Patient Portal, Patient-Generated Images, and Medical Decision-Making in a Pediatric Ambulatory Setting

Abstract

Background Electronic health record (EHR) patient portals are a secure electronic method of communicating with health care providers. In addition to sending secure messages, images, and videos generated by families can be sent to providers securely. With the widespread use of smart phones, there has been an increase in patient-generated images (PGI) sent to providers via patient portals. There are few studies that have evaluated the role of PGI in medical decision-making.

Objectives The study aimed to characterize PGI sent to providers via a patient portal, determine how often PGI-affected medical decision-making, and determine the rate of social PGI sent via patient portal.

Methods A retrospective chart review of PGI uploaded to a children's hospital's ambulatory patient portal from January 2011 to December 2017 was conducted. Data collected included patient demographics, number and type of images sent, person sending images (patient or parent/guardian), and whether an image-affected medical decision-making. Images were classified as medical related (e.g., blood glucose readings and skin rashes), nonmedical or administrative related (e.g., medical clearance or insurance forms), and social (e.g., self-portraits and camp pictures).

Results One hundred forty-three individuals used the portal a total of 358 times, sending 507 images over the study period. Mean (standard deviation) patient age was 9.5 (5.9) years, 50% were females, 89% were White, and 64% had private insurance. About 9% of images were sent directly by patients and the rest by parents/guardians. A total of 387 (76%) images were sent for medical related reasons, 20% for nonmedical, and 4% were deemed social images. Of the 387 medical related images, 314 (81%) affected medical decision-making.

Conclusion PGI-affected medical decision-making in most cases. Additional studies are needed to characterize use of PGI in the pediatric population.

Keywords

patient-generated images - patient portal - electronic health record - medical decision-making

Note

Results of this study were presented in part as a podium presentation at the 2018 Pediatric Academy Association annual meeting in Toronto, Canada. The first author, K.G., was a final year medical student at the time the study was conducted and presented at the PAS.

Protection of Human and Animal Subjects

The study was performed in compliance with the World Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was conducted after approval from the institutional review board of the study site. This study was conducted after approval from the Dayton Children's Hospital Institutional Review Board.

Publication History

Received: 01 May 2020

Accepted: 10 September 2020

Article published online:
18 November 2020

• References

• 1 The Office of the National Coordinator for Health Information Technology. What is a web portal?. Available at: https://www.healthit.gov/faq/what-patient-portal. Accessed April 17, 2020
• 2 Price-Haywood EG, Luo Q. Primary care practice reengineering and associations with patient portal use, service utilization, and disease control among patients with hypertension and/or diabetes. Ochsner J 2017; 17 (01) 103-111
• 3 Kelly MM, Hoonakker PLT, Dean SM. Using an inpatient portal to engage families in pediatric hospital care. J Am Med Inform Assoc 2017; 24 (01) 153-161
• 4 Li MK, Howard DP, King R. “A picture tells a thousand words” smartphone-based secure clinical image transfer improves compliance in open fracture management. Injury 2019; 50 (07) 1284-1287
• 5 Joseph B, Pandit V, Wynne J. et al. Telephotography in trauma: a 2-year clinical experience. Telemed J E Health 2014; 20 (04) 342-345
• 6 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
• 7 Pell JM, Mancuso M, Limon S, Oman K, Lin CT. Patient access to electronic health records during hospitalization. JAMA Intern Med 2015; 175 (05) 856-858
• 8 Castillo RM, Kim GY, Wyatt KD, Lohse CM, Hellmich TR. Use of an EHR-integrated point-of-care mobile medical photography application in a pediatric emergency department. Appl Clin Inform 2019; 10 (05) 888-897
• 9 Wyatt KD, Willaert BN, Lohse CM, Pallagi PJ, Yiannias JA, Hellmich TR. Experiences of health care providers using a mobile medical photography application. Appl Clin Inform 2020; 11 (01) 122-129
• 10 Price-Haywood EG, Luo Q, Monlezun D. Dose effect of patient-care team communication via secure portal messaging on glucose and blood pressure control. J Am Med Inform Assoc 2018; 25 (06) 702-708
• 11 Goldzweig CL, Orshansky G, Paige NM. et al. Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review. Ann Intern Med 2013; 159 (10) 677-687
• 12 Fraccaro P, Vigo M, Balatsoukas P, Buchan IE, Peek N, van der Veer SN. The influence of patient portals on users' decision making is insufficiently investigated: A systematic methodological review. Int J Med Inform 2018; 111: 100-111
• 13 Six domains of health care quality. Available at: http://www.ahrq.gov/talkingquality/measures/six-domains.html. Accessed April 22, 2020
• 14 Steitz B, Cronin RM, Davis SE, Yan E, Jackson GP. Long-term patterns of patient portal use for pediatric patients at an academic medical center. Appl Clin Inform 2017; 8 (03) 779-793