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      Patient Portal Functionalities and Uptake: Systematic Review Protocol

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          Abstract

          Background

          Patient portals are digital health tools adopted by health care organizations. The portals are generally connected to the electronic health record of the health care organization and offer patients functionalities such as access to the medical record, ability to order repeat prescriptions, make appointments, or message the health care provider. Patient portals may be beneficial for both patients and the health care system. Patient portals can widely differ from one context to another due to the differences in the portal functionalities and capabilities and it is anticipated that outcomes associated with the functionalities also differ. Current systematic reviews report outcomes associated with patient portal uptake but do not explicitly specify the patient portal functionalities.

          Objective

          The aim of this systematic review is to synthesize the evidence on health and health care quality outcomes associated with patient portal use among adult (18 years or older) patients. The review research questions are as follows: What kind of health outcomes do tethered patient portals and patient portal functionalities contribute to in adult patients (18 years or older)? and What kind of health care quality outcomes, including health care utilization outcomes, do tethered patient portals and patient portal functionalities contribute to in adult patients (18 years or older)?

          Methods

          The systematic review will be conducted by searching the MEDLINE, EMBASE, and Scopus databases for relevant literature. The review inclusion criteria will be studies about adult patients (18 years or older), studies only about tethered patient portals, and studies with or without a comparator. We will report patient portal–associated health and health care quality outcomes based on the patient portal functionalities. All quantitative primary study types will be included. Risk of bias of included studies will be assessed using the Cochrane Collaboration’s tool for assessing risk of bias in randomized trials and the National Heart, Lung, and Blood Institute’s quality assessment tools. Data will be synthesized using narrative synthesis and will be reported according to the patient portal functionalities, country, disease, and health care system model.

          Results

          Searches will be conducted in September 2019, and the review is anticipated to be completed by the end of June 2020.

          Conclusions

          This systematic review will provide an overview of health and health care quality outcomes associated with patient portal use among adult patients, providing detailed information about the functionalities of the portals and their associations with the outcomes. The review could potentially help patient portal evaluation studies by providing insights into outcomes associated with the different functionalities of patient portals.

          Trial Registration

          International Prospective Register of Systematic Reviews (PROSPERO) CRD42019141131; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141131

          International Registered Report Identifier (IRRID)

          PRR1-10.2196/14975

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          Most cited references29

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

          Elske Ammenwerth, Petra Schnell-Inderst, Alexander Hoerbst (2012)
          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.
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            Personal Health Records: A Systematic Literature Review

            Juliano Alex Roehrs, Cristiano André da Costa, Rodrigo da Rosa Righi … (2017)
            Background Information and communication technology (ICT) has transformed the health care field worldwide. One of the main drivers of this change is the electronic health record (EHR). However, there are still open issues and challenges because the EHR usually reflects the partial view of a health care provider without the ability for patients to control or interact with their data. Furthermore, with the growth of mobile and ubiquitous computing, the number of records regarding personal health is increasing exponentially. This movement has been characterized as the Internet of Things (IoT), including the widespread development of wearable computing technology and assorted types of health-related sensors. This leads to the need for an integrated method of storing health-related data, defined as the personal health record (PHR), which could be used by health care providers and patients. This approach could combine EHRs with data gathered from sensors or other wearable computing devices. This unified view of patients’ health could be shared with providers, who may not only use previous health-related records but also expand them with data resulting from their interactions. Another PHR advantage is that patients can interact with their health data, making decisions that may positively affect their health. Objective This work aimed to explore the recent literature related to PHRs by defining the taxonomy and identifying challenges and open questions. In addition, this study specifically sought to identify data types, standards, profiles, goals, methods, functions, and architecture with regard to PHRs. Methods The method to achieve these objectives consists of using the systematic literature review approach, which is guided by research questions using the population, intervention, comparison, outcome, and context (PICOC) criteria. Results As a result, we reviewed more than 5000 scientific studies published in the last 10 years, selected the most significant approaches, and thoroughly surveyed the health care field related to PHRs. We developed an updated taxonomy and identified challenges, open questions, and current data types, related standards, main profiles, input strategies, goals, functions, and architectures of the PHR. Conclusions All of these results contribute to the achievement of a significant degree of coverage regarding the technology related to PHRs.
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              Patients' online access to their electronic health records and linked online services: a systematic review in primary care.

              Freda Mold, Simon de Lusignan, Aziz Sheikh … (2015)
              Online access to medical records by patients can potentially enhance provision of patient-centred care and improve satisfaction. However, online access and services may also prove to be an additional burden for the healthcare provider.
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                Author and article information

                Contributors
                Abrar Alturkistani:
                ORCID: https://orcid.org/0000-0001-7935-8870
                Global Digital Health UnitDepartment of Primary Care and Public HealthImperial College LondonReynolds Building, St Dunstan's RoadLondon, W6 8RPUnited Kingdom44 020 7589Abrar.alturkistani16@imperial.ac.uk
                Journal
                Journal ID (nlm-ta): JMIR Res Protoc
                Journal ID (iso-abbrev): JMIR Res Protoc
                Journal ID (publisher-id): ResProt
                Title: JMIR Research Protocols
                Publisher: JMIR Publications (Toronto, Canada )
                ISSN (Electronic): 1929-0748
                Publication date Collection: July 2020
                Publication date (Electronic): 31 July 2020
                Volume: 9
                Issue: 7
                Electronic Location Identifier: e14975
                Affiliations
                [1 ] Global Digital Health Unit Department of Primary Care and Public Health Imperial College London London United Kingdom
                [2 ] Public Health Policy Evaluation Unit Department of Primary Care and Public Health Imperial College London London United Kingdom
                [3 ] Department of Primary Care and Public Health Imperial College London London United Kingdom
                Author notes
                Corresponding Author: Abrar Alturkistani Abrar.alturkistani16@ 123456imperial.ac.uk
                Author information
                https://orcid.org/0000-0001-7935-8870
                https://orcid.org/0000-0001-9779-2486
                https://orcid.org/0000-0001-9393-3122
                https://orcid.org/0000-0003-3611-7377
                https://orcid.org/0000-0003-4600-2258
                https://orcid.org/0000-0002-3475-7525
                Article
                Publisher ID: v9i7e14975
                DOI: 10.2196/14975
                PMC ID: 7428936
                PubMed ID: 32734928
                SO-VID: aa455160-ea17-4ba8-9569-d08834a2b425
                Copyright © ©Abrar Alturkistani, Geva Greenfield, Felix Greaves, Shirin Aliabadi, Rosemary H Jenkins, Ceire Costelloe. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 31.07.2020.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.

                History
                Date received : 8 June 2019
                Date revision requested : 3 October 2019
                Date revision received : 28 November 2019
                Date accepted : 9 June 2020
                Categories
                Subject: Protocol
                Subject: Protocol

                Keywords: personal health record,patient portal,electronic health records,online access,patient records,systematic review
                Data availability:
                Keywords: personal health record, patient portal, electronic health records, online access, patient records, systematic review

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