Addressing Hospital Patient Information Needs Using a Personal Health Record Portal

Although evidence indicates that better informed, more engaged patients have improved health outcomes, information needs of patients are often inadequately addressed. This is especially true in hospital settings, where the lack of information often contributes to anxiety and feelings of helplessness. Patient portals provide secure, online access to personal health information and are a potential mechanism to engage patients in their own care. To date, while portals have been made available to ambulatory patients, they have rarely been available in inpatient settings.

This project evaluated the impact of a personal health record on patient activation, patient satisfaction, and patient engagement when a patient portal was made available to cardiac care patients. A randomized clinical trial was done in two cardiac units at an academic medical center in New York City, with randomization to one of three arms: 1) usual care, 2) use of a tablet with general Internet access, and 3) use of a tablet with access to the inpatient portal. A secondary study site was used in Mountain View, California, to assess the scalability and potential reach of the intervention.

The specific aims of the project were as follows:

• Evaluate the effect of a personalized inpatient portal intervention on patient engagement. 
• Characterize information needs of hospital patients, assess clinicians’ attitudes toward patient engagement in the hospital setting, and evaluate the salience of patient-centered information to issues of care quality and safety. 
• Examine the intervention's effect on 30-day hospital readmission rate. 

All participants completed baseline and follow-up assessments to measure changes in patient activation, engagement with health information, and all-cause 30-day hospital readmissions. Healthcare providers were surveyed post-trial to assess the portal's usefulness and impact on care delivery. There was no evidence of a difference in patient activation among patients with access to the inpatient portal, though patients in this group did have a lower 30-day hospital readmission rate. There was evidence of a difference in patient engagement with health information between the portal (89 percent) and tablet-only group (51 percent), including better access to health information online. Healthcare providers perceived that patients found the portal useful and that the portal did not negatively impact healthcare delivery. The project team plans to study how and why patient activation increased over the course of a hospitalization and how to involve caregivers with proxy access to acute care portals.