUMyChart. Thirty of the 48 surveyed patients have home internet access. Of patients with home internet, 19/30 (63%) were willing to have an ACP discussion with their provider using OSUMyChart. Fourteen of the 48 surveyed patients have activated OSUMyChart accounts. Of these 10/14 (73%) patients with activated OSUMyChart accounts report willingness to have an electronic ACP discussion with a provider. A majority of patients who are unwilling to use the EHR-tethered patient portal for ACP discussions report limited computer access as the barrier to its use. Less reported concerns involved security of electronic ACP documentation and a desire to have printed documentation. Patient reported benefits for OSUMyChart communication include convenience and accessibility to providers.
Conclusions: EHR-tethered patient portals can be used for patient-provider ACP communication to promote compatibility with busy practice workflows. About half of all surveyed patients are willing to use these portals for patient/ provider ACP communication. Although larger sample size is needed, current data suggests that patients with home internet and activated EHR-tethered patient portals may be more willing to have electronic patient-provider ACP communication. Lack of home internet and computer access, barriers to electronic ACP communication, are more likely in patients who are older and economically challenged. Electronic ACP communication does present unique opportunities for ACP communication. However, in order to prevent economic and age related health disparities, implementation of an electronic ACP communication tool must include usability testing, technology assistance, and accessible, internet-connected devices. Practical approaches could include on-site tech support, patient education areas providing internet connected devices, clinic based computer kiosks, and public-private partnerships with internet providers to improve home connectivity. Patient focus groups, including minority focus groups, are currently underway to develop additional patient-centered strategies that could promote success of EHR-tethered patient portal based ACP communication while addressing health disparities.
Table: Patient Willingness to Use OSUMyChart for ACP Communication
OSUMyChart Response Positive Negative
Total Patients (n = 48) 25 (52.1%) 23 (47.9%)
Male (n = 17) 8 (47.1%) 9 (52.9%)
Female (n = 31) 17 (54.8%) 14 (45.2%)
Internet Access (n = 30) 19 (63.3%) 11 (36.7%)
Has OSUMyChart (n = 14) 10 (71.4%) 4 (28.6%)
Median Age Range (n = 48) 65-70 65-70
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