Design and implementation of a web-based patient portal linked to an ambulatory care electronic health record: patient gateway for diabetes collaborative care

Abstract

Background: Despite the availability of expert guidelines and widespread diabetes quality improvement efforts, care of patients with diabetes remains suboptimal. Two key barriers to care that may be amenable to informatics-based interventions include (1) lack of patient engagement with therapeutic care plans and (2) lack of medication adjustment by physicians ("clinical inertia") during clinical encounters.

Methods: The authors describe the conceptual framework, design, implementation, and analysis plan for a diabetes patient web-portal linked directly to the electronic health record (EHR) of a large academic medical center via secure Internet access designed to overcome barriers to effective diabetes care.

Results: Partners HealthCare System (Boston, MA), a multi-hospital health care network comprising several thousand physicians caring for over 1 million individual patients, has developed a comprehensive patient web-portal called Patient Gateway that allows patients to interact directly with their EHR via secure Internet access. Using this portal, a specific diabetes interface was designed to maximize patient engagement by importing the patient's current clinical data in an educational format, providing patient-tailored decision support, and enabling the patient to author a "Diabetes Care Plan." The physician view of the patient's Diabetes Care Plan was designed to be concise and to fit into typical EHR clinical workflow.

Conclusions: We successfully designed and implemented a Diabetes Patient portal that allows direct interaction with our system's EHR. We are assessing the impact of this advanced informatics tool for collaborative diabetes care in a clinic-randomized controlled trial among 14 primary care practices within our integrated health care system.

Fig. 1

Screen shot of the Diabetes Patient Portal shows the three core diabetes-related medically managed conditions (glucose control, blood pressure control, and cholesterol control) and patient decision support related to glucose control.

Fig. 2

Screen shot of a completed Diabetes Care Plan.

Fig. 3

Screen shot of the Diabetes Patient Portal shows the six behavioral/referral-related areas (diet and exercise, smoking cessation, anti-platelet agent, and eye and foot exam referrals) and patient decision support related to eye care.

Fig. 4

Schematic diagram shows the integration of the Patient Gateway patient portal with the clinical data repository (CDR), EHR, scheduling systems, and underlying decision support tools. MPI, Message Passing Interface.