Abstract
Patient web portals (PWPs), defined as the integration of electronic medical records and patient health records, have been related to enhanced patient outcomes. A literature review was conducted to characterize the design and evaluation of PWPs to improve health care processes and outcomes in diabetes. A summary of 26 articles revealed the positive impact PWPs have on patient outcomes, patient-provider communication, disease management, and access to and patient satisfaction with health care. Innovative and useful approaches included the evaluation of specific components of the PWPs, assessing the impact of PWPs on mediators of health behaviors, such as patient distress, identification of barriers to use, and patient willingness to pay for access. Future research should focus on relevant processes that mediate patient and provider use, impact on health care utilization, and a patient-centered approach to the design and integration of educational opportunities afforded through PWPs.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
Wild S, Roglic G, Green A, et al.: Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004, 27:1047–1053.
Yach D, Stuckler D, Brownell KD: Epidemiologic and economic consequences of the global epidemics of obesity and diabetes. Nat Med 2006, 12:62–66.
Stratton IM, Adler AI, Neil HA, et al.: Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000, 321:405–412.
Expert Committee on the Diagnosis and Classification of Diabetes Mellitus: American Diabetes Association: clinical practice recommendations 2002. Diabetes Care 2002, 25(Suppl 1):S1–S147.
Institute of Medicine: Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
Krishna S, Boren SA: Diabetes self-management care via cell phone: a systematic review. J Diabetes Sci Technol 2008, 2:509–517.
Verhoeven F, Tanja-Dijkstra K, Nijland N, et al.: Asynchronous and synchronous teleconsultation for diabetes care: a systematic literature review. J Diabetes Sci Technol, 4:666–684.
Knecht LA, Gauthier SM, Castro JC, et al.: Diabetes care in the hospital: is there clinical inertia? J Hosp Med 2006, 1:151–160.
• Holbrook A, Thabane L, Keshavjee K, et al.: Individualized electronic decision support and reminders to improve diabetes care in the community: COMPETE II randomized trial. CMAJ 2009, 181:37–44. Unlike other studies that examine clinical outcomes and patient satisfaction only, the primary outcome for this study was a process composite score that represented the change in relevant clinical monitoring behaviors, by patients and providers, between the intervention and control groups over 6 months. This process score reflects quality of care, and improvement in quality of care over time.
Kushniruk AW, Borycki EM, Armstrong B, et al.: Bringing electronic patient records into health professional education: towards an integrative framework. Stud Health Technol Inform 2009, 150:883–887.
Crosson JC, Ohman-Strickland PA, Hahn KA, et al.: Electronic medical records and diabetes quality of care: results from a sample of family medicine practices. Ann Fam Med 2007, 5:209–215.
Varonen H, Kortteisto T, Kaila M: What may help or hinder the implementation of computerized decision support systems (CDSSs): a focus group study with physicians. Fam Pract 2008, 25:162–167.
Dorr D, Bonner LM, Cohen AN, et al.: Informatics systems to promote improved care for chronic illness: a literature review. J Am Med Inform Assoc 2007, 14:156–163.
Burrington-Brown J, Fishel J, Fox L, et al.: Defining the personal health record. AHIMA releases definition, attributes of consumer health record. J AHIMA 2005, 76:24–25.
Tang PC, Ash JS, Bates DW, et al.: Personal health records: definitions, benefits, and strategies for overcoming barriers to adoption. J Am Med Inform Assoc 2006, 13:121–126.
Detmer D, Bloomrosen M, Raymond B, Tang P: Integrated personal health records: transformative tools for consumer-centric care. BMC Med Inform Decis Mak 2008, 8:45.
•• Fonda SJ, McMahon GT, Gomes HE, et al.: Changes in diabetes distress related to participation in an internet-based diabetes care management program and glycemic control. J Diabetes Sci Technol 2009, 3:117–124. PWP usage, clinical outcomes, and diabetes distress levels were all assessed, allowing the authors to examine how diabetes distress impacts PWP usage and moderates clinical benefits from PWP usage. Findings show that individuals who have a high level of diabetes distress are less likely to consistently use PWPs. Recommendations include working aggressively with patients whose diabetes is poorly controlled before introducing a PWP to maintain health.
Fonda SJ, Paulsen CA, Perkins J, et al.: Usability test of an internet-based informatics tool for diabetes care providers: the comprehensive diabetes management program. Diabetes Technol Ther 2008, 10:16–24.
Olshansky E, Sacco D, Fitzgerald K, et al.: Living with diabetes: normalizing the process of managing diabetes. Diabetes Educ 2008, 34:1004–1012.
Hess R, Bryce CL, Paone S, et al.: Exploring challenges and potentials of personal health records in diabetes self-management: implementation and initial assessment. Telemed J E Health 2007, 13:509–517.
Bryce CL, Zickmund S, Hess R, et al.: Value versus user fees: perspectives of patients before and after using a web-based portal for management of diabetes. Telemed J E Health 2008, 14:1035–1043.
Zickmund SL, Hess R, Bryce CL, et al.: Interest in the use of computerized patient portals: role of the provider-patient relationship. J Gen Intern Med 2008, 23(Suppl 1):20–26.
•• Quinn CC, Gruber-Baldini AL, Shardell M, et al.: Mobile diabetes intervention study: testing a personalized treatment/behavioral communication intervention for blood glucose control. Contemp Clin Trials 2009, 30:334–346. Researchers randomly assigned 36 provider practices in geographically diverse areas to four conditions: treatment as usual, patient access to PWP only, patient and provider communication with PWP, and patient and provider access to PWP plus treatment algorithms. By using three different treatment groups, this study can compare specific aspects of PWPs to empirically assess what specific processes of PWPs have the most impact on clinical outcomes. Results from this study are forthcoming.
Ma C, Warren J, Phillips P, Stanek J: Empowering patients with essential information and communication support in the context of diabetes. Int J Med Inform 2006, 75:577–596.
Ross SE, Nowels CT, Haverhals LM, et al.: Qualitative assessment of Diabetes-STAR: a patient portal with disease management functions. AMIA Annu Symp Proc 2007:1097.
Kobb R, Hoffman N, Lodge R, Kline S: Enhancing elder chronic care through technology and care coordination: report from a pilot. Telemed J E Health 2003, 9:189–195.
Tang CH, Li CC, Chang GH, Chang P: Implementing a personalized portal combined with workflow management tools used in diabetes care. AMIA Annu Symp Proc 2003:1026.
Wald JS, Grant RW, Schnipper JL, et al.: Survey analysis of patient experience using a practice-linked PHR for type 2 diabetes mellitus. AMIA Annu Symp Proc 2009, 2009:678–682.
Kollmann A, Riedl M, Kastner P, et al.: Feasibility of a mobile phone-based data service for functional insulin treatment of type 1 diabetes mellitus patients. J Med Internet Res 2007, 9:e36.
Ross SE, Haverhals LM, Main DS, et al.: Adoption and use of an online patient portal for diabetes (Diabetes-STAR). AMIA Annu Symp Proc 2006:1080.
Bellazzi R, Arcelloni M, Ferrari P, et al.: Management of patients with diabetes through information technology: tools for monitoring and control of the patients' metabolic behavior. Diabetes Technol Ther 2004, 6:567–578.
Kim HS, Kim NC, Ahn SH: Impact of a nurse short message service intervention for patients with diabetes. J Nurs Care Qual 2006, 21:266–271.
McMahon GT, Gomes HE, Hickson Hohne S, et al.: Web-based care management in patients with poorly controlled diabetes. Diabetes Care 2005, 28:1624–1629.
Noel HC, Vogel DC, Erdos JJ, et al.: Home telehealth reduces healthcare costs. Telemed J E Health 2004, 10:170–183.
Quinn CC, Clough SS, Minor JM, et al.: WellDoc mobile diabetes management randomized controlled trial: change in clinical and behavioral outcomes and patient and physician satisfaction. Diabetes Technol Ther 2008, 10:160–168.
Smith KE, Levine BA, Clement SC, et al.: Impact of MyCareTeam for poorly controlled diabetes mellitus. Diabetes Technol Ther 2004, 6:828–835.
Kaufman DR, Pevzner J, Hilliman C, et al.: Redesigning a Telehealth Diabetes Management Program for a Digital Divide Seniors Population. Home Health Care Mgmt Prac 2006, 18:223–234.
Hsu J, Huange J, Kinsman J, et al.: Use of e-Health services between 1999 and 2002: a growing digital divide. J Am Med Inform Assoc 2005, 12:164–171.
Kim EH, Stolyar A, Lober WB, et al.: Challenges to using an electronic personal health record by low-income elderly population. J Med Internet Res 2009, 11:44.
Ralston JD, Rutter CM, Carrell D, et al.: Patient use of secure electronic messaging within a shared medical record: a cross-sectional study. J Gen Intern Med 2009, 24:349–355.
Nordqvist C, Hanberger L, Timpka T, Nordfeldt S: Health professionals' attitudes towards using a Web 2.0 portal for child and adolescent diabetes care: qualitative study. J Med Internet Res 2009, 11:e12.
Britto MT, Jimison HB, Munafo JK, et al.: Usability testing finds problems for novice users of pediatric portals. J Am Med Inform Assoc 2009, 16:660–669.
Ralston JD, Hereford J, Carrell D: Use and satisfaction of a patient Web portal with a shared medical record between patients and providers. AMIA Annu Symp Proc 2006:1070.
Weingart SN, Rind D, Tofias Z, Sands DZ: Who uses the patient internet portal? The PatientSite experience. J Am Med Inform Assoc 2006, 13:91–95.
Leveille SG, Huang A, Tsai SB, et al.: Screening for chronic conditions using a patient internet portal: recruitment for an internet-based primary care intervention. J Gen Intern Med 2008, 23:472–475.
Koonce TY, Giuse DA, Beauregard JM, Giuse NB: Toward a more informed patient: bridging health care information through an interactive communication portal. J Med Libr Assoc 2007, 95:77–81.
Lin CT, Wittevrongel L, Moore L, et al.: An Internet-based patient-provider communication system: randomized controlled trial. J Med Internet Res 2005, 7:e47.
Businger A, Buckel L, Gandhi T, et al.: Patient review of selected electronic health record data improves visit experience. AMIA Annu Symp Proc 2007:887.
Kittler AF, Carlson GL, Harris C, et al.: Primary care physician attitudes towards using a secure web-based portal designed to facilitate electronic communication with patients. Inform Prim Care 2004, 12:129–138.
Nordfeldt S, Hanberger L, Bertero C: Patient and parent views on a Web 2.0 Diabetes Portal—the management tool, the generator, and the gatekeeper: qualitative study. J Med Internet Res, 12:e17.
Lobach DF, Willis JM, Macri JM, et al.: Perceptions of Medicaid beneficiaries regarding the usefulness of accessing personal health information and services through a patient Internet portal. AMIA Annu Symp Proc 2006:509–513.
DesRoches CM, Campbell EG, Rao SR, et al.: Electronic health records in ambulatory care—a national survey of physicians. N Engl J Med 2008, 359:50–60.
Jha AK, DesRoches CM, Campbell EG, et al.: Use of electronic health records in U.S. hospitals. N Engl J Med 2009, 360:1628–1638.
Stead WW, Lin HS: Computational Technology for Effective Health Care: Immediate Steps and Strategic Directions. Washington, DC: National Research Council; 2009.
Faridi Z, Liberti L, Shuval K, et al.: Evaluating the impact of mobile telephone technology on type 2 diabetic patients' self-management: the NICHE pilot study. J Eval Clin Pract 2008, 14:465–469.
Beaudoin DE, Rocha RA, Tse T: Enhancing access to patient education information: a pilot usability study. AMIA Annu Symp Proc 2005:892.
Acknowledgment
Dr. Chandra Y. Osborn is supported by a Diversity Supplement Award (NIDDK P60 DK020593). Dr. Shelagh A. Mulvaney is supported by NIDDK P60 DK020593, DK 070026, and AHRQ R18 HS018168. Dr. Rachel Hess is supported by a grant from the Department of Defense for development, evaluation, and adaptation of a PWP.
Disclosure
No potential conflicts of interest relevant to this article were reported.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Osborn, C.Y., Mayberry, L.S., Mulvaney, S.A. et al. Patient Web Portals to Improve Diabetes Outcomes: A Systematic Review. Curr Diab Rep 10, 422–435 (2010). https://doi.org/10.1007/s11892-010-0151-1
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11892-010-0151-1