Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 15, 2020
Date Accepted: Mar 24, 2021
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Patient Portal Use, Perceptions of EHR Value, and Self-Rated Primary Care Quality among Older Adults: A Cross-Sectional Survey
ABSTRACT
Background:
Older adults are increasingly encouraged to use patient-facing portals to access information and communicate electronically, but there’s little understanding of their satisfaction with care at different intensities of portal use, or the contextual factors associated with differences in satisfaction at their chosen level of engagement. We hypothesize that patients’ perceptions of how well their provider utilizes technology to generate value in the relationship may be one key factor.
Objective:
To analyze whether older adults’ assessment of primary care quality differs across levels of patient portal engagement, and whether perceptions of how well their provider uses the electronic health record (EHR) to support care moderates this relationship.
Methods:
Cross-sectional survey analysis of 158 older adults across Michigan. We use a 13-measure composite of self-assessed healthcare quality. Portal use was categorized as none, moderate (use of 1-3 functionalities) or extensive (use of 4-7 functionalities). EHR value perception was measured by asking respondents how they felt their doctor’s EHR use improved the patient-provider relationship.
Results:
Moderate portal users, compared to those who were extensive users, had lower estimated care quality (-0.214 on 4-point scale; p=0.027). Differences between extensive portal users and non-portal users were not significant. Quality perception is only particularly low among moderate portal users with low EHR value perception; those with high EHR value perception rated quality similarly to other portal user groups.
Conclusions:
Older adults who are moderate portal users are the least satisfied with their care, and the most sensitive to perceptions of how well their provider uses the EHR to support the relationship. Encouraging portal use without compromising perceptions of quality requires thinking beyond patient-focused education. Achieving value from use of patient-facing technologies with older adults is contingent upon matched organizational investments that support technology-enabled care delivery. Providers and staff need policies and practices that demonstrate technology adeptness. Older adults may need more tailored signaling and accommodation for technology to be maximally impactful.
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