Thursday, December 13, 2012

It Looks Like Patient Portals Are Not Exactly Proven So Far. Did We Jump The Gun On An Unproven Approach?

The following came up a few days ago.

Monday, November 26, 2012

The Impact of Electronic Patient Portals on Patient Care: A Systematic Review of Controlled Trials

From the report: "Modern information technology is changing and provides new challenges to health care. The emergence of the Internet and the electronic health record (EHR) has brought new opportunities for patients to play a more active role in his/her care. Although in many countries patients have the right to access their clinical information, access to clinical records electronically is not common. Patient portals consist of provider-tethered applications that allow patients to electronically access health information that are documented and managed by a health care institution. Although patient portals are already being implemented, it is still unclear in which ways these technologies can influence patient care." Read more
Here is the abstract.

The Impact of Electronic Patient Portals on Patient Care: A Systematic Review of Controlled Trials

Elske Ammenwerth1, PhD; Petra Schnell-Inderst2,3, PhD; Alexander Hoerbst4, PhD
1Institute of Health Informatics, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
2Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
3Oncotyrol Center for Personalized Cancer Medicine, Innsbruck, Austria
4Research Division for eHealth and Telemedicine, UMIT - University for Health Sciences, Medical Informatics and Technology, Hall in Tyrol, Austria
Corresponding Author:
Alexander Hoerbst, PhD

Research Division for eHealth and Telemedicine
UMIT - University for Health Sciences, Medical Informatics and Technology
Eduard-Wallnoefer-Zentrum 1
Hall in Tyrol, 6060
Austria

ABSTRACT

Background: Modern information technology is changing and provides new challenges to health care. The emergence of the Internet and the electronic health record (EHR) has brought new opportunities for patients to play a more active role in his/her care. Although in many countries patients have the right to access their clinical information, access to clinical records electronically is not common. Patient portals consist of provider-tethered applications that allow patients to electronically access health information that are documented and managed by a health care institution. Although patient portals are already being implemented, it is still unclear in which ways these technologies can influence patient care.
Objective: To systematically review the available evidence on the impact of electronic patient portals on patient care.
Methods: A systematic search was conducted using PubMed and other sources to identify controlled experimental or quasi-experimental studies on the impact of patient portals that were published between 1990 and 2011. A total of 1,306 references from all the publication hits were screened, and 13 papers were retrieved for full text analysis.
Results: We identified 5 papers presenting 4 distinct studies. There were no statistically significant changes between intervention and control group in the 2 randomized controlled trials investigating the effect of patient portals on health outcomes. Significant changes in the patient portal group, compared to a control group, could be observed for the following parameters: quicker decrease in office visit rates and slower increase in telephone contacts; increase in number of messages sent; changes of the medication regimen; and better adherence to treatment.
Conclusions: The number of available controlled studies with regard to patient portals is low. Even when patient portals are often discussed as a way to empower patients and improve quality of care, there is insufficient evidence to support this assumption.
(J Med Internet Res 2012;14(6):e162)
doi:10.2196/jmir.2238
---- End Extract.
I think we need to wait for some more evidence but given the restricted functionality of the NEHRS / PCEHR I hardly expect to see useful proof of value soon!
David.

8 comments:

Cris Kerr said...

A bit off topic... wondering if anyone is familiar with or has an opinion on quality of med terminologies, eg; SNOWMED or the Medical Dictionary for Regulatory Activities (MedDRA)?

Anonymous said...

SNOMED

Terry Hannan said...

David, as I read this post I had the thought that this process explains the current situation of Dr TO Patient communication. With more patients gaining their health information off the internet and sharing with other community members (Wisdom Of Crowds) we may see in a few years time the doctor seeking information FROM the patient. Recent studies Jha, Frisse and the IOM [Nov 2011]reveaal that clincians have done little to use the technologies available to improve patient care and safety.

Cris Kerr said...

David, Within minutes of my first post, by 6.10pm, I added another post, a correction with my name, that read 'oops... SNOMED'.

Why were the words, source, and time changed to the following?

Anonymous said...
SNOMED


12/13/2012 11:35:00 PM


casehealth@optusnet.com.au

Dr David More MB PhD FACHI said...

Sorry Cris, I have no idea..

David.

Anonymous said...

It was I, the anonymous internet spelling fairy.

(in all seriousness, it was indeed me just posting a spelling correction because I didn't want the entry sitting there uncorrected. I had no idea the author has also tried to correct it)

Cris Kerr said...

Oh, okay... thanks to all.

Anonymous said...

Depends on what you mean by "quality" Cris

Perhaps you could ask a more specific question:
Do you mean:
they are comprehensive?
maintained and up to date?
cheap and available?
open to scrutiny and improvement?
fit for purpose? and if yes - WHAT purpose?

And importantly, will we judge their quality by their own content or terminology characteristics?
or do you mean that their 'quality' is apparent despite the fact that they may be poorly implemented in clinical desktop delivery systems?