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Sarah E. Barnett MSc, CRaNHR John C. Hogenbirk MSc, CRaNHR May 27, 2013

Evaluation of a Patient Portal Pilot Project in Northern Ontario. Sarah E. Barnett MSc, CRaNHR John C. Hogenbirk MSc, CRaNHR May 27, 2013 eHealth 2013: Accelerating Change – Ottawa, ON. Presenter Disclosure. Presenter: Sarah E. Barnett Relationships with commercial interests:

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Sarah E. Barnett MSc, CRaNHR John C. Hogenbirk MSc, CRaNHR May 27, 2013

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  1. Evaluation of aPatient Portal Pilot Project in Northern Ontario Sarah E. Barnett MSc, CRaNHR John C. Hogenbirk MSc, CRaNHR May 27, 2013 eHealth 2013: Accelerating Change – Ottawa, ON

  2. Presenter Disclosure • Presenter: Sarah E. Barnett • Relationships with commercial interests: • Nothing to disclose

  3. Pilot Overview • eHealth Ontario’s Consumer eHealth Program commissioned a pilot study to determine the implications of giving patients access to their medical records electronically 1740 patients registered

  4. The mydoctor.ca Health Portal • Provides patients the ability to track & share health information & communicate with their care team (MD Physician Services, 2012) • Saves physician & clerical staff time, improves patient outcomes & minimizes follow-up visits (MD Physician Services, 2012)

  5. Previous Research • Encourage patients to play a more active role in their healthcare (Coulter & Ellins, 2007) • Take responsibility for their health (Parker, 2006) • Discuss issues & options with their provider & to share in decision making (Health Council of Canada, 2011) • Achieve better health outcomes (Coulter & Ellins, 2007; Health Council of Canada, 2011; Herrin et al, 2012; Parker, 2006) • Benefits can only be realized if patients & providers adopt & utilize (Patel et al., 2011; Yamin et al., 2011) • Products with limited value will not be adopted (Kahn et al., 2009) • Disparities in access & utilization (Ancker et al., 2011; Kahn et al., 2009; Patel et al., 2011; Yamin et al., 2011) • Typically less than 10% of patients tend to use a personal health record on a monthly basis (Kaelber et al., 2008).

  6. Methodology

  7. Methodology Clerical Staff Utilization Data Patient Surveys Chart Extraction Consultations mydoctor.ca Health Portal Patients Physicians

  8. Methodology • Patients: • Utilization Data: Health Portal System Activity Logs • July 24th, 2012 • September 26th, 2012 • Patient Survey: 28-Question Online Survey • September 27, 2012 • 2 reminders sent at 1 week Intervals • Chart Extraction: Completed by Physicians • October 4, 2012 • 10 patients each

  9. Methodology • Patients: • Utilization Data: Health Portal System Activity Logs • July 24th, 2012 • September 26th, 2012 • Patient Survey: 28-Question Online Survey • September 27, 2012 • 2 reminders sent at 1 week Intervals • Chart Extraction: Completed by Physicians • October 4, 2012 • 10 patients each

  10. Methodology Research Objectives: • Physicians & Clerical Staff: • Consultations: 6-10 Questions • Physicians: in person interviews • Clerical Staff: responded in writing

  11. Findings: Adoption & Utilization Number of Patients Registered shown by Month Invited • 228 patients invited • 205 patients registered

  12. Findings: Adoption & Utilization

  13. Findings: Patient Survey • Patient Survey Respondents (n=61) • 83% very (6 or 7) comfortable using computers • 80% use the internet at least once a day • 38% spend at least 10 hours/week on the internet • 10% had not used the Internet to search for medical or health related information • Utilization of the mydoctor.ca Health Portal • 98% of respondents accessed the portal from home • other locations/modalities: work, smart phone/iPad, relative’s home & on vacation • 68-83% had a high level of comfort or confidence (6 or 7) in… • Entering or Checking information • Logging on or Using the portal • Sending & receiving messages

  14. Findings: Benefits of the Portal • Patient Survey: • 43% strongly agree that the Health Portal was useful to them • 70% indicated the portal increased their ability to monitor their health • 64% indicated the portal made it easier to manage their health • 33% indicated the portal decreased their use of other health care services • e.g., emergency department, specialists, walk-in clinics • Other Benefits Gained by Using the Health Portal: Note: 1 = Strongly disagree, 4 = Neither agree nor disagree, 7 = Strongly agree

  15. Findings: Benefits of the Portal • Physician & Clerical Staff Consultations: • Recognized importance & benefits of using a portal • For physicians incorporating the Health Portal into their practice was either “neutral” or a slight increase in workload • Patients using the portal regularly generally “very happy”, followed treatment plans well & more engaged

  16. Findings: Issues with the Portal • Patient Survey: • Being kicked out of the portal when attempting to input data • Lack of customizability of Health Metrics • Lack of availability of test results (e.g., lab work & imaging) • “lost interest” after lab results were no longer updated • Physician & Clerical Staff Consultations: • Lack of consistency in the portal’s ability to function properly • Synchronization issues & discontinuity with the EMR • “major issue” & “huge disappointment” • Problems with the health metric tools • Difficulty getting lab & diagnostic test results uploaded to the portal • Amount of time spent trying to get the portal working properly

  17. Findings: Potential Improvements • Patient Survey: • Easier portal navigation, recording & tracking health • Receive notification as new information or data becomes available or for upcoming seminars • Ability to add sub-accounts for children • Inclusion of the patient’s full medical history • Ability to schedule appointments & have automatic appointment reminders sent • Physician Consultations: • Incorporate patient entered data into the EMR with the press of a button • “Upload the data to the portal directly from [the] meter” • Analyze & trend patient entered data • Use secure messaging between patient & other health professionals within the FHT • Ability for patients to schedule appointments

  18. Findings: Patient Intentions Endorsement, Willingness to Use & Willingness to Pay for the Portal Note: 1 = Not at all likely, 4 = Somewhat likely, 7 = Very likely* Scale for Recommend to friends and family: 1 = Strongly disagree, 4 = Neither agree nor disagree, 7 = Strongly agree

  19. Limitations • Select Group of Respondents: • Physicians self-selected into the Health Portal pilot project • Patients who were invited to participate comprise a select group • Patient Survey Methodology Created Further Selection: • Invitations were sent through the portal messaging system • Patients had to have some level of comfort with the internet complete survey • Respondents may not be fully representative of the patients invited to participate & CoL patients as a whole • Reliance on Self-Reported Data: • May be social desirability bias in patient responses • respond in a way that will they feel will be viewed favourably

  20. Conclusion & Implications • All three study populations acknowledged that the Health Portal had potential benefits • BUT the benefits were not fully realized • There was considerable effort by clerical staff in the initial stages of the project • Physicians planned to discontinue use of this specific patient portal • BUT remained optimistic about future endeavours

  21. Acknowledgements

  22. Thank You sbarnett@laurentian.ca www.cranhr.ca

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