Electronic Health Record Portals and Patient-Centered Outcomes in CKD

Related article, p. 231 Related article, p. 231 With ongoing health care reform efforts in the United States, focus is shifting to the quality of health care delivery.1Jha A. Pronovost P. Toward a safer health care system: the critical need to improve measurement.JAMA. 2016; 315: 1831-1832Crossref PubMed Scopus (20) Google Scholar Standardized quality indicators have been developed and proposed to measure key components of care across the full continuum of care delivery, including patient-centered outcomes, defined as outcomes meaningful and important to patients and caregivers (patient-centered outcomes).2Stelfox H.T. Straus S.E. Measuring quality of care: considering measurement frameworks and needs assessment to guide quality indicator development.J Clin Epidemiol. 2013; 66: 1320-1327Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar In recent years, electronic health record (EHR) measures of patient-centered outcomes and comparative effectiveness research have been integrated.3Wu A.W. Kharrazi H. Boulware L.E. Snyder C.F. Measure once, cut twice--adding patient-reported outcome measures to the electronic health record for comparative effectiveness research.J Clin Epidemiol. 2013; 66 (suppl): S12-S20Abstract Full Text Full Text PDF PubMed Scopus (120) Google Scholar The relationships between patient portal use and outcomes have been evaluated in different clinical settings and disease processes.4Hernandez-Boussard T. Kourdis P.D. Seto T. et al.Mining electronic health records to extract patient-centered outcomes following prostate cancer treatment.AMIA Annu Symp Proc. 2017; 2017: 876-882PubMed Google Scholar, 5Apter A.J. Bryant Stephens T. Perez L. et al.Patient portal usage and outcomes among adult patients with uncontrolled asthma.J Allergy Clin Immunol Pract. 2020; 8 (e4): 965-970Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar, 6Jhamb M. Cavanaugh K.L. Bian A. et al.Disparities in electronic health record patient portal use in nephrology clinics.Clin J Am Soc Nephrol. 2015; 10: 2013-2022Crossref PubMed Scopus (59) Google Scholar, 7Tome J. Ahmed S. Fagerlin A. et al.Patient electronic health record portal use and patient-centered outcomes in CKD.Kidney Med. 2021; 3: 231-240Abstract Full Text Full Text PDF Scopus (2) Google Scholar EHR and patient-centered outcome measures are important tools for encouraging patient engagement in health care, informing clinical decision making, and improving patient care (Box 1). Patient-provider communication is essential for favorable outcomes, and patients increasingly are encouraged to communicate with their health care providers through internet-based portals tethered to the EHR.5Apter A.J. Bryant Stephens T. Perez L. et al.Patient portal usage and outcomes among adult patients with uncontrolled asthma.J Allergy Clin Immunol Pract. 2020; 8 (e4): 965-970Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Patient-centered outcome measures are one means of systematically gathering meaningful subjective information for patient care, population health, and research.8Bayliss E.A. Tabano H.A. Gill T.M. et al.Data management for applications of patient reported outcomes.EGEMS (Wash DC). 2018; 6: 5PubMed Google Scholar It has been shown that patients who are more engaged in decision making and collaboration with health care providers can have better outcomes.9Eland-de Kok P. van Os-Medendorp H. Vergouwe-Meijer A. Bruijnzeel-Koomen C. Ros W. A systematic review of the effects of e-health on chronically ill patients.J Clin Nurs. 2011; 20: 2997-3010Crossref PubMed Scopus (81) Google Scholar Especially in chronic diseases, it is important that patients have more access to their own medical records in a simple way. Streamlining patient access to medical records plays an important role in patients feeling that they have more control over the treatment or management of their own chronic conditions.Box 1Benefits and Pitfalls of EHR UsePatient CareIncreased adherence to guideline-based careEnhanced surveillance and monitoringDecreased medication errorsImproved quality of patient care by physiciansImprovement in vaccination ratesFacilitates smoking cessationBenefits in primary care settings (eg, improved cholesterol management in diabetic patients)Public health alerts: useful in reporting and recommending specific tests as well as suggesting secondary preventionResearchGeneration of samples for case-control studiesConstruction of a cohortIdentification of people with certain conditions or outcomesLarge-scale high-throughput genetic researchImproved aggregation of patient data for quality improvement or clinical researchMore reliable longitudinal clinical dataExamination of costs incurred for various CKD management aspectsCKD CareEarly identification/diagnosis of CKD and high-risk patientsImproved quality of careImproved referral rates to nephrology clinicsEfficient exchange of information between caregivers and improved multidisciplinary collaborationTimely referrals for dialysis access and renal transplantationCKD stage-specific goals of care and CKD patient educationMedication monitoring and dose adjustmentNational CKD surveillance to improve health through broader availability of population-level CKD dataPatient BenefitsAccess, management, and sharing of personal health information with health care providers through secure messagingRequest of prescription renewals, viewing health summaries, reviewing test results, and accessing current list of medicationsReceiving sex- and age-based automated important health remindersPitfallsIncreased work tasks; computerized order entryFragmentation of dataLoss of communicationRigid clinical decision support, outdated content, alert fatigueHuman and capital resources required rendering inequalities among health care settingsPrivacy and protection of personal health informationAbbreviations: CKD, chronic kidney disease; EHR, electronic health record.Data from references.14Drawz P.E. Archdeacon P. McDonald C.J. et al.CKD as a model for improving chronic disease care through electronic health records.Clin J Am Soc Nephrol. 2015; 10: 1488-1499Crossref PubMed Scopus (39) Google Scholar,15Navaneethan S.D. Jolly S.E. Sharp J. et al.Electronic health records: a new tool to combat chronic kidney disease?.Clin Nephrol. 2013; 79: 175-183Crossref PubMed Scopus (21) Google Scholar Patient CareIncreased adherence to guideline-based careEnhanced surveillance and monitoringDecreased medication errorsImproved quality of patient care by physiciansImprovement in vaccination ratesFacilitates smoking cessationBenefits in primary care settings (eg, improved cholesterol management in diabetic patients)Public health alerts: useful in reporting and recommending specific tests as well as suggesting secondary prevention ResearchGeneration of samples for case-control studiesConstruction of a cohortIdentification of people with certain conditions or outcomesLarge-scale high-throughput genetic researchImproved aggregation of patient data for quality improvement or clinical researchMore reliable longitudinal clinical dataExamination of costs incurred for various CKD management aspects CKD CareEarly identification/diagnosis of CKD and high-risk patientsImproved quality of careImproved referral rates to nephrology clinicsEfficient exchange of information between caregivers and improved multidisciplinary collaborationTimely referrals for dialysis access and renal transplantationCKD stage-specific goals of care and CKD patient educationMedication monitoring and dose adjustmentNational CKD surveillance to improve health through broader availability of population-level CKD data Patient BenefitsAccess, management, and sharing of personal health information with health care providers through secure messagingRequest of prescription renewals, viewing health summaries, reviewing test results, and accessing current list of medicationsReceiving sex- and age-based automated important health reminders PitfallsIncreased work tasks; computerized order entryFragmentation of dataLoss of communicationRigid clinical decision support, outdated content, alert fatigueHuman and capital resources required rendering inequalities among health care settingsPrivacy and protection of personal health information Abbreviations: CKD, chronic kidney disease; EHR, electronic health record. Data from references.14Drawz P.E. Archdeacon P. McDonald C.J. et al.CKD as a model for improving chronic disease care through electronic health records.Clin J Am Soc Nephrol. 2015; 10: 1488-1499Crossref PubMed Scopus (39) Google Scholar,15Navaneethan S.D. Jolly S.E. Sharp J. et al.Electronic health records: a new tool to combat chronic kidney disease?.Clin Nephrol. 2013; 79: 175-183Crossref PubMed Scopus (21) Google Scholar Although chronic kidney disease (CKD) is common and associated with considerable morbidity and mortality, particularly among disadvantaged patients,10Unruh M.L. Arzhan S. Feldman H.I. et al.American Indian Chronic Renal Insufficiency Cohort Study (AI-CRIC study).BMC Nephrol. 2020; 21: 291Crossref PubMed Scopus (1) Google Scholar many patients remain unaware of their diagnosis. EHR patient portals are one way to facilitate patient-provider communication and information sharing and help patients be more engaged in their CKD care through regular follow-up appointments, frequent tests, dissemination of test results, and receipt of education about CKD and CKD management, including lifestyle modifications.11Diamantidis C.J. Becker S. Health information technology (IT) to improve the care of patients with chronic kidney disease (CKD).BMC Nephrol. 2014; 15: 7Crossref PubMed Scopus (63) Google Scholar, 12Lopez-Vargas P.A. Tong A. Howell M. Craig J.C. Educational interventions for patients with CKD: a systematic review.Am J Kidney Dis. 2016; 68: 353-370Abstract Full Text Full Text PDF PubMed Scopus (58) Google Scholar, 13Diamantidis C.J. Fink W. Yang S. et al.Directed use of the internet for health information by patients with chronic kidney disease: prospective cohort study.J Med Internet Res. 2013; 15: e251Crossref PubMed Scopus (26) Google Scholar Providing portal access to disadvantaged patients with CKD affords them opportunities to become aware of their CKD and its progression. Furthermore, such access may encourage patients to be in closer contact with their health care providers while facilitating adherence to treatment and management modalities for comorbid conditions, CKD, and its complications.14Drawz P.E. Archdeacon P. McDonald C.J. et al.CKD as a model for improving chronic disease care through electronic health records.Clin J Am Soc Nephrol. 2015; 10: 1488-1499Crossref PubMed Scopus (39) Google Scholar,15Navaneethan S.D. Jolly S.E. Sharp J. et al.Electronic health records: a new tool to combat chronic kidney disease?.Clin Nephrol. 2013; 79: 175-183Crossref PubMed Scopus (21) Google Scholar EHR and technology use can improve patient-centered outcomes in patients with CKD; notably, the association between the use of EHR portals by nondialysis patients with CKD and patient-centered outcomes is an important area that needs more research.6Jhamb M. Cavanaugh K.L. Bian A. et al.Disparities in electronic health record patient portal use in nephrology clinics.Clin J Am Soc Nephrol. 2015; 10: 2013-2022Crossref PubMed Scopus (59) Google Scholar,7Tome J. Ahmed S. Fagerlin A. et al.Patient electronic health record portal use and patient-centered outcomes in CKD.Kidney Med. 2021; 3: 231-240Abstract Full Text Full Text PDF Scopus (2) Google Scholar,11Diamantidis C.J. Becker S. Health information technology (IT) to improve the care of patients with chronic kidney disease (CKD).BMC Nephrol. 2014; 15: 7Crossref PubMed Scopus (63) Google Scholar,13Diamantidis C.J. Fink W. Yang S. et al.Directed use of the internet for health information by patients with chronic kidney disease: prospective cohort study.J Med Internet Res. 2013; 15: e251Crossref PubMed Scopus (26) Google Scholar In this issue of Kidney Medicine, Tome et al7Tome J. Ahmed S. Fagerlin A. et al.Patient electronic health record portal use and patient-centered outcomes in CKD.Kidney Med. 2021; 3: 231-240Abstract Full Text Full Text PDF Scopus (2) Google Scholar conducted a cross-sectional survey (between April 2015 and March 2018) of 245 nondialysis patients with CKD from nephrology clinics within 1 large academic medical center. They explored whether patient use of an EHR portal was associated with demographics or kidney function and whether portal use predicted patient-centered outcomes such as CKD-specific knowledge, CKD-related stress, and two patient self-ratings of health status. An important finding of this study was that 65% of patients reported using the EHR portal to check their laboratory test results, manage appointments, message their providers, view their medical history, review educational resources, and renew prescriptions. They found that African Americans (odds ratio [OR], 0.34; 95% CI, 0.16-0.72 vs White patients), those with less formal education (OR, 0.06; 95% CI, 0.01-0.36), and those with lower income (OR, 0.28; 95% CI, 0.13-0.60; and OR, 0.26; 95% CI, 0.12-0.54 comparing income <$25,000 and $25,000-$50,000, respectively, with ≥$50,000) had lower odds of EHR portal use in univariate analysis. After adjustment for these factors, only income was associated with lower EHR portal use. Another important finding in univariable analysis was that portal users had higher CKD-specific knowledge (P = 0.02), higher ratings of current health (P = 0.03), and a trend for lower CKD-related stress (P = 0.05). Interestingly, kidney function (estimated glomerular filtration rate) was not associated with EHR portal use. The findings of this study are an extension of previous work by Harrison et al16Harrison T.G. Wick J. Ahmed S.B. et al.Patients with chronic kidney disease and their intent to use electronic personal health records.Can J Kidney Health Dis. 2015; 2: 23Crossref PubMed Scopus (11) Google Scholar conducted in Calgary, Alberta, Canada, between 2013 and 2014 at a multidisciplinary CKD clinic. In this study, a self-administered paper-based patient survey was used on 63 non–dialysis-dependent patients with CKD to determine perceptions of EHRs and identify factors that were associated with intention to use the EHR portal. In that report, most patients expressed their intention to use their portal (70%). Older patients with CKD (aged >65 years) were less likely to intend to use an EHR compared with younger patients with CKD (OR, 0.22; 95% CI, 0.06-0.78), whereas those with postsecondary education (OR, 3.31; 95% CI, 1.06-10.41) and internet access (OR, 5.70; 95% CI, 1.64-19.81) were more likely to intend to use an EHR portal. Greater involvement in their own care (50%), better access to laboratory results (76%), and access to health information (57%) were among the perceived benefits. In both studies, older patients and those with less formal education were less likely to use their portal. Although both studies were limited by their small sample size, the study by Tome et al has the advantage of measuring concurrently patient-centered outcomes, income, and kidney function. In another interesting study originating from the United Kingdom, Phelps et al17Phelps R.G. Taylor J. Simpson K. Samuel J. Turner A.N. Patients' continuing use of an online health record: a quantitative evaluation of 14,000 patient years of access data.J Med Internet Res. 2014; 16: e241Crossref PubMed Scopus (34) Google Scholar longitudinally investigated the Renal Patient View (RPV) use by patients over 4 years, as well as factors associated with more persistent RPV use. RPV is a system that allows patients with CKD access to test results and information about their health status and personal treatment. An impressive quantitative evaluation of 14,000 patient-years of access data took place in this study. The investigators found that a large proportion of patients with CKD regularly used their online EHRs. Patients were strongly interested in recent test results and clinic letters, while access to timely blood test results was a key factor driving the use of the RPV. Initial patient support increased persistent patient use.17Phelps R.G. Taylor J. Simpson K. Samuel J. Turner A.N. Patients' continuing use of an online health record: a quantitative evaluation of 14,000 patient years of access data.J Med Internet Res. 2014; 16: e241Crossref PubMed Scopus (34) Google Scholar Agarwal et al18Agarwal R. Anderson C. Zarate J. Ward C. If we offer it, will they accept? Factors affecting patient use intentions of personal health records and secure messaging.J Med Internet Res. 2013; 15: e43Crossref PubMed Scopus (83) Google Scholar explored how individual and environmental factors influenced the intentions to use the EHR and showed that patients who were more satisfied with their provider and felt more empowered and more actively involved had higher EHR use intentions. Their findings highlight the importance of communication tactics and technology characteristics in influencing patients’ intentions to access and use their personal EHRs.18Agarwal R. Anderson C. Zarate J. Ward C. If we offer it, will they accept? Factors affecting patient use intentions of personal health records and secure messaging.J Med Internet Res. 2013; 15: e43Crossref PubMed Scopus (83) Google Scholar Both studies explore different aspects and factors of EHR portal use and complement the findings in the study by Tome et al. Older age is associated with lower EHR use in patients with CKD,6Jhamb M. Cavanaugh K.L. Bian A. et al.Disparities in electronic health record patient portal use in nephrology clinics.Clin J Am Soc Nephrol. 2015; 10: 2013-2022Crossref PubMed Scopus (59) Google Scholar,13Diamantidis C.J. Fink W. Yang S. et al.Directed use of the internet for health information by patients with chronic kidney disease: prospective cohort study.J Med Internet Res. 2013; 15: e251Crossref PubMed Scopus (26) Google Scholar,16Harrison T.G. Wick J. Ahmed S.B. et al.Patients with chronic kidney disease and their intent to use electronic personal health records.Can J Kidney Health Dis. 2015; 2: 23Crossref PubMed Scopus (11) Google Scholar,17Phelps R.G. Taylor J. Simpson K. Samuel J. Turner A.N. Patients' continuing use of an online health record: a quantitative evaluation of 14,000 patient years of access data.J Med Internet Res. 2014; 16: e241Crossref PubMed Scopus (34) Google Scholar an association not seen in the study by Tome et al. With a study population having a mean age of 60 ± 17 years, the only age-related effect mentioned was that younger age (P = 0.02) was significantly associated with more patient-perceived CKD stress. The cross-sectional design of the study and limited sample size could be a possible explanation. In general, patients with CKD are usually older and more selective in their uptake of modern information technologies, while their level of education and knowledge of EHR functionality is lower compared with younger patients. In this regard, previous studies found that older patients who identified the benefits of greater personal engagement in their health care and of higher access to health information and laboratory results had a higher tendency to use EHR portals.16Harrison T.G. Wick J. Ahmed S.B. et al.Patients with chronic kidney disease and their intent to use electronic personal health records.Can J Kidney Health Dis. 2015; 2: 23Crossref PubMed Scopus (11) Google Scholar,18Agarwal R. Anderson C. Zarate J. Ward C. If we offer it, will they accept? Factors affecting patient use intentions of personal health records and secure messaging.J Med Internet Res. 2013; 15: e43Crossref PubMed Scopus (83) Google Scholar Older adults are still underusing patient portals to engage with their health care providers. Engaging older adults requires more than just signing them up for patient portals. Creativity, simplicity, and confidentiality are crucial factors for successful engagement. Making patient portals more user friendly for older adults is essential. Getting people up is the with the crucial to them through the of a portal. Patient portal access needs to It is important to the of that be through the patient portal while still encouraging for and medical be as an and not as a of the Health care can advantage of older patients are in the or in the to the benefits of patient portals to them in In to older various may the of EHR portal use. Patients with a chronic disease and a lower income may not be to electronic and may not have internet Patients with less formal education and those with resources are particularly for health care and the benefits of EHR portal use in this population remain A.J. Bryant Stephens T. Perez L. et al.Patient portal usage and outcomes among adult patients with uncontrolled asthma.J Allergy Clin Immunol Pract. 2020; 8 (e4): 965-970Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar,7Tome J. Ahmed S. Fagerlin A. et al.Patient electronic health record portal use and patient-centered outcomes in CKD.Kidney Med. 2021; 3: 231-240Abstract Full Text Full Text PDF Scopus (2) Google Scholar studies have shown that African older and patients primary is are less likely to use portals compared with White younger and those with of M. Cavanaugh K.L. Bian A. et al.Disparities in electronic health record patient portal use in nephrology clinics.Clin J Am Soc Nephrol. 2015; 10: 2013-2022Crossref PubMed Scopus (59) Google Scholar,13Diamantidis C.J. Fink W. Yang S. et al.Directed use of the internet for health information by patients with chronic kidney disease: prospective cohort study.J Med Internet Res. 2013; 15: e251Crossref PubMed Scopus (26) Google Scholar findings were in the by Tome et al. results that in order to in care health interventions older African and patients with lower are J. Ahmed S. Fagerlin A. et al.Patient electronic health record portal use and patient-centered outcomes in CKD.Kidney Med. 2021; 3: 231-240Abstract Full Text Full Text PDF Scopus (2) Google Scholar limited patient education how to for EHR portal access and use of (eg, message and C.J. Becker S. Health information technology (IT) to improve the care of patients with chronic kidney disease (CKD).BMC Nephrol. 2014; 15: 7Crossref PubMed Scopus (63) Google in and patient portal and confidentiality are of the A.J. Bryant Stephens T. Perez L. et al.Patient portal usage and outcomes among adult patients with uncontrolled asthma.J Allergy Clin Immunol Pract. 2020; 8 (e4): 965-970Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar,7Tome J. Ahmed S. Fagerlin A. et al.Patient electronic health record portal use and patient-centered outcomes in CKD.Kidney Med. 2021; 3: 231-240Abstract Full Text Full Text PDF Scopus (2) Google M. C. et of a personal health record in health care and of including about patient portal users and characteristics of Annu Symp Proc. 2013; Google Scholar Health portals be to patient-provider communication is a crucial of care for disadvantaged patients who this of A issue is that many health patient is a of patients who are not the from with of the in internet and internet as well as patient well portals may in care for those most of improving access to care for J. Ahmed S. Fagerlin A. et al.Patient electronic health record portal use and patient-centered outcomes in CKD.Kidney Med. 2021; 3: 231-240Abstract Full Text Full Text PDF Scopus (2) Google Scholar may be more access in patients in or those with limited means who or internet factors can to limited or less access to internet for the portals that on internet A.J. Bryant Stephens T. Perez L. et al.Patient portal usage and outcomes among adult patients with uncontrolled asthma.J Allergy Clin Immunol Pract. 2020; 8 (e4): 965-970Abstract Full Text Full Text PDF PubMed Scopus (3) Google A.J. in access to and use of electronic personal health information between and in the United 2018; PubMed Scopus Google Scholar research explore how EHRs can be used to improve CKD care and research for individual health and and The that they have in to an from the by the in

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.