- Patient portals might be better suited for chronic disease management and preventive measures, but that doesn’t mean the healthcare industry should ignore the tool’s potential for inpatient use, according to a group of researchers.
In a study recently published in the Journal of the American Medical Informatics Association, researchers investigated how inpatient hospital patient portal use could improve inpatient outcomes.
The uses for the patient portal in the outpatient setting are numerous – secure messaging, access to lab notes, prescription refills, and other functions make the tool the bedrock of current patient engagement efforts.
But there is also a potential inpatient utility to patient portals, the research team explained.
“The amount of medical information generated during a hospitalization can be extensive and delivered to the patient rapidly over a short period of time,” the team noted. “Consequently, patients may have difficulty comprehending and integrating this information, as well as understanding the plan of care.”
Using the patient portal in the hospital can help patients access their new health information on their own time, ideally supporting patient education during a hectic care encounter.
Using data from over 7,500 adult patients at a Mayo Clinic Hospital in Florida, the research team sought to understand how patient portal use could reduce 30-day readmission rates, inpatient mortality, and 30-day mortality.
About 20 percent of all patients accessed their patient portals while in the hospital, the report revealed.
These patients were younger (average of 58 years versus 62 years), had fewer elective admissions (54 percent versus 64 percent), were more frequently admitted to medical services (46 percent versus 35 percent), and were more likely to have liver disease (22 percent versus 13 percent) and a higher severity score (0.653 versus 0.456).
The reason for the split was likely because of the uncertainty of the hospital encounter, the researchers hypothesized. Patients with few elective admissions, for example, may not know as much about their conditions and procedures and therefore use the patient portal to cope.
“It is possible that patients (or their families) access the portal when they are uncertain of the hospital course,” the research team noted. “This would account for lower use among surgical patients (large portion of elective surgery) and those with shorter stays.”
An analysis of patient outcomes and portal use propensity scores revealed that there was no statistical difference between the groups for any outcomes measures. Metrics including 30-day readmissions, inpatient mortality, and 30-day mortality was the same for both portal users and non-users.
These results indicate that the patient portal is still better used as a preventive care and chronic disease management tool. Once a patient has been admitted into the hospital, the functions offered over the patient portal may not make a large clinical difference. The tool is better suited for outpatient and pre-hospital use.
“Use of a patient portal may play a more important role in the longitudinal management of chronic medical issues than in the outcomes associated with acute management of a decompensating clinical situation,” the research team explained.
“While patients and their families can review clinical information via patient portals, this passive, unguided review of clinical data may have little bearing on the overall hospital and immediate posthospital course,” they added.
Likewise, the patient portal is effective in guiding and creating patient behavior change. This function is ideal for managing a condition such as diabetes, but has little impact on an acute case of pneumonia, for example.
On the whole, however, inpatient patient portal use was low, the researchers said. This may be because the patient portal and hospital workflows are not designed to facilitate meaningful use of the technology.
“The inpatient portal lacks specific features that allow communication between patients and care teams,” the researchers suggested.
“Only admission notes, operative notes, consultations, and laboratory studies are available in real time,” the team added. “Daily progress notes cannot be viewed, and there is a 72-hour delay in the viewing of radiology and pathology reports. Finally, the inpatient portal does not provide education regarding patient-specific disease processes.”
These results do not mean the healthcare industry should forgo all efforts to integrate the patient portal into the inpatient encounter, the researchers said. Health IT developers should identify ways the portal can be adapted to the inpatient setting, and clinical leaders should take the time to educate patients on how to effectively use the technology in the hospital.
Likewise, researchers should look beyond the clinical benefits of patient portals and focus on how portals can enhance the patient experience.
“The first step in determining whether patient portal use can improve hospital outcomes is to increase adoption and use by designing inpatient-specific portal tools that can engage patients and make them active participants in their health care,” the researchers concluded.
“Future research should examine the role of portal use on more immediate outcomes such as patient experience and engagement to help clarify how patient portals can be used to improve outcomes.”