Understanding Internet access and use to facilitate patient portal adoption.

Understanding the information-seeking preferences and Internet access habits of the target audiences for a patient portal is essential for successful uptake. The resource must deliver culturally and educationally appropriate information via technology that is accessible to the intended users and be designed to meet their needs and preferences. Providers must consider multiple perspectives when launching a portal and make any needed adjustments once the launch is underway. We report results of a study of 270 parents and caregivers of paediatric patients in a major health system during the process of implementing a patient portal. Through a 26-question paper-and-pencil survey, data were collected on participant demographics, Internet access and use, health information-seeking behaviours, health literacy, and potential use of a patient portal. Results indicate a positive attitude towards portal use but also suggest that low health literacy may be a key issue to portal adoption.

Visualizing Patterns and Trends of 25 Years of Published Health Literacy Research.

BACKGROUND: With an increase in the number of disciplines contributing to health literacy scholarship, we sought to explore the nature of interdisciplinary research in the field. OBJECTIVE: This study sought to describe disciplines that contribute to health literacy research and to quantify how disciplines draw from and contribute to an interdisciplinary evidence base, as measured by citation networks. METHODS: We conducted a literature search for health literacy articles published between 1991 and 2015 in four bibliographic databases, producing 6,229 unique bibliographic records. We employed a scientometric tool (CiteSpace [Version 4.4.R1]) to quantify patterns in published health literacy research, including a visual path from cited discipline domains to citing discipline domains. KEY RESULTS: The number of health literacy publications increased each year between 1991 and 2015. Two spikes, in 2008 and 2013, correspond to the introduction of additional subject categories, including information science and communication. Two journals have been cited more than 2,000 times-the Journal of General Internal Medicine (n = 2,432) and Patient Education and Counseling (n = 2,252). The most recently cited journal added to the top 10 list of cited journals is the Journal of Health Communication (n = 989). Three main citation paths exist in the health literacy data set. Articles from the domain "medicine, medical, clinical" heavily cite from one domain (health, nursing, medicine), whereas articles from the domain "psychology, education, health" cite from two separate domains (health, nursing, medicine and psychology, education, social). CONCLUSIONS: Recent spikes in the number of published health literacy articles have been spurred by a greater diversity of disciplines contributing to the evidence base. However, despite the diversity of disciplines, citation paths indicate the presence of a few, self-contained disciplines contributing to most of the literature, suggesting a lack of interdisciplinary research. To address complex and evolving challenges in the health literacy field, interdisciplinary team science, that is, integrating science from across multiple disciplines, should continue to grow. [Health Literacy Research and Practice. 2017;1(4):e182-e191.]. PLAIN LANGUAGE SUMMARY: The addition of diverse disciplines conducting health literacy scholarship has spurred recent spikes in the number of publications. However, citation paths suggest that interdisciplinary research can be strengthened. Findings directly align with the increasing emphasis on team science, and support opportunities and resources that incentivize interdisciplinary health literacy research.

The long-term financial impact of electronic health record implementation.

OBJECTIVE: To examine the financial impact of electronic health record (EHR) implementation on ambulatory practices. METHODS: We tracked the practice productivity (ie, number of patient visits) and reimbursement of 30 ambulatory practices for 2 years after EHR implementation and compared each practice to their pre-EHR implementation baseline. RESULTS: Reimbursements significantly increased after EHR implementation even though practice productivity (ie, the number of patient visits) decreased over the 2-year observation period. We saw no evidence of upcoding or increased reimbursement rates to explain the increased revenues. Instead, they were associated with an increase in ancillary office procedures (eg, drawing blood, immunizations, wound care, ultrasounds). DISCUSSION: The bottom line result-that EHR implementation is associated with increased revenues-is reassuring and offers a basis for further EHR investment. While the productivity losses are consistent with field reports, they also reflect a type of efficiency-the practices are receiving more reimbursement for fewer seeing patients. For the practices still seeing fewer patients after 2 years, the solution likely involves advancing their EHR functionality to include analytics. Although they may still see fewer patients, with EHR analytics, they can focus on seeing the right patients. CONCLUSIONS: Practice reimbursements increased after EHR implementation, but there was a long-term decrease in the number of patient visits seen in this ambulatory practice context.

Assessing internet access and use in a medically underserved population: implications for providing enhanced health information services.

BACKGROUND: The relationship between health information seeking, patient engagement and health literacy is not well understood. This is especially true in medically underserved populations, which are often viewed as having limited access to health information. OBJECTIVE: To improve communication between an urban health centre and the community it serves, a team of library and information science researchers undertook an assessment of patients' level and methods of access to and use of the Internet. METHODS: Data were collected in 53 face-to-face anonymous interviews with patients at the centre. Interviews were tape-recorded for referential accuracy, and data were analysed to identify patterns of access and use. RESULTS: Seventy-two percentage of study participants reported having access to the Internet through either computers or cell phones. Barriers to Internet access were predominantly lack of equipment or training rather than lack of interest. Only 21% of those with Internet access reported using the Internet to look for health information. CONCLUSION: The findings suggest that lack of access to the Internet in itself is not the primary barrier to seeking health information in this population and that the digital divide exists not at the level of information access but rather at the level of information use.

Applying evidence in practice: a qualitative case study of the factors affecting residents' decisions.

Patient care based on best available evidence is increasingly viewed as the hallmark of good quality medical diagnosis and treatment, yet its uptake is often slow and uneven and the reasons underlying the slow diffusion of evidence-based guidelines remain elusive. The authors report a qualitative study conducted at a major US teaching hospital which sought to discover the reasons why an evidence-based anticoagulation guideline appeared to be applied irregularly, with problematic results. Using a theoretical framework derived from Rogers' work on the diffusion of innovation, this article describes the ways in which a group of residents evaluated and applied evidence in the context of caring for their patients. Future work in evidence-based practice can benefit from a greater emphasis on studies that use multi-method, qualitative designs to explore the complex ways in which people interact with information and the changes that ensue from its use.