Perceived barriers and enablers of a personal health record from the healthcare provider perspective.

Personal health records (PHRs) have been implemented around the world as a means to increase the safety, quality, and efficiency of health care. The Ministry of National Guard Health Affairs in the Kingdom of Saudi Arabia launched their PHR in 2018. This study aimed to explore healthcare provider (HCP) perspectives of barriers to and enablers of PHR adoption in Saudi Arabia. The 291 participating HCPs (40.5% nurses, 23.0% pharmacists, 17.2% physicians, 15.5% technicians, and 3.8% other) selected the following as top-3 barriers to PHR adoption: 1) lack of patient awareness (19.4%), 2) patient low literacy (17.7%), and 3) patient resistance to new technologies (12.5%). Of these, 36 responded to the open-ended question gauging feedback on the PHR. Three main themes were identified from the comments: 1) general perceptions of the PHR (positive attitudes, negative attitudes, additional features); 2) patient engagement as a requirement for the successful implementation of the PHR; and 3) education/training of HCPs, patients, and caregivers. This analysis extends our understanding of HCP perspectives of barriers and enablers to PHR adoption. Further qualitative research with patients is required to confirm our findings.

Predicting Health Care Providers' Acceptance of a Personal Health Record Secure Messaging Feature.

BACKGROUND: Personal health records (PHRs) can facilitate patient-centered communication through the secure messaging feature. As health care organizations in the Kingdom of Saudi Arabia implement PHRs and begin to implement the secure messaging feature, studies are needed to evaluate health care providers' acceptance. OBJECTIVE: The aim of this study was to identify predictors of health care providers' behavioral intention to support the addition of a secure messaging feature in PHRs using an adapted model of the Unified Theory of Acceptance and Use of Technology as the theoretical framework. METHODS: Using a cross-sectional survey design, data on acceptance of secure messaging features in PHRs were collected from health care providers working at the Ministry of National Guard Health Affairs between April and May 2021. The proposed model was tested using partial least squares structural equation modeling in SmartPLS. RESULTS: There were 224 participants: female (66.5%), 40 to 49 years of age (39.9%), nurses (45.1%), and those working more than 10 years in the organization (68.8%). Behavioral intention to support the addition of a secure messaging feature was significantly influenced by performance expectancy (ß = 0.21, p = 0.01) and attitude (ß = 0.50, p < 0.01), while other predicting factors, such as effort expectancy, social influence, and facilitating condition, did not significantly affect the intention. Furthermore, age, years of experience, and professional role did not moderate the relationships. CONCLUSION: Health care professionals will support introducing a secure messaging feature in the PHRs if they serve the intended purpose. Considering attitude also plays a significant role in acceptance, it is necessary to arrange for training and support, so that caregivers, health care providers, and the patients become familiar with the benefits and expected outcomes of using the feature.

Associations Between Patient-Provider Secure Message Content and Patients' Health Care Visits.

Background:Between-visit communications can play a vital role in improving intermediate patient outcomes such as access to care and satisfaction. Secure messaging is a growing modality for these communications, but research is limited about the influence of message content on those intermediate outcomes. We examined associations between secure message content and patients' number of health care visits.Methods:Our study included 2,111 adult patients with hypertension and/or diabetes and 18,309 patient- and staff-generated messages. We estimated incident rate ratios (IRRs) for associations between taxonomic codes assigned to message content, and the number of office, emergency department, and inpatient visits.Results:Patients who initiated message threads in 2017 had higher numbers of outpatient visits (p < 0.001) compared with patients who did not initiate threads. Among patients who initiated threads, we identified an inverse relationship between outpatient visits and preventive care scheduling requests (IRR = 0.92; 95% confidence interval [CI]: 0.86-0.98) and requests for appointments for new conditions (IRR = 0.95; 95% CI: 0.92-0.99). Patients with higher proportions of request denials or more follow-up appointment requests had more emergency department visits compared with patients who received or sent other content (IRR = 1.18; 95% CI: 1.03-1.34 and IRR = 1.14; 95% CI: 1.07-1.23, respectively). We identified a positive association between outpatient visits and the proportion of threads that lacked a clinic response (IRR = 1.02; 95% CI: 1.00-1.03).Discussion:We report on the first analyses to examine associations between message content and health care visits.Conclusions:Our findings are relevant to understanding how to better use secure messaging to support patients and their care.

Health Care Providers' Acceptance of a Personal Health Record: Cross-sectional Study.

BACKGROUND: Personal health records (PHRs) are eHealth tools designed to support patient engagement, patient empowerment, and patient- and person-centered care. Endorsement of a PHR by health care providers (HCPs) facilitates patient acceptance. As health care organizations in the Kingdom of Saudi Arabia begin to adopt PHRs, understanding the perspectives of HCPs is important because it can influence patient adoption. However, no studies evaluated HCPs' acceptance of PHRs in the Kingdom of Saudi Arabia. OBJECTIVE: The aim of this study was to identify predictors of HCPs' acceptance of PHRs using behavioral intention to recommend as a proxy for adoption. METHODS: This cross-sectional study was conducted among HCPs (physicians, pharmacists, nurses, technicians, others) utilizing a survey based on the Unified Theory of Acceptance and Use of Technology. The main theory constructs of performance expectancy, effort expectancy, social influence, facilitating conditions, and positive attitude were considered independent variables. Behavioral intention was the dependent variable. Age, years of experience, and professional role were tested as moderators between the main theory constructs and behavioral intention using partial least squares structural equation modeling. RESULTS: Of the 291 participants, 246 were included in the final analysis. Behavioral intention to support PHR use among patients was significantly influenced by performance expectancy (ß=.17, P=.03) and attitude (ß=.61, P<.01). No moderating effects were present. CONCLUSIONS: This study identified performance expectancy and attitude as predictors of HCPs' behavioral intention to recommend PHR to patients. To encourage HCPs to endorse PHRs, health care organizations should involve HCPs in the implementation and provide training on the features available as well as expected benefits. Future studies should be conducted in other contexts and include other potential predictors.

Patient and Clinician Characteristics Associated With Secure Message Content: Retrospective Cohort Study.

BACKGROUND: Good communication has been shown to affect patient outcomes; however, the effect varies according to patient and clinician characteristics. To date, no research has explored the differences in the content of secure messages based on these characteristics. OBJECTIVE: This study aims to explore characteristics of patients and clinic staff associated with the content exchanged in secure messages. METHODS: We coded 18,309 messages that were part of threads initiated by 1031 patients with hypertension, diabetes, or both conditions, in communication with 711 staff members. We conducted four sets of analyses to identify associations between patient characteristics and the types of messages they sent, staff characteristics and the types of messages they sent, staff characteristics and the types of messages patients sent to them, and patient characteristics and the types of messages they received from staff. Logistic regression was used to estimate the strength of the associations. RESULTS: We found that younger patients had reduced odds of sharing clinical updates (odds ratio [OR] 0.77, 95% CI 0.65-0.91) and requesting prescription refills (OR 0.77, 95% CI 0.65-0.90). Women had reduced odds of self-reporting biometrics (OR 0.78, 95% CI 0.62-0.98) but greater odds of responding to a clinician (OR 1.20, 95% CI 1.02-1.42) and seeking medical guidance (OR 1.19, 95% CI 1.01-1.40). Compared with White patients, Black patients had greater odds of requesting preventive care (OR 2.68, 95% CI 1.30-5.51) but reduced odds of requesting a new or changed prescription (OR 0.72, 95% CI 0.53-0.98) or laboratory or other diagnostic procedures (OR 0.66, 95% CI 0.46-0.95). Staff had lower odds of sharing medical guidance with younger patients (OR 0.83, 95% CI 0.69-1.00) and uninsured patients (OR 0.21, 95% CI 0.06-0.73) but had greater odds of sharing medical guidance with patients with public payers (OR 2.03, 95% CI 1.26-3.25) compared with patients with private payers. Staff had reduced odds of confirming to women that their requests were fulfilled (OR 0.82, 95% CI 0.69-0.98). Compared with physicians, nurse practitioners had greater odds of sharing medical guidance with patients (OR 2.74, 95% CI 1.12-6.68) and receiving prescription refill requests (OR 3.39, 95% CI 1.49-7.71). Registered nurses had greater odds of deferred information sharing (OR 1.61, 95% CI 1.04-2.49) and receiving responses to messages (OR 3.93, 95% CI 2.18-7.11) than physicians. CONCLUSIONS: The differences we found in content use based on patient characteristics could lead to the exacerbation of health disparities when content is associated with health outcomes. Disparities in the content of secure messages could exacerbate disparities in patient outcomes, such as satisfaction, trust in the system, self-care, and health outcomes. Staff and administrators should evaluate how secure messaging is used to ensure that disparities in care are not perpetuated via this communication modality.

Predicting Patients' Intention to Use a Personal Health Record Using an Adapted Unified Theory of Acceptance and Use of Technology Model: Secondary Data Analysis.

BACKGROUND: With the rise in the use of information and communication technologies in health care, patients have been encouraged to use eHealth tools such as personal health records (PHRs) for better health and well-being services. PHRs support patient-centered care and patient engagement. To support the achievement of the Kingdom of Saudi Arabia's Vision 2030 ambitions, the National Transformation program provides a framework to use PHRs in meeting the 3-fold aim for health care-increased access, reduced cost, and improved quality of care-and to provide patient- and person-centered care. However, there has been limited research on PHR uptake within the country. OBJECTIVE: Using the Unified Theory of Acceptance and Use of Technology (UTAUT) as the theoretical framework, this study aims at identifying predictors of patient intention to utilize the Ministry of National Guard-Health Affairs PHR (MNGHA Care) app. METHODS: Using secondary data from a cross-sectional survey, data measuring the intention to use the MNGHA Care app, along with its predictors, were collected from among adults (n=324) visiting Ministry of National Guard-Health Affairs facilities in Riyadh, Jeddah, Dammam, Madinah, Al Ahsa, and Qassim. The relationship of predictors (main theory constructs) and moderators (age, gender, and experience with health apps) with the dependent variable (intention to use MNGHA Care) was tested using hierarchical multiple regression. RESULTS: Of the eligible population, a total of 261 adult patients were included in the analysis. They had a mean age of 35.07 (SD 9.61) years, 50.6 % were male (n=132), 45.2% had university-level education (n=118), and 53.3% had at least 1 chronic medical condition (n=139). The model explained 48.9% of the variance in behavioral intention to use the PHR (P=.38). Performance expectancy, effort expectancy, and positive attitude were significantly associated with behavioral intention to use the PHR (P<.05). Prior experience with health apps moderated the relationship between social influence and behavioral intention to use the PHR (P=.04). CONCLUSIONS: This study contributes to the existing literature on PHR adoption broadly as well as in the context of the Kingdom of Saudi Arabia. Understanding which factors are associated with patient adoption of PHRs can guide future development and support the country's aim of transforming the health care system. Similar to previous studies on PHR adoption, performance expectancy, effort expectancy, and positive attitude are important factors, and practical consideration should be given to support these areas.

Classification of patient- and clinician-generated secure messages using a theory-based taxonomy.

BACKGROUND: As secure electronic message exchange increases between patients and clinicians, we must explore and understand how patients and clinicians use those messages to communicate between clinical visits. OBJECTIVE: To present the application of a taxonomy developed specifically to code secure message content in a way that allows for identification of patient and clinician communication functions demonstrated to be associated with patients' intermediate and health outcomes. METHOD: We randomly sampled 1031 patients who sent and received 18 309 messages and coded those messages with codes from our taxonomy. We present the prevalence of each taxon (ie, code) within the sample. RESULTS: The most common taxon among initial patient-generated messages were Information seeking (29.09%), followed by Scheduling requests (27.91%), and Prescription requests (23.09%). Over half of subsequent patient-generated messages included responses to clinic staffs' questions (58.31%). Six in 10 clinic staff responses included some form of Information sharing with process-based responses being most common (32.81%). A third of all clinician-generated messages (36.28%) included acknowledgement or some level of fulfilment of a patient's task-oriented request. Clinic staff sought information from patients in 20.54% of their messages. CONCLUSION: This taxonomy is the first step toward examining whether secure messaging communication can be associated with patients' health outcomes. Knowing which content is positively associated with outcomes can support training of, and targeted responses from, clinicians with the goal of generating message content designed to improve outcomes. PATIENT CONTRIBUTION: This study is based on analyses of patient-initiated secure message threads.

Infusing, sustaining, and replenishing compassion in health care organizations through compassion practices.

BACKGROUND: Human suffering is prevalent and costly in health care organizations. Recent research links the use of compassion practices with improved patient experience and employee well-being, but little is known about how these practices create and sustain compassion to address workplace suffering and enhance care quality. PURPOSE: This study examines the dynamics of compassion practices, specifically how compassion practices create and sustain compassion in caregiving work. METHODOLOGY: We conducted a qualitative field study at two acute care hospitals utilizing three forms of data collection: semistructured interviews, nonparticipant observation, and archival data. Data were analyzed utilizing thematic coding. RESULTS: Both organizations attempted to foster workplace compassion through their hiring, socialization, employee support, and rewards practices. CONCLUSION: Organizations enable compassion through common organizational practices that perform three functions: (a) infusing the organization with new members and resources to enact compassion, (b) sustaining compassion by reinforcing its appropriateness in the workplace, and (c) replenishing compassion resources by improving and restoring employee well-being and ability to provide high-quality compassionate care. PRACTICE IMPLICATIONS: This study provides managers with a detailed guide for how health care organizations use compassion practices as a managerial tool to address two key challenges: (a) high rates of employee ill-being due to the demanding nature of the work and (b) providing high-quality compassionate care.

Associations Between Patient Health Outcomes and Secure Message Content Exchanged Between Patients and Clinicians: Retrospective Cohort Study.

BACKGROUND: The number of electronic messages securely exchanged between clinic staff and patients has risen dramatically over the last decade. A variety of studies explored whether the volume of messages sent by patients was associated with outcomes. None of these studies, however, examined whether message content itself was associated with outcomes. Because secure messaging is a significant form of communication between patients and clinic staff, it is critical to evaluate the context of the communication to best understand its impact on patient health outcomes. OBJECTIVE: To examine associations between patients' and clinicians' message content and changes in patients' health outcomes. METHODS: We applied a taxonomy developed specifically for secure messages to 14,394 patient- and clinic staff-generated messages derived from patient-initiated message threads. Our study population included 1602 patients, 50.94% (n=816) of whom initiated message threads. We conducted linear regression analyses to determine whether message codes were associated with changes in glycemic (A1C) levels in patients with diabetes and changes in systolic (SBP) and diastolic (DBP) blood pressure in patients with hypertension. RESULTS: Patients who initiated threads had larger declines in A1Cs (P=.01) compared to patients who did not initiate threads. Clinic nonresponse was associated with decreased SBP (ß=-.30; 95% CI -0.56 to -0.04), as were staffs' action responses (ß=-30; 95% CI -0.58 to -0.02). Increased DBP, SBP, and A1C levels were associated with patient-generated appreciation and praise messages and staff encouragement with effect sizes ranging from 0.51 (A1C) to 5.80 (SBP). We found improvements in SBP associated with patients' complaints (ß=-4.03; 95% CI -7.94 to -0.12). Deferred information sharing by clinic staff was associated with increased SBP (ß=1.29; 95% CI 0.4 to 2.19). CONCLUSIONS: This is the first research to find associations between message content and patients' health outcomes. Our findings indicate mixed associations between patient message content and patient outcomes. Further research is needed to understand the implications of this work; in the meantime, health care providers should be aware that their message content may influence patient health outcomes.

Compassion Practices, Nurse Well-Being, and Ambulatory Patient Experience Ratings.

BACKGROUND: Compassion practices both recognize and reward compassion in the workplace as well as provide compassionate support to health care employees. However, these practices represent an underexplored organizational tool that may aid clinician well-being and positively impact patient ambulatory care experiences. OBJECTIVE: To examine the relationship between compassion practices and nursing staff well-being and clinic-level patients' experience ratings in the ambulatory clinic setting. RESEARCH DESIGN: Surveys were collected from ambulatory nurses in January and February of 2015 in 30 ambulatory clinics affiliated with an academic medical center. Patient experience ratings were collected April to June of 2015. SUBJECTS: One hundred seventy-seven ambulatory nurses (Registered Nurses, LPNs, medical assistants), as well as 3525 adult patients from the ambulatory clinics. MEASURES: Ambulatory nurses assessed compassion practices, emotional exhaustion, and psychological vitality. Patient experience ratings were patient perceptions of courtesy and caring shown by nurses and patients' ratings of the outpatient services. RESULTS: Compassion practices are significantly and negatively associated with nurse emotional exhaustion and positively associated with nurse psychological vitality. At the clinic-level, compassion practices are significantly and positively associated with patient perceptions of caring shown by nurses and overall patient ratings of the outpatient clinic. Supplemental analyses provide preliminary evidence that nurse well-being mediates the relationship between compassion practices and patient ratings of their care experience. CONCLUSIONS: Our findings illustrate that compassion practices are positively associated with nurse well-being and patient perceptions of the care experience in outpatient clinics.

Compassion practices and HCAHPS: does rewarding and supporting workplace compassion influence patient perceptions?

OBJECTIVE: To examine the benefits of compassion practices on two indicators of patient perceptions of care quality-the Hospital Consumer Assessment of Healthcare Providers and systems (HCAHPS) overall hospital rating and likelihood of recommending. STUDY SETTING: Two hundred sixty-nine nonfederal acute care U.S. hospitals. STUDY DESIGN: Cross-sectional study. DATA COLLECTION: Surveys collected from top-level hospital executives. Publicly reported HCAHPS data from October 2012 release. PRINCIPAL FINDINGS: Compassion practices, a measure of the extent to which a hospital rewards compassionate acts and compassionately supports its employees (e.g., compassionate employee awards, pastoral care for employees), is significantly and positively associated with hospital ratings and likelihood of recommending. CONCLUSIONS: Our findings illustrate the benefits for patients of specific and actionable organizational practices that provide and reinforce compassion.

Oculomotor measures as predictors of performance during sleep deprivation.

INTRODUCTION: Studies have indicated that working under sleep deprivation conditions results in deficits in performance on various tasks. Few studies, however, have attempted to find a measure for predicting performance changes under sleep deprivation conditions. The current study examined whether oculomotor measures could predict changes in performance under non-sleep deprivation and acute short-term sleep deprivation conditions. METHODS: Oculomotor measures and performance were examined during five testing sessions in each study. In the non-sleep deprivation study (N = 23) the testing sessions took place during 2 consecutive days. The sleep deprivation study (N = 26) took place in an 18-h sustained operations period during the night of sleep deprivation. RESULTS: Under non-sleep deprivation conditions, pupil diameter significantly predicted performance on grammatical reasoning (B = 0.360) and constriction latency significantly predicted performance on combined tasks (B = 0.182). Under sleep deprivation conditions, diameter, constriction latency, and saccadic velocity significantly predicted performance on a psychomotor vigilance task (B = -21.002, B = -23.126, B = -18.028, respectively). Overall, oculomotor measures better predicted performance changes under sleep deprivation conditions and better predicted performance decrements on vigilance-based tasks than cognitive tasks under acute sleep deprivation conditions. DISCUSSION: The current research suggests saccadic velocity and pupil diameter may be the most useful predictors of performance under sleep deprivation conditions, perhaps because these measures are largely controlled by involuntary neural components that slow during sleep deprivation. These data support research suggesting that saccadic velocity and pupil diameter detect excessive sleepiness and predict performance decrements under sleep deprivation conditions using additional oculomotor measures and a non-sleep deprivation comparison group.

Social influence and pain response in women and men.

The purpose of this study was to examine the effects of social influence on responses to acute pain in women and men in a randomized experimental design. Sixty-eight undergraduates (32 women; 36 men) were randomly assigned to perform a cold pressor task either alone or in the presence of a same-sex friend. Expressions of pain were assessed with the short form of the McGill Pain Questionnaire. Overall social support was measured using the Krause social support assessment scale. The presence of a same-sex friend significantly increased pain reports in women, but not in men. Persons who reported high levels of social support on the Krause scale also reported greater cold pressor pain. Results suggest that the presence of a friend can increase pain report to an acute laboratory pain stimulus in women. These findings are consistent with models of social reinforcement in chronic pain syndromes.

Language performance under sustained work and sleep deprivation conditions.

INTRODUCTION: Although substantial research has been completed on the effects of sleep deprivation on performance, very little research has focused on language-based tasks. The purpose of the current study was two-fold: 1) to determine the extent to which short-term sleep deprivation affects language performance; and 2) to examine whether relatively short and easy-to-administer "probe" tasks could signal decrements in language performance under sleep deprivation conditions. METHODS: There were 38 non-native English-speaking students who were paid to complete a 28-h sleep deprivation study. The participants completed several potential cognitive and vigilance probe tasks and a variety of language-based tasks. Each task was administered four times, once in each testing session during the night (18:30-22:30, 23:00-03:00, 03: 30-07:30, and 08:00-12:00). All tasks were counterbalanced across the testing sessions. RESULTS: Repeated-measures ANOVAs indicated that language tasks that required sustained attention and higher level processing (e.g., reading comprehension) were negatively affected by sleep deprivation, whereas other tasks that relied primarily on more basic language processing (e.g., antonym identification) were not affected. Hierarchical linear modeling analyses assessed how well the probe tasks predicted language performance. These results indicated that performance accuracy and/or speed on many of the probe tasks predicted decrements in language performance. CONCLUSIONS: These findings suggest that sustained work conditions and sleep deprivation negatively affect some types of language performance. Moreover, the use of probe tasks indicates that easy-to-administer tasks may be useful to identify when detriments are likely to occur in language-based performance under sleep deprivation conditions.

Assessing subjective sleepiness during a night of sleep deprivation: examining the internal state and behavioral dimensions of sleepiness.

Investigators in previous research have indicated that subjective measures of sleepiness may separate into state- and behavior-based dimensions; however, researchers have not examined this under sleep deprivation conditions. The authors' purpose in this study was to examine several measures of subjective sleepiness under sleep deprivation conditions following completion of various tasks. Fourteen students participated in a 28-hour sleep deprivation study and completed vigilance and cognitive tasks 4 times during the night. The authors administered subjective measures of sleepiness after each task. Factor analyses indicated that when individuals were not excessively sleepy, subjective sleepiness measures separated into 2 dimensions: state and behavioral sleepiness. However, when individuals were more fatigued, there was no distinction between the state and behavior dimensions of sleepiness. The current results suggest that using measures that assess state and behavioral sleepiness separately could be useful in clinical and research settings when extreme levels of sleepiness are not expected.