Older Adult Consumers’ Attitudes and Preferences on Electronic Patient-Physician Messaging
Published Online: November 21, 2013
Richard Lam, MD, MBA; Victor S. Lin BS; Wendy S. Senelick, MPH; Hong-Phuc Tran, MD; Alison A. Moore, MD, MPH; and Brandon Koretz, MD, MBA
As the Health Information Technology for Economic and Clinical Health (HITECH) Act enters stage 2 of implementation,1 providers must be cognizant of patient attitudes toward health information exchange (HIE) while optimizing their electronic health record (EHR) systems. The crux of health information technology (HIT) integration lies in the ability to improve and enhance the providers’ delivery of care, as well as positive patient outcomes, through meaningful use. According to the Centers for Medicare & Medicaid Services (CMS), benefits of meaningful use must include: complete and accurate information, better access to information, and patient empowerment.1 Health information technology literature has repeatedly shown quality and efficiency benefits with successful implementation of EHR systems into capable healthcare systems. These benefits include increased adherence to guidelines, enhanced disease surveillance, and decreased medication errors.2 EHR systems have demonstrated tremendous promise in improving healthcare delivery efficiency and quality, cost-effectiveness, and patient safety at benchmark institutions such as Regenstrief Institute (Indianapolis, IN), Partners/Brigham and Women’s Hospital (Boston, MA), Intermountain Health (Salt Lake City, UT), Vanderbilt University (Nashville, TN), and Kaiser Permanente Health Care System.3
Lacking, however, is adequate health services research regarding the attitudes and preferences of older patients as compared with younger patients with respect to electronic communication with their providers. Such research is important, especially with our aging population and the cost of providing care for this population. As of 2011, more than 1 in every 8 Americans (13.3% of the population) is 65 years or older and, by 2040, there will be about 79.7 million older adults (21% of the population).4 The increase in prevalence of chronic comorbidities among the older adult population affords the opportunity for electronic health information exchange platforms to improve health outcomes through patient engagement. Given current patient trends toward consolidation into large healthcare organizations, comprehensive EHR systems can scale effective management of large populations. A comprehensive EHR system is composed of 2 essential components: (1) the provider network, allowing for storage/retrieval of patient medical records as well as communication between providers, and (2) the patient web portal (PWP), allowing patients (andproxy users) to access certain health records as well as communicate with the medical care team through various functions.
Both components work in unison to enhance healthcare delivery with secure and reliable medical record management, efficient interdepartmental communication, and interactive patient-centered care.
We surveyed older and younger adults who enrolled in a simple, secure patient-physician messaging system, to better understand attitudes and preferences regarding electronic communication with providers. Between April 2010 and January 2012, 46 primary care physicians at UCLA’s Geriatrics and Internal Medicine ambulatory practices, along with their medical care teams, enrolled 3543 patients and exchanged 13,259 messages between them. This study surveyed patients and/or their proxies enrolled in this program to identify end user attitudes, concerns, and preferences and inform the development of a more comprehensive PWP.
Patient-Physician Messaging System
Vision Tree is a secure, freestanding, Internet-based 2-way messaging system that allows patients and caregivers to communicate with the medical care team. Patients (or proxy users) do not have direct access to their personal medical records, but can be sent personal medical information through electronic messages. In the pilot program, interested patients were e-mailed a message containing log-in information and instructions on account setup. Once the account has been set up, the account user is directed to the messaging site landing page, where one can compose and send new messages and receive and review messages from the medical care team.
Messages are addressed to the provider and triaged by assigned medical staff during regular clinic hours. During triage, medical staff answer messages that are within their scope of work (eg, appointment scheduling, referrals, and authorizations) or forward, via encrypted e-mail, questions that require the physician’s attention. The physician may then call the patient or reply to the medical staff’s e-mail with a response. The medical staff transfers the physician’s response to the Vision Tree messaging system and sends the message to the patient. Once the office’s response is sent, an alert notification arrives at the patient’s e-mail address instructing him or her to log in to Vision Tree to view the new message.
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