Are Your Patients Signing Up? Patient-Centered EMR Portals in Pediatrics

The American Academy of Pediatrics in 2001 published special requirements for electronic medical record (EMR) systems in pediatric practice,¹ acknowledging the importance of electronic health information and its relationship with the medical home. The policy recognized that electronic medical charting, which at the time was geared toward adult care, was being increasingly utilized in pediatrics. Now, more than 13 years later, EMRs are being widely implemented in health care, both in pediatrics and adult medicine. Not only are EMRs seen as a reliable record of data, but also they are being explored as another resource for communication with patients.

In their recently published study,² Alex H. Krist, MD, MPH, and colleagues analyzed the implementation of an interactive preventive health record (IPHR) at small to medium sized practices. They describe an IPHR as “personal health records that are patient-centered, interactive, relevant, and integrated into care.” The authors also looked to identify the patient populations most likely to use and benefit from an electronic personal health record. They hypothesized that practices could more effectively promote the use of an IPHR by making it a part of patient care and by using approaches and workflows that are customized by individual practices.

Conducted between December 2010 and June 2013, the study analyzed the strategy of actively recruiting patients for implementing an IPHR. Eight practices in Northern Virginia, which operate independently but use a common EMR system and commercial portal providing secure patient messaging, were enrolled. Beginning in 2009, the practices offered the IPHR to all patients aged 18 to 75 years. The IPHR provides personalized recommendations and resources recommended by the U.S. Preventive Service Task Force (USPSTF). It links to their clinician’s EMRs and extracts hundreds of data points from it. The patients also completed a health risk assessment.

Based on the USPSTF and 6 other guidelines, the IPHR applies programmed logic to generate a personally tailored list of preventive and chronic care recommendations, with 392 variations of patient educational material. It eventually enabled participating patients to view all laboratory results with an explanatory message from their clinician. Five pieces of quantitative and qualitative sources were used for outcomes: EMR data, IPHR data, transcripts of “learning collaboratives” (in which representatives of each practice met to share implementation experiences), a clinician survey, and exit interviews.

After 31 months, 25.6% of patients had a new or preexisting IPHR account—an improvement over previous recruitment efforts that comprised only mailed invitations to patients. The largest uptake of patients occurred within 1 day of the patient’s office visit, with a median of 6 days. IPHR uptake was lower among smaller practices and practices that relied primarily on clinicians to notify patients about the IPHR, practices that sent IPHR clinical summaries to the clinician rather than to medical records departments or nursing staff, and practices that did not use the IPHR to inform patients about laboratory results.

Older patients and patients with chronic conditions were more likely to create an IPHR account. Black and Hispanic patients were less likely to use the IPHR, but race was a weaker predictor of use than age and chronic condition. Patients in the 60- to 69-year-old range were the largest group of enrollees.

IPHR use was less likely when clinicians were older than 55 years, younger than 35 years, or male. IPHR use was strongly associated with clinicians who self-identified as early adopters and those who said they were confident using the IPHR.

The study showed that small to medium practices can engage patients to use electronic patient portals such as an IPHR. This is best accomplished by promoting IPHR use during routine care, adopting a team-based approach, and adding a new IPHR feature to report laboratory test results. Using a team-based approach and laboratory results reporting may be helpful in introducing an IPHR into pediatric practices, as well.

Chalanda Jones, MD, is a pediatrician at Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.

Charles A. Pohl, MD—Series Editor, is professor of pediatrics and senior associate dean of student affairs and career counseling at Jefferson College in Philadelphia, Pennsylvania.

References

1. American Academy of Pediatrics Task Force on Medical Informatics. Special requirements for electronic medical record systems in pediatrics. Pediatrics. 2001;108(2):513-515.

2. Krist AH, Woolf SH, Bello GA, et al. Engaging primary care patients to use a patient-centered personal health record. Ann Fam Med. 2014;12(5):418-426.