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Observational Study
. 2022 Oct;13(5):1123-1130.
doi: 10.1055/a-1951-3268. Epub 2022 Sep 27.

Real-Time Patient Portal Use Among Emergency Department Patients: An Open Results Study

Robert W Turer  1   2 , Katherine R Martin  1 , Daniel Mark Courtney  1 , Deborah B Diercks  1 , Ling Chu  2   3 , DuWayne L Willett  2   3 , Bhaskar Thakur  1   4 , Amy Hughes  4 , Christoph U Lehmann  2   4   5   6 , Samuel A McDonald  1   2
Affiliations
Observational Study

Real-Time Patient Portal Use Among Emergency Department Patients: An Open Results Study

Robert W Turer et al. Appl Clin Inform. 2022 Oct.

Abstract

Objectives: We characterized real-time patient portal test result viewing among emergency department (ED) patients and described patient characteristics overall and among those not enrolled in the portal at ED arrival.

Methods: Our observational study at an academic ED used portal log data to trend the proportion of adult patients who viewed results during their visit from May 04, 2021 to April 04, 2022. Correlation was assessed visually and with Kendall's τ. Covariate analysis using binary logistic regression assessed result(s) viewed as a function of time accounting for age, sex, ethnicity, race, language, insurance status, disposition, and social vulnerability index (SVI). A second model only included patients not enrolled in the portal at arrival. We used random forest imputation to account for missingness and Huber-White heteroskedasticity-robust standard errors for patients with multiple encounters (α = 0.05).

Results: There were 60,314 ED encounters (31,164 unique patients). In 7,377 (12.2%) encounters, patients viewed results while still in the ED. Patients were not enrolled for portal use at arrival in 21,158 (35.2%) encounters, and 927 (4.4% of not enrolled, 1.5% overall) subsequently enrolled and viewed results in the ED. Visual inspection suggests an increasing proportion of patients who viewed results from roughly 5 to 15% over the study (Kendall's τ = 0.61 [p <0.0001]). Overall and not-enrolled models yielded concordance indices (C) of 0.68 and 0.72, respectively, with significant overall likelihood ratio χ 2 (p <0.0001). Time was independently associated with viewing results in both models after adjustment. Models revealed disparate use between age, race, ethnicity, SVI, sex, insurance status, and disposition groups.

Conclusion: We observed increased portal-based test result viewing among ED patients over the year since the 21st Century Cures act went into effect, even among those not enrolled at arrival. We observed disparities in those who viewed results.

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Conflict of interest statement

C.U.L. reports royalties or licenses from Springer-Verlag (<$20) and stock ownership of Celanese and Markel.

Figures

Fig. 1
Fig. 1
Weekly proportion of ED patients viewing one or more test results during their ED encounter. ED, emergency department.
Fig. 2
Fig. 2
Overall model (all patients): Odds ratios (ORs) of result(s) viewed vs. result(s) not viewed for all model features with 95% confidence intervals.
Fig. 3
Fig. 3
Model of patients not enrolled at arrival: odds ratios (ORs) of result(s) viewed vs. result(s) not viewed for all model features with 95% confidence intervals.
See this image and copyright information in PMC

References

    1. 114th Congress of the United StatesH.R.34 - Public Law No: 114 - 255 - 21st Century Cures Act. Washington, DC;2016
    1. Office of the National Coordinator for Health Information Technology USDoHaHS Federal Register: 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program;2020
    1. Steitz B D, Sulieman L, Wright A, Rosenbloom S T. Association of immediate release of test results to patients with implications for clinical workflow. JAMA Netw Open. 2021;4(10):e2129553–e2129553. - PMC - PubMed
    1. Arvisais-Anhalt S, Lau M, Lehmann C U. The 21st century cures act and multiuser electronic health record access: potential pitfalls of information release. J Med Internet Res. 2022;24(02):e34085. - PMC - PubMed
    1. Office of the National Coordinator for Health Information Technology USDoHaHS United States Core Data for Interoperability (USCDI)Accessed June 9, 2022 at:https://www.healthit.gov/uscdi

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