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
Objective: To evaluate and compare the attitudes and preferences of younger and older adults regarding health information exchange with providers, and identify barriers and limitations to meaningful use.

Study Design: Cross-sectional study.

Methods: Qualitative and quantitative data gathered from online surveys of younger and older adult patients enrolled in a freestanding, Internetbased patient-physician messaging system that requires an individual account. This messaging system is only a secure messaging center, and does not allow for direct access to personal medical records.

Results: Data were collected from 324 patients (or proxy users) who reported their age, with 55.2% of respondents under the age of 65 years (mean age 48.2 years) and 44.8% of respondents 65 years or older (mean age 74.9 years). Family and non-family caregivers (proxy users) (mean age 59.2 years) comprised 21.0% of respondents. Overall, 83.9% of all respondents preferred to communicate with the provider via e-mail, and 84.5% of users found the messaging system easy to use, with a majority utilizing the messaging system to communicate about health questions and/or medication requests. Finally, 83% of user respondents were satisfied with the messaging system. Results highlight several areas where improvement is needed to increase patient use and satisfaction including adequate patient education, user-friendly interface, and provider engagement. No significant differences  between the younger and older adult populations were found.

Conclusion: Although a majority of enrolled older adult patients have positive attitudes about health information exchange, electronic communication platforms must address key issues in consumer education, physician commitment, and adoption of an accessible interface to ensure productive older adult consumer participation.

Am J Manag Care. 2013;19(11 Spec No. 10):eSP7-eSP11
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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Issue: Special Issue: Health Information Technology - Guest Editor: Farzad Mostashari, MD, ScM
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