Potential of an Electronic Health Record-Integrated Patient Portal for Improving Care Plan Concordance during Acute Care

Abstract

Background: Care plan concordance among patients and clinicians during hospitalization is suboptimal.

Objective: This article determines whether an electronic health record (EHR)-integrated patient portal was associated with increased understanding of the care plan, including the key recovery goal, among patients and clinicians in acute care setting.

Methods: The intervention included (1) a patient portal configured to solicit a single patient-designated recovery goal and display the care plan from the EHR for participating patients; and (2) an electronic care plan for all unit-based nurses that displays patient-inputted information, accessible to all clinicians via the EHR. Patients admitted to an oncology unit, including their nurses and physicians, were enrolled before and after implementation. Main outcomes included mean concordance scores for the overall care plan and individual care plan elements.

Results: Of 457 and 283 eligible patients approached during pre- and postintervention periods, 55 and 46 participated in interviews, respectively, including their clinicians. Of 46 postintervention patients, 27 (58.7%) enrolled in the patient portal. The intention-to-treat analysis demonstrated a nonsignificant increase in the mean concordance score for the overall care plan (62.0-67.1, adjusted p = 0.13), and significant increases in mean concordance scores for the recovery goal (30.3-57.7, adjusted p < 0.01) and main reason for hospitalization (58.6-79.2, adjusted p < 0.01). The on-treatment analysis of patient portal enrollees demonstrated significant increases in mean concordance scores for the overall care plan (61.9-70.0, adjusted p < 0.01), the recovery goal (30.4-66.8, adjusted p < 0.01), and main reason for hospitalization (58.3-81.7, adjusted p < 0.01), comparable to the intention-to-treat analysis.

Conclusion: Implementation of an EHR-integrated patient portal was associated with increased concordance for key care plan components. Future efforts should be directed at improving concordance for other care plan components and conducting larger, randomized studies to evaluate the impact on key outcomes during transitions of care.

Clinical trials identifier: NCT02258594.

Conflict of interest statement

None declared.

Georg Thieme Verlag KG Stuttgart · New York.

Figures

Fig. 1

Acute Care Patient Portal integrated with Electronic Health Record (EHR). During the postintervention period, the acute care patient portal (background, left) was accessible to patients and designated caregivers via tablet computers and configured to improve communication with clinicians by synchronizing with the EHR (foreground, right). In the patient portal, patients could select a single recovery goal which was communicated to their care team via the EHR. Patients could also view other key elements of their care plan, including the main reason for hospitalization, active problems, and a schedule for the day; these elements were maintained by nurses via the EHR.

Fig. 2

CONSORT diagram.