research-article

Design Considerations for Patient Portal Adoption by Low-Income, Older Adults

Authors:

Celine Latulipe,

David P. Miller,

Sara A. Quandt,

Alain G. Bertoni,

Thomas A. ArcuryAuthors Info & Claims

CHI '15: Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems

Pages 3859 - 3868

https://doi.org/10.1145/2702123.2702392

Published: 18 April 2015 Publication History

Abstract

This paper describes the results of an interview study investigating facilitators and barriers to adoption of patient portals among low-income, older adults in rural and urban populations in the southeastern USA. We describe attitudes of this population of older adults and their current level of technology use and patient portal use. From qualitative analysis of 36 patient interviews and 16 caregiver interviews within these communities, we derive themes related to benefits of portals, barriers to use, concerns and desired features. Based on our initial findings, we present a set of considerations for designing the patient portal user experience, aimed at helping healthcare clinics to meet U.S. federally-mandated `meaningful use' requirements.

References

[1]

Rural-urban continuum codes, 2013. http://www.ers.usda.gov/data-products/ rural-urban-continuum-codes.aspx#.VAW_UmRdW-S {Online; accessed 2-Sept-2014}.

[2]

Step 5: Achieve meaningful use, 2014. http: //www.healthit.gov/providers-professionals/ step-5-achieve-meaningful-use-stage-2 {Online; accessed 2-Sept-2014}.

[3]

Ahern, D. K., Woods, S. S., Lightowler, M. C., Finley, S. W., and Houston, T. K. Promise of and potential for patient-facing technologies to enable meaningful use. American Journal of Preventive Medicine 40, 5 (2011), S162--S172.

[4]

Ancker, J. S., Barrón, Y., Rockoff, M. L., Hauser, D., Pichardo, M., Szerencsy, A., and Calman, N. Use of an electronic patient portal among disadvantaged populations. Journal of General Internal Medicine 26, 10 (2011), 1117--1123.

[5]

Arcury, T. A., and Quandt, S. A. Qualitative methods in arthritis research: sampling and data analysis. Arthritis & Rheumatism 11, 1 (1998), 66--74.

[6]

Arcury, T. A., and Quandt, S. A. Participant recruitment for qualitative research: A site-based approach to community research in complex societies. Human Organization 58, 2 (1999), 128--133.

[7]

Baird, A., North, F., and Raghu, T. S. Personal health records (phr) and the future of the physician-patient relationship. In Proceedings of the 2011 iConference, iConference '11, ACM (2011), 281--288.

Digital Library

[8]

Buntin, M. B., Burke, M. F., Hoaglin, M. C., and Blumenthal, D. The benefits of health information technology: a review of the recent literature shows predominantly positive results. Health Affairs 30, 3 (2011), 464--471.

[9]

Fruhling, A. Perceptions of e-health in rural communities. Patient-Centered E-Health (2008), 157--167.

[10]

Goel, M. S., Brown, T. L., Williams, A., Cooper, A. J., Hasnain-Wynia, R., and Baker, D. W. Patient reported barriers to enrolling in a patient portal. Journal of the American Medical Informatics Association 18, 1 (2011), 8--12.

[11]

Greysen, S., Chin, G. C., Sudore, R., Cenzer, I., and Covinsky, K. Functional impairment and internet use among older adults: Implications for meaningful use of patient portals. JAMA Internal Medicine (2014).

[12]

Hoffman, D. L., and Novak, T. P. Bridging the racial divide on the internet. Science 280, 5362 (1998), 390--391.

[13]

Kellermann, A. L., and Jones, S. S. What it will take to achieve the as-yet-unfulfilled promises of health information technology. Health Affairs 32, 1 (2013), 63--68.

[14]

Kim, E.-H., Stolyar, A., Lober, W. B., Herbaugh, A. L., Shinstrom, S. E., Zierler, B. K., Soh, C. B., and Kim, Y. Usage patterns of a personal health record by elderly and disabled users. In AMIA Annual Symposium Proceedings, vol. 2007, American Medical Informatics Association (2007), 409--413.

[15]

Klein, R. An empirical examination of patient-physician portal acceptance. European Journal of Information Systems 16, 6 (2007), 751--760.

[16]

Kumar, S., and Aldrich, K. Overcoming barriers to electronic medical record (EMR) implementation in the us healthcare system: A comparative study. Health informatics journal 16, 4 (2010), 306--318.

[17]

Liu, L. S., Shih, P. C., and Hayes, G. R. Barriers to the adoption and use of personal health record systems. In Proceedings of the 2011 iConference, iConference '11, ACM (2011), 363--370.

Digital Library

[18]

Luborsky, M. R. The identification and analysis of themes and patterns. Sage Publications, Inc, 1994.

[19]

Mauro, A., and de Quiros, F. G. B. Patient-centered e-health design. Patient-Centered E-Health: Medical Info Science Reference (2009).

[20]

Milewski, J., and Parra, H. Gathering requirements for a personal health management system. In CHI '11 Extended Abstracts on Human Factors in Computing Systems, CHI EA '11, ACM (2011), 2377--2382.

Digital Library

[21]

Moyer, C. A., Stern, D. T., Dobias, K. S., Cox, D. T., and Katz, S. J. Bridging the electronic divide: patient and provider perspectives on e-mail communication in primary care. The American Journal of Managed Care 8, 5 (2002), 427--433.

[22]

Or, C. K., and Karsh, B.-T. A systematic review of patient acceptance of consumer health information technology. Journal of the American Medical Informatics Association 16, 4 (2009), 550--560.

[23]

Pai, F.-Y., and Huang, K.-I. Applying the technology acceptance model to the introduction of healthcare information systems. Technological Forecasting and Social Change 78, 4 (2011), 650--660.

[24]

Pang, C. E., Neustaedter, C., Riecke, B. E., Oduor, E., and Hillman, S. Technology preferences and routines for sharing health information during the treatment of a chronic illness. In Proceedings of ACM CHI 2013, ACM (2013), 1759--1768.

Digital Library

[25]

Pratt, W., Unruh, K., Civan, A., and Skeels, M. M. Personal health information management. Communications of the ACM 49, 1 (2006), 51--55.

Digital Library

[26]

Ruland, C. M., Brynhi, H., Andersen, R., and Bryhni, T. Developing a shared electronic health record for patients and clinicians. Studies in health technology and informatics 136 (2008), 57.

[27]

Simon, S. R., Evans, J. S., Benjamin, A., Delano, D., and Bates, D. W. Patients attitudes toward electronic health information exchange: qualitative study. Journal of Medical Internet research 11, 3 (2009).

[28]

Sun, S., Zhou, X., Denny, J. C., Rosenbloom, T. S., and Xu, H. Messaging to your doctors: Understanding patient-provider communications via a portal system. In Proceedings of ACM CHI 2013, CHI '13, ACM (2013), 1739--1748.

Digital Library

[29]

Tang, P. C., Ash, J. S., Bates, D. W., Overhage, J. M., and Sands, D. Z. Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. Journal of the American Medical Informatics Association 13, 2 (2006), 121--126.

[30]

Wilson, E. V., and Lankton, N. K. Modeling patients' acceptance of provider-delivered e-health. Journal of the American Medical Informatics Association 11, 4 (2004), 241--248.

[31]

Wilson, E. V., and Lankton, N. K. Predicting patients use of provider-delivered e-health: The role of facilitating conditions. Patient-centered e-health (2009), 217--229.

[32]

Yagil, D., Cohen, M., and Beer, J. D. Older adults coping with the stress involved in the use of everyday technologies. Journal of Applied Gerontology (2013), 0733464813515089.

[33]

Zickmund, S. L., Hess, R., Bryce, C. L., McTigue, K., Olshansky, E., Fitzgerald, K., and Fischer, G. S. Interest in the use of computerized patient portals: role of the provider-patient relationship. Journal of General Internal Medicine 23, 1 (2008), 20--26.

Cited By

Ellis JDellavalle NHamer MAkerson MAndazola MMoore ACampbell EDeCamp M(2025)The Halo Effect: Perceptions of Information Privacy Among Healthcare Chatbot UsersJournal of the American Geriatrics Society10.1111/jgs.19393Online publication date: 12-Feb-2025
https://doi.org/10.1111/jgs.19393
Meier-Diedrich EEsch THägglund MHeinze MHochwarter SSpeck JWagener MDahling VSchwarz J(2024)Experiences of Elderly Mental Health Patients and Their Care Partners Using a Proxy Account to Access Open Notes: Qualitative Study (Preprint)JMIR Aging10.2196/66690Online publication date: 20-Sep-2024
https://doi.org/10.2196/66690
Akyirem SWagner JChen HLipson JMinchala MCortez KWhittemore R(2024)Recommendations to Address Barriers to Patient Portal Use Among Persons With Diabetes Seeking Care at Community Health Centers: Interview Study With Patients and Health Care ProvidersJMIR Diabetes10.2196/585269(e58526)Online publication date: 16-Sep-2024
https://doi.org/10.2196/58526
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Index Terms

Design Considerations for Patient Portal Adoption by Low-Income, Older Adults
1. Human-centered computing

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cover image ACM Conferences

CHI '15: Proceedings of the 33rd Annual ACM Conference on Human Factors in Computing Systems

April 2015

4290 pages

ISBN:9781450331456

DOI:10.1145/2702123

General Chairs:
Bo Begole
Huawei, USA
,
Jinwoo Kim
Yonsei University, Korea
,
Program Chairs:
Kori Inkpen
Microsoft Research, USA
,
Woontack Woo
KAIST, Korea

Copyright © 2015 ACM.

Permission to make digital or hard copies of all or part of this work for personal or classroom use is granted without fee provided that copies are not made or distributed for profit or commercial advantage and that copies bear this notice and the full citation on the first page. Copyrights for components of this work owned by others than the author(s) must be honored. Abstracting with credit is permitted. To copy otherwise, or republish, to post on servers or to redistribute to lists, requires prior specific permission and/or a fee. Request permissions from [email protected].

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SIGCHI: ACM Special Interest Group on Computer-Human Interaction

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Association for Computing Machinery

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Publication History

Published: 18 April 2015

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Agency for Healthcare Research and Quality

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CHI '15

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SIGCHI

CHI '15: CHI Conference on Human Factors in Computing Systems

April 18 - 23, 2015

Seoul, Republic of Korea

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CHI '15 Paper Acceptance Rate 486 of 2,120 submissions, 23%;

Overall Acceptance Rate 6,199 of 26,314 submissions, 24%

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Cited By

Ellis JDellavalle NHamer MAkerson MAndazola MMoore ACampbell EDeCamp M(2025)The Halo Effect: Perceptions of Information Privacy Among Healthcare Chatbot UsersJournal of the American Geriatrics Society10.1111/jgs.19393Online publication date: 12-Feb-2025
https://doi.org/10.1111/jgs.19393
Meier-Diedrich EEsch THägglund MHeinze MHochwarter SSpeck JWagener MDahling VSchwarz J(2024)Experiences of Elderly Mental Health Patients and Their Care Partners Using a Proxy Account to Access Open Notes: Qualitative Study (Preprint)JMIR Aging10.2196/66690Online publication date: 20-Sep-2024
https://doi.org/10.2196/66690
Akyirem SWagner JChen HLipson JMinchala MCortez KWhittemore R(2024)Recommendations to Address Barriers to Patient Portal Use Among Persons With Diabetes Seeking Care at Community Health Centers: Interview Study With Patients and Health Care ProvidersJMIR Diabetes10.2196/585269(e58526)Online publication date: 16-Sep-2024
https://doi.org/10.2196/58526
Zhong YHahne JWang XWang XWu YZhang XLiu X(2024)Telehealth Care Through Internet Hospitals in China: Qualitative Interview Study of Physicians’ Views on Access, Expectations, and CommunicationJournal of Medical Internet Research10.2196/4752326(e47523)Online publication date: 29-Mar-2024
https://doi.org/10.2196/47523
Velverthi N(2024)Usage and Adoption of Patient Portalsundefined10.12794/metadc2356214Online publication date: Jul-2024
https://doi.org/10.12794/metadc2356214
Kamps JBirk MVriens CWallner GBernhaupt R(2024)Do You Dare to Ask? Influence of Question Recipient and Information Medium on Prompting Preparatory Questions for MR ImagingProceedings of Mensch und Computer 202410.1145/3670653.3670675(53-66)Online publication date: 1-Sep-2024
https://dl.acm.org/doi/10.1145/3670653.3670675
Orii LFeldacker CHuwa JThawani AViola EKiruthu-Kamamia CSande OTweya HAnderson R(2024)HIV Client Perspectives on Digital Health in MalawiProceedings of the 2024 CHI Conference on Human Factors in Computing Systems10.1145/3613904.3642245(1-13)Online publication date: 11-May-2024
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Pobee FMensah Abraham EJibril A(2024)A socio-economic analysis of the adoption of the sharing economyCogent Economics & Finance10.1080/23322039.2024.242653112:1Online publication date: 11-Nov-2024
https://doi.org/10.1080/23322039.2024.2426531
Chan DLee STeh P(2024)Bringing Rational Choice Theory Back to Reality: Understanding Low-Income Older Adults’ Intention to Use Mobility AppsEmerging Technologies in Business10.1007/978-981-97-2211-2_5(95-128)Online publication date: 4-May-2024
https://doi.org/10.1007/978-981-97-2211-2_5
Faber JAl-Dhahir IKraal JBreeman Lvan den Berg-Emons RReijnders Tvan Dijk SJanssen VKraaijenhagen RVisch VChavannes NEvers A(2023)Guide development for eHealth interventions targeting people with a low socioeconomic position: A participatory design approach. (Preprint)Journal of Medical Internet Research10.2196/48461Online publication date: 26-Apr-2023
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