Patient Portals Facilitating Engagement With Inpatient Electronic Medical Records: A Systematic Review

Abstract

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: Engaging patients in the delivery of healthcare has the potential to improve health outcomes and patient satisfaction. Patient portals may enhance patient engagement; by enabling patients to access their electronic medical records (EMRs) and facilitating secure patient-provider communication. Objective: The aim of this study was to review literature describing patient portals tethered to an EMR in inpatient settings, their role in patient engagement, and their impact on healthcare delivery in order to identify factors and best practices for successful implementation of this technology, and areas that require further research. Methods: A systematic search for articles in the PubMed, CINAHL and Embase databases was conducted, using keywords associated with patient engagement, electronic health records and patient portals, and their respective subject headings in each database. Articles for inclusion were evaluated for quality using ‘A MeaSurement Tool to Assess systematic Reviews’ (AMSTAR 2) for systematic review articles and the ‘Quality Assessment Tool for Studies with Diverse Designs’ (QATSDD) for empirical studies. Included studies were categorized by their focus on input factors (e.g., portal design), process factors (e.g., portal usage), and output factors (e.g., benefits), and by the valence of their findings regarding patient portals (i.e., positive, negative, or mixed). Results: The systematic search identified 58 articles for inclusion. The ‘inputs’ category was addressed by 40 articles, while the ‘processes’ and ‘outputs’ categories were addressed by 36 and 46 articles, respectively; 47 articles addressed multiple themes across the three categories and 11 addressed only a single theme. Nineteen articles had high to very high quality, 21 had medium quality and 18 had low to very low quality. Findings in the ‘inputs’ category showed wide-ranging portal designs; patients’ privacy concerns and lack of encouragement were among portal adoption barriers while information access and communication were facilitators. Several methods were used to train portal users with varying success. In the ‘processes’ category, socio-demographic characteristics and medical conditions of patients were predictors of portal usage; some patients wanted unlimited access to their EMRs, personalized medical education and non-clinical information; and patients were keen to use portals for communicating with their healthcare teams. In the ‘outputs’ category, some but not all studies found patient portals improved patient engagement; patients perceived some portal functions inadequate but others useful; patients and staff thought portals may improve patient care but could cause anxiety in some patients; and portals improved patient safety, adherence to medications, patient-provider communication but had no impact on objective health outcomes. Conclusions: While the evidence is currently immature, patient portals have demonstrated benefit by enabling the discovery of medical errors, improving adherence to medications and patient-provider communication, etc. High-quality studies are needed to fully understand, improve and evaluate their impact.