RSS-Feed abonnieren
DOI: 10.1055/s-0039-1700867
Facilitating Organizational Change to Accommodate an Inpatient Portal
Funding This work was supported by the Agency for Healthcare Research and Quality (AHRQ) grants R01HS024091, R21HS024767, and P30HS024379. While this research was funded by AHRQ, the study sponsor had no involvement in the collection, analysis, or interpretation of data; in the writing of this manuscript; or in the decision to submit the manuscript for publication.Publikationsverlauf
05. August 2019
18. September 2019
Publikationsdatum:
27. November 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035026/201905/lookinside/thumbnails/10-1055-s-0039-1700867_190165soa-1.jpg)
Abstract
Background Patient portals are becoming more commonly used in the hospital inpatient setting. While the potential benefits of inpatient portals are acknowledged, there is a need for research that examines the challenges of portal implementation and the development of best practice approaches for successful implementation.
Objective We conducted this study to improve our understanding of the impact of the implementation of an inpatient portal on care team members in the context of a large academic medical center. Our study focused on the perspectives of nursing care team members about the inpatient portal.
Methods We interviewed care team members (n = 437) in four phases throughout the 2 years following implementation of an inpatient portal to learn about their ongoing perspectives regarding the inpatient portal and its impact on the organization.
Results The perspectives of care team members demonstrated a change in acceptance of the inpatient portal over time in terms of buy-in, positive workflow changes, and acknowledged benefits of the portal for both care team members and patients. There were also changes over time in perspectives of the care team in regards to (1) challenges with new technology, (2) impact of the portal on workflow, and (3) buy-in. Six strategies were identified as important for implementation success: (1) convene a stakeholder group, (2) offer continual portal training, (3) encourage shared responsibility, (4) identify champions, (5) provide provisioning feedback, and (6) support patient use.
Conclusion Inpatient portals are recognized as an important tool for both patients and care team members, but the implementation of such a technology can create challenges. Given the perspectives care team members had about the impact of the inpatient portal, our findings suggest implementation requires attention to organizational changes that are needed to accommodate the tool and the development of strategies that can address challenges associated with the portal.
Keywords
patient portals - implementation - organizational culture - hospitalization - nursing informatics - engagement - organizational changeProtection of Human and Anmial Subject
Conduct of this research was reviewed and approved by The Ohio State University Institutional Review Board.
-
References
- 1 Tai-Seale M, Downing NL, Jones VG. , et al. Technology-enabled consumer engagement: promising practices at four health care delivery organizations. Health Aff (Millwood) 2019; 38 (03) 383-390
- 2 Ghafur S, Schneider EC. Engaging patients using digital technology - learning from other industries. NEJM Catalyst 2019. . Available at: https://catalyst.nejm.org/patients-digital-consumer-focused-industries . Accessed October 7, 2019
- 3 Ahern DK, Woods SS, Lightowler MC, Finley SW, Houston TK. Promise of and potential for patient-facing technologies to enable meaningful use. Am J Prev Med 2011; 40 (05) (Suppl. 02) S162-S172
- 4 Hefner JL, Sieck CJ, McAlearney AS. Training to optimize collaborative use of an inpatient portal. Appl Clin Inform 2018; 9 (03) 558-564
- 5 Kelly MM, Hoonakker PLT, Coller RJ. Inpatients sign on: an opportunity to engage hospitalized patients and caregivers using inpatient portals. Med Care 2019; 57 (02) 98-100
- 6 Huerta T, Fareed N, Hefner JL. , et al. Patient engagement as measured by inpatient portal use: methodology for log file analysis. J Med Internet Res 2019; 21 (03) e10957
- 7 Masterson Creber RM, Grossman LV, Ryan B. , et al. Engaging hospitalized patients with personalized health information: a randomized trial of an inpatient portal. J Am Med Inform Assoc 2019; 26 (02) 115-123
- 8 Fareed N, Walker D, Sieck CJ. , et al. Inpatient portal clusters: identifying user groups based on portal features. J Am Med Inform Assoc 2019; 26 (01) 28-36
- 9 Sieck CJ, Walker DM, Hefner JL, Volney J, Huerta TR, McAlearney AS. Understanding secure messaging in the inpatient environment: a new avenue for communication and patient engagement. Appl Clin Inform 2018; 9 (04) 860-868
- 10 Kelly MM, Hoonakker PL, Dean SM. Using an inpatient portal to engage families in pediatric hospital care. J Am Med Inform Assoc 2017; 24 (01) 153-161
- 11 Walker DM, Menser T, Yen PY, McAlearney AS. Optimizing the user experience: identifying opportunities to improve use of an inpatient portal. Appl Clin Inform 2018; 9 (01) 105-113
- 12 Yen PY, Walker DM, Smith JMG, Zhou MP, Menser TL, McAlearney AS. Usability evaluation of a commercial inpatient portal. Int J Med Inform 2018; 110: 10-18
- 13 Haun JN, Lind JD, Shimada SL. , et al. Evaluating user experiences of the secure messaging tool on the Veterans Affairs' patient portal system. J Med Internet Res 2014; 16 (03) e75
- 14 Ali SB, Romero J, Morrison K, Hafeez B, Ancker JS. Focus section health IT usability: applying a task-technology fit model to adapt an electronic patient portal for patient work. Appl Clin Inform 2018; 9 (01) 174-184
- 15 McAlearney AS, Fareed N, Gaughan A, MacEwan SR, Volney J, Sieck CJ. Empowering patients during hospitalization: perspectives on inpatient portal use. Appl Clin Inform 2019; 10 (01) 103-112
- 16 McAlearney AS, Sieck CJ, Gaughan A, Fareed N, Volney J, Huerta TR. Patients' perceptions of portal use across care settings: qualitative study. J Med Internet Res 2019; 21 (06) e13126
- 17 Woollen J, Prey J, Wilcox L. , et al. Patient experiences using an inpatient personal health record. Appl Clin Inform 2016; 7 (02) 446-460
- 18 Wieland D, Gibeau A, Dewey C, Roshto M, Frankel H. Patient portal readiness among postpartum patients in a safety net setting. Appl Clin Inform 2017; 8 (03) 698-709
- 19 McAlearney AS, Gaughan A, MacEwan SR, Fareed N, Huerta TR. Improving acceptance of inpatient portals: patients' and care team members' perspectives. Telemed J E Health 2019; DOI: 10.1089/tmj.2019.0026.
- 20 Hoonakker PLT, Rankin RJ, Passini JC. , et al. Nurses' expectations of an inpatient portal for hospitalized patients and caregivers. Appl Clin Inform 2019; 10 (04) 625-633
- 21 Hefner JL, Sieck CJ, Walker DM, Huerta TR, McAlearney AS. System-wide inpatient portal implementation: survey of health care team perceptions. JMIR Med Inform 2017; 5 (03) e31
- 22 Kelly MM, Dean SM, Carayon P, Wetterneck TB, Hoonakker PL. Healthcare team perceptions of a portal for parents of hospitalized children before and after implementation. Appl Clin Inform 2017; 8 (01) 265-278
- 23 Collins S, Dykes P, Bates DW. , et al. An informatics research agenda to support patient and family empowerment and engagement in care and recovery during and after hospitalization. J Am Med Inform Assoc 2018; 25 (02) 206-209
- 24 Walker DM, Hefner JL, Sieck CJ, Huerta TR, McAlearney AS. Framework for evaluating and implementing inpatient portals: a multi-stakeholder perspective. J Med Syst 2018; 42 (09) 158
- 25 Collins SA, Rozenblum R, Leung WY. , et al. Acute care patient portals: a qualitative study of stakeholder perspectives on current practices. J Am Med Inform Assoc 2017; 24 (e1): e9-e17
- 26 McAlearney AS, Hefner JL, Sieck CJ, Huerta TR. The journey through grief: insights from a qualitative study of electronic health record implementation. Health Serv Res 2015; 50 (02) 462-488
- 27 Miles MB, Huberman AM. Qualitative Data Analysis: an Expanded Sourcebook. Thousand Oaks, CA: Sage Publications; 1994
- 28 Crabtree BF, Miller WL. Using codes and code manuals: a template organizing style of interpretation. Doing Qualitative Research 1999; 2: 163-177
- 29 Glaser BG, Strauss AL. The Discovery of Grounded Theory: Strategies for Qualitative Research. Chicago, IL: Aldine Publishing Company; 1967
- 30 ATLAS.ti. Version 8.3.1. Berlin: Scientific Software Development GmbH; 2013
- 31 Dendere R, Slade C, Burton-Jones A, Sullivan C, Staib A, Janda M. Patient portals facilitating engagement with inpatient electronic medical records: a systematic review. J Med Internet Res 2019; 21 (04) e12779
- 32 Baldwin JL, Singh H, Sittig DF, Giardina TD. Patient portals and health apps: pitfalls, promises, and what one might learn from the other. Healthc (Amst) 2017; 5 (03) 81-85
- 33 Shah SD, Liebovitz D. It takes two to tango: engaging patients and providers with portals. PM R 2017; 9 (5S): S85-S97
- 34 Morrow D, Hasegawa-Johnson M, Huang T. , et al. A multidisciplinary approach to designing and evaluating electronic medical record portal messages that support patient self-care. J Biomed Inform 2017; 69: 63-74
- 35 Schein EH. Organizational Culture. Vol 45. American Psychological Association; 1990
- 36 Otte-Trojel T, Rundall TG, de Bont A, van de Klundert J, Reed ME. The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente. BMC Health Serv Res 2015; 15: 559
- 37 McAlearney AS, Terris D, Hardacre J. , et al. Organizational coherence in health care organizations: conceptual guidance to facilitate quality improvement and organizational change. Qual Manag Health Care 2013; 22 (02) 86-99
- 38 Grossman LV, Masterson Creber RM, Ancker JS. , et al. Technology access, technical assistance, and disparities in inpatient portal use. Appl Clin Inform 2019; 10 (01) 40-50
- 39 Walker DM, Hefner JL, Fareed N, Huerta TR, McAlearney AS. Exploring the digital divide: age and race disparities in use of an inpatient portal. Telemed J E Health 2019 . Doi: 10.1089/tmj.2019.0065
- 40 Stein JN, Klein JW, Payne TH. , et al. Communicating with vulnerable patient populations: a randomized intervention to teach inpatients to use the electronic patient portal. Appl Clin Inform 2018; 9 (04) 875-883