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      Patient portals and health apps: Pitfalls, promises, and what one might learn from the other

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          Abstract

          Widespread use of health information technology (IT) could potentially increase patients’ access to their health information and facilitate future goals of advancing patient-centered care. Despite having increased access to their health data, patients do not always understand this information or its implications, and digital health data can be difficult to navigate when displayed in a small-format, complex interface. In this paper, we discuss two forms of patient-facing health IT tools—patient portals and applications (apps)—and highlight how, despite several limitations of each, combining high-yield features of mobile health (mHealth) apps with portals could increase patient engagement and self-management and be more effective than either of them alone. Patient portal adoption is variable, and due to design and interface limitations and health literacy issues, many people find the portal difficult to use. Conversely, apps have experienced rapid adoption and traditionally have more consumer-friendly features with easy log-in access, real-time tracking, and simplified data display. These features make the applications more intuitive and easy-to-use than patient portals. While apps have their own limitations and might serve different purposes, patient portals could adopt some high-yield features and functions of apps that lead to engagement success with patients. We thus suggest that to improve user experience with future portals, developers could look towards mHealth apps in design, function, and user interface. Adding new features to portals may improve their use and empower patients to track their overall health and disease states. Nevertheless, both these health IT tools should be subjected to rigorous evaluation to ensure they meet their potential in improving patient outcomes.

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          A new sociotechnical model for studying health information technology in complex adaptive healthcare systems.

          Conceptual models have been developed to address challenges inherent in studying health information technology (HIT). This manuscript introduces an eight-dimensional model specifically designed to address the sociotechnical challenges involved in design, development, implementation, use and evaluation of HIT within complex adaptive healthcare systems. The eight dimensions are not independent, sequential or hierarchical, but rather are interdependent and inter-related concepts similar to compositions of other complex adaptive systems. Hardware and software computing infrastructure refers to equipment and software used to power, support and operate clinical applications and devices. Clinical content refers to textual or numeric data and images that constitute the 'language' of clinical applications. The human--computer interface includes all aspects of the computer that users can see, touch or hear as they interact with it. People refers to everyone who interacts in some way with the system, from developer to end user, including potential patient-users. Workflow and communication are the processes or steps involved in ensuring that patient care tasks are carried out effectively. Two additional dimensions of the model are internal organisational features (eg, policies, procedures and culture) and external rules and regulations, both of which may facilitate or constrain many aspects of the preceding dimensions. The final dimension is measurement and monitoring, which refers to the process of measuring and evaluating both intended and unintended consequences of HIT implementation and use. We illustrate how our model has been successfully applied in real-world complex adaptive settings to understand and improve HIT applications at various stages of development and implementation.
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            Patient and Provider Attitudes Toward the Use of Patient Portals for the Management of Chronic Disease: A Systematic Review

            Background Patient portals provide patients with the tools to better manage and understand their health status. However, widespread adoption of patient portals faces resistance from patients and providers for a number of reasons, and there is limited evidence evaluating the characteristics of patient portals that received positive remarks from patients and providers. Objective The objectives of this systematic review are to identify the shared characteristics of portals that receive favorable responses from patients and providers and to identify the elements that patients and providers believe need improvement. Methods The authors conducted a systematic search of the CINAHL and PubMed databases to gather data about the use of patient portals in the management of chronic disease. Two reviewers analyzed the articles collected in the search process in order remove irrelevant articles. The authors selected 27 articles to use in the literature review. Results Results of this systematic review conclude that patient portals show significant improvements in patient self-management of chronic disease and improve the quality of care provided by providers. The most prevalent positive attribute was patient-provider communication, which appeared in 10 of 27 articles (37%). This was noted by both patients and providers. The most prevalent negative perceptions are security (concerns) and user-friendliness, both of which occurred in 11 of 27 articles (41%). The user-friendliness quality was a concern for patients and providers who are not familiar with advanced technology and therefore find it difficult to navigate the patient portal. The high cost of installation and maintenance of a portal system, not surprisingly, deters some providers from implementing such technology into their practice, but this was only mentioned in 3 of the 27 articles (11%). It is possible that the incentives for meaningful use assuage the barrier of cost. Conclusions This systematic review revealed mixed attitudes from patients and their providers regarding the use of patient portals to manage their chronic disease. The authors suggest that a standard patient portal design providing patients with the resources to understand and manage their chronic conditions will promote the adoption of patient portals in health care organizations.
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              Usability of Commercially Available Mobile Applications for Diverse Patients.

              Mobile applications or 'apps' intended to help people manage their health and chronic conditions are widespread and gaining in popularity. However, little is known about their acceptability and usability for low-income, racially/ethnically diverse populations who experience a disproportionate burden of chronic disease and its complications.
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                Author and article information

                Journal
                101622189
                42059
                Healthc (Amst)
                Healthc (Amst)
                Healthcare (Amsterdam, Netherlands)
                2213-0764
                2213-0772
                14 August 2021
                03 October 2016
                September 2017
                25 August 2021
                : 5
                : 3
                : 81-85
                Affiliations
                [a ]Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
                [b ]Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
                [c ]School of Biomedical Informatics, University of Texas Health Science Center, Houston, TX, USA
                Author notes
                [* ]Corresponding author at: Houston Veterans Affairs Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, and Baylor College of Medicine, Houston, TX, USA. jessica.baldwin@ 123456bcm.edu (J.L. Baldwin).
                Article
                HHSPA1732677
                10.1016/j.hjdsi.2016.08.004
                8386919
                27720139
                62f9205f-aa75-4910-a38f-24f4387c7a4a

                This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/).

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