Patients Web Portal Improves Patient Health Outcome in Comparison to Non-Web Portal - Term Paper Example

Effects of Patients Web Portal on health outcome of patients who use it March 31, Technology offers benefits and patient web portal is an example. The application’s advantages promises better health outcome and government initiatives that promote it suggests its significance in healthcare. This paper conducts a literature review on the topic, ‘effects of patients web portal on health outcome of patients who use it.’ Using key words and based on inclusion and exclusion criteria, CIHAL and PubMed online libraries were used to recruit articles. Screening of the recruited article then informed selection f five articles for review. Review results identify possible but unascertained and indirect benefits of patient web portal to quality of health, amidst barriers to use of the technology. It is therefore necessary to promote use of the technology and to conduct further research to identify direct effects of the technology on health outcomes. Reliability and validity of reviewed quantitative studies are the main strengths while failure to identify direct relationship between the technology and health outcomes is the weakness. Effects of Patients Web Portal on health outcome of patients who use it Introduction Information technology is one of the contemporary environmental factors in the healthcare sector. It offers many benefits to organizations and need for efficiency and cost effectiveness has facilitated incorporation of information technology in many healthcare facilities. Reliance on information technology has for example helped in eliminating errors in the healthcare sector and therefore reduced cost that was initially used in correcting the errors. Costs of recording and managing data as well as cost of processing data for communication and disseminating information have also reduced because of such technologies as the internet. Other reported benefits of information technology in the healthcare sector are improvement in management of disease, reduction in patients’ length of stay in hospitals, improved screening initiatives (The United States General Accounting Office, 2003). These benefits have been consistent and emerging technologies facilitate them besides introducing other benefits. Patient web portal, a web-based application that allows patients to access their health information through an internet connection, is an example of contemporary information technology applications. Its features allow users to register and organize for services, complete payments, and access their health information conveniently with the use of the internet (HIMSS, 2013). Benefits of patient web portal include efficiency, timely service delivery, and effective communication between patients and caregivers for better health outcomes. Ability to pre-schedule appointments and to make payments conveniently, for example, saves patients time and facilitate access to care services where time could be a barrier and this is particularly applicable to preventive measures and self-care control measures (Berkowitz and McCarthy, 2012). These suggest that web portal usage improves patients’ outcomes, a hypothesis that if true in the nursing environment, requires advocacy for patients’ reliance on web portal. Government, through the meaningful use of stage 2 criteria on patient engagement program, which seeks to promote reliance on internet technology, shows significance of the technology on achieving positive health outcomes. The Meaningful use Stage 2 criteria are part of measures for motivating professionals and hospitals to implement recommended electronic health standards. Government offers initiatives based on a series of criteria and stage 2 compliance with core objectives and menu objectives in order to receive incentives. Eligible professionals must satisfy 17 core objectives and 3 menu objectives while hospitals must satisfy 16 core objectives and three menu objectives and these facilitates implementation of competent electronic health records and associated applications (The Centers for Medicare & Medicaid Services, 2012). The topic is therefore important to nursing because of its ability to improve quality of life, an objective of the scope of nursing. A review of evidence from empirical studies and further evidence-based research are therefore necessary for ascertaining the hypothesized benefits of patient web portals and the resultant benefit on quality of health. This paper seeks to conduct literature review on use of patients’ web portal and associated benefits. Methods A random search was conducted through PubMed and EbscoHost libraryies using patient web portal, effects, experiences, barriers, and impacts as key search words. The phrase ‘patient web portal’ was used with one or more of the other key words to recruit literature from the two sources. The articles’ publication date was another criterion for inclusion and exclusion and for quantitative studies, a five-year limit was put and articles that were published more than five years ago were omitted. This exclusion criterion did not however apply to qualitative studies. Five articles were then used for the literature review, based on personal rationale on the articles’ relative relevance to the topic. Titles of the recruited literatures were then screened for relevance to the study’s topic and articles whose titles were not incident the study’s topic were excluded. Literature review/ Discussion This section discusses literature review results, focusing on the studies’ methodologies that indicate reliability and validity, and the studies’ results. The methodologies and results are then compared with the aim of identifying possible consistencies and differences between developed knowledge on effects of patient web portal on health outcomes. Nagykaldi, Aspy, Chou, and Mold (2012) investigated effects of a wellness portal on provision of patient centered preventive care using a randomized design. A pilot study identified a significant level of acceptability of the portal, which the researchers developed, among patients. Ninety percent of participants in the pilot study identified ease of the portal’s use, 83 identified its value, and 80 percent realized benefits of the tool in facilitating involvement in self-care. Five hundred and thirty eight participants were used in the study, 422 adults, and 116 parents of children, a large enough number for external reliability and validity, especially with application of a randomized controlled design. Patients who used the wellness portal recorded greater levels of patient activation, patient centeredness of care, preventive measures, and use of online personal health records. This suggest effectiveness of patient web portals in improving health outcomes through promoting effective self care for preventive and management of diseases. The difference was significant even though participants who used wellness portals did not have more face-to-face visits. An independent cohort study by North, et al. (2014) supports the role of web portal on improving health outcomes despite possible face-to-face interactions between patients and physicians. The researchers studied patients’ frequencies of face-to-face visits to care givers, with focus on periods before and after the patients’ used web portal. Two thousand three hundred and fifty seven participants were used, an indicator of reliability. In addition, retrospective scope of the study and reliance on existing data of patients’ frequencies of face-to-face visits identifies validity of the study. No significant difference existed in patients’ frequency of face-to-face visit after use of web portal and this attributes possible better health outcomes to effects of patient web portal. Other studies have however undermined effectiveness of web portals in facilitating health outcomes. Identifying gap in literature on effectiveness of web portal usage, Ronda, Dijkhorst-Oei, Gorter, Beulens, and Rutten (2013) conducted a study to investigate differences between diabetic patients who had log in and those who did not have log in into web portals. A survey design, with questionnaire, was used to collect data from 4500 participants, 1500 with log in and 3000 without log in. Less than half of the respondents requested for long in, and requests were more among type 1 diabetic patients. Factors such as age, duration of the disease, level of education, and type of practitioner, whether an intern or a senior practitioner, determined request for log in. Identified significant differences exist in request for log in, by the factors suggests that demographic barriers exist to use of web portal despite identified benefits. Use of questionnaires and large sample size suggest reliability and validity of the study and its results. A qualitative study, literature review, on effects of patient portals on quality of health and patients’ attitude into usage also reported mixed results and support the notion that demographic factors affects effectiveness of web portal in realizing its benefits. The authors conducted two reviews of 6508 titles of literature, with diversified designs, factors that establishes reliability and validity. The study suggests inefficiency of existing literature on effectiveness of web portals in improving health outcomes, and therefore need for further research (Goldzweig, et al., 2013). Using 159 patients and telephone survey, Goel, et al. (2011) collected data on barriers that patients face in using patient portal. The qualitative scope of the study undermines reliability need for large sample size for use of a study. Lack of motivation, poor attitude towards patient portal and usage, barriers to computer usage are some of the identified barriers to usage of patient portal. The literature identifies mixed data on benefits of web portal and identified barriers could be reasons for the differences. Implications for practice and conclusion The reviewed literature suggests indirect significance of web portal in improving health outcomes. Some of the literature identifies insufficiency in the significance, due to barriers, but none of the reviewed literature undermines the significance. These suggest that patient web portal is able to improve patient outcomes but the barriers limit the capacity. The gap means need for nurse advocacy as an initiative for public health programs that can educate people on barriers to use of web portal and need to overcome the barriers. The initiative is likely to facilitate use of web portal towards the benefits. Existence of inconsistent information on effectiveness of web portal in improving health outcomes and scarcity of literature on direct effects of patient web portal on health outcomes suggest need for further evidence-based research to ascertain significance of web portal to health outcomes. Reliability and validity are the major overall strengths of the explored literature. Three of the studies were quantitative and the large sample sizes and designs that included randomized control design, questionnaire-based survey, and longitudinal cohort study established the strengths. Professional and expertise status of the researchers that conducted telephone interviews in one of the qualitative studies, by Goel et al., establish credibility of the study as reliance of existing literature in the literature review study does. Failure to identify literature on direct effects of patient web portal on patient outcomes is the main weakness of the studies. Based on the identified information gap, the following study topics are proposed. Effects of patient portal web on perceived efficiency of practitioners among patients Effects of patient education in overcoming barriers to use of web portal The literature review sought to investigate use of patients’ web portal and associated benefits. Existing literature however identified relationships between usage and factors to quality of health but not to health outcomes, and barriers to portal usage. both qualitative and quantitative studies were reviewed and their validity and reliability, ot credibility ascertained. The review results suggests need to promote awareness of barriers to portal usage and need to overcome then and need for further studies on effects of portal usage on health outcomes given the barriers. References Berkowitz, L. and McCarthy, C. (2012). Innovation with information technologies in healthcare. Chicago, IL: Springer Science & Business Media. Goel, M., et al. (2011). Patient reported barriers to enrolling in a patient portal. Journal of the American Medical Informatics Association 18(1), i8-12. Goldzweig, C. et al. (2013). Electronic patient portals: Evidence on health outcomes, satisfaction, efficiency, and attitudes. Annals of Internal Medicine 159(10), 677-700. HIMSS. (2013). HIMSS dictionary of healthcare information technology terms, acronyms and organizations (3rd Ed.). Chicago, IL: HIMSS. Nagykaldi, Z., Aspy, C., Chou, A., and Mold, J. (2012). Impact of a wellness portal on the delivery of patient-centered preventive care. Journal of the American Board of Family Medicine 25(2), 158-167. North, F. et al. (2014). Impact of patient portal secure messages and electronic visits on adult primary care office visits. Telemedicine and e-Health 20(3), 192-198. Ronda, M., Dijkhorst-Oei, L., Gorter, K., Beulens, J., and Rutten, G. (2013). Differences between diabetes patients who are interested or not in the use of a patient web portal. Diabetes Technology & Therapeutics 15(7), 556-563. The Centers for Medicare & Medicaid Services. (2012). Stage 2 overview tipsheet. The Centers for Medicare & Medicaid Services. Retrieved from: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.pdf. The United States General Accounting Office. (2003). Information on technology: Benefits realized for selected health care functions: Report to the ranking minority member, committee on health, education, labor, and pensions, U.S. Senate. Philadelphia, PA: DIANE Publishing. Appendix: Individual evidence summary table Authors (Year) Evidence type (Study design) Setting, sample, sample size Variables and outcome measures Results/recommendations limitations Goel, M., et al. (2011) Survey design The study’s setting was Northwestern Medical Faculty foundation. Patients who had a physician at the clinic, had two visits in the past 18 month, had had an electronic order between January 2009 and march 2010, and never enrolled within a month after order placement formed the sample. 159 participants were used. Variable: Barriers to enrolling in a patient portal Measures: Reasons for not enrolling, reasons for not trying to enroll, perceived advantages of the portal Lack of motivation, poor attitude towards patient portal and usage, barriers to computer usage are barriers to portal usage. Further research for addressing barriers is recommended Possible participant bias Focus on a single facility Lack of knowledge on content of physician-participant communication Goldzweig, C. et al. (2013) Systematic review The study was conducted through online literature search and articles on patients’ access to patient portals and 46 articles on descriptive qualitative, descriptive quantitative and hypothesis testing formed the sample. Health outcomes, satisfaction, efficiency, and attitudes Patients have positive attitude towards portal usage but evidence on benefits is insufficient Efforts for overcoming barriers and further research on the barriers are recommended Limited data and lack of reporting by organizations Nagykaldi, Z., Aspy, C., Chou, A., and Mold, J. (2012) Randomized control design Clinician practices in Oklahoma Physicians Resource/ Research network was used. Clinician practices formed the sample and 8 were used. Patients and clinicians’ behavior and experiences were the variables Use of the portal, patient activation, patient perception of personal responsibility, communication, and medication were the outcome measures Use of the wellness portal identified greater levels of patient activation, patient centeredness of care, preventive measures, and use of online personal health records Recommendation for use of the portal can be infered Inability to blind participants, possible effects of improved documentation, and better health of participants North, F. et al. (2014) Retrospective cohort study Mayo Clinic primary care practice, Rochester, with its clinical care was used with patients who used e-messaging on patient portal as sample. Sample size was 2357 was used Use of patient portal for communication and face-to-face visit were the measure both variables and outcome measures No significant difference patients’ frequency of face-to-face visit before and after use of web portal Limitations include inability to use randomized controlled design and lack of a diverse population Ronda, M., Dijkhorst-Oei, L., Gorter, K., Beulens, J., and Rutten, G. (2013). Survey design General practices and outpatient clinic of Diamuraal formed the study’s setting. Patients in the facilities were the participants and a sample size of 4500 was used Patients’ characteristics were the variables with level of education, ethnicity, living status, employment, medication, and drug abuse as outcome measures Few request for log ins, request higher among type 1 diabetes patients, and age, duration of the disease, level of education, and type of practitioner are barriers to request for log in Applied design does not explain a causal relationship Low response rate, 66.6 percent including those who were not willing to participate Very low number of participants with type 1 diabetes Read More