JMIR Publications

ABSTRACT

Background:

The decision to use patient portals can be influenced by multiple factors including individuals perceptions of the tool in regard to their personal skills and experiences. Prior experience with one type of portal may make individuals more comfortable with using newer portal technologies. Experienced outpatient portal users, in particular, may have confidence in their abilities to use inpatient portals that have similar functionality. In practice, the use of both outpatient and inpatient portal technologies can provide patients with continuity of access to their health information across care settings, but the influence of one type of portal use on the use of the other has not been studied.

Objective:

This study sought to understand how patients’ use of an inpatient portal was influenced by outpatient portal use.

Methods:

This study included patients at an academic medical center who were provided access to an inpatient portal during their hospital stay between 2016 and 2018 (n=1,571). We analyzed inpatient portal log files to investigate how inpatient portal use varied using three categories of outpatient portal users: Prior Users, New Users, and Non-Users.

Results:

Compared to Prior Users (n=695) of an outpatient portal, New Users (n=214) had higher use of a select set of inpatient portal functions (incidence rate ratio (IRR): 1.36; 95% confidence intervals (CI): 1.08-1.70 for the messaging function and IRR of 1.37; 95% CI 1.16-1.62 for the function that provides access to the outpatient portal through the inpatient portal). Non-Users (n=662), compared to Prior Users, had lower overall inpatient portal use (IRR: 0.64; 95% CI 0.54-0.74 for all active tasks) and lower use of specific functions, which included the function to review vitals and lab results (IRR: 0.43; 95% CI 0.30-0.62) and the function to access the outpatient portal (IRR: 0.54; 95% CI 0.45-0.63). In comparison to Prior Users, Non-Users also had lower odds of being comprehensive users (defined as using eight or more unique portal functions) (odds ratios (OR): 0.57; 95% CI 0.45-0.73) or composite users (defined as comprehensive users having 75th or greater percentile of portal sessions) of the inpatient portal (OR: 0.44; 95% CI 0.31-0.61).

Conclusions:

Patients’ use of an inpatient portal during their hospital stay appeared to be influenced by a combination of factors including prior outpatient portal use. For New Users, hospitalization itself, a major event that can motivate behavioral changes, may have influenced portal use. In contrast, Non-Users’ might have lower self-efficacy around their ability to use technology to manage one’s health contributing to their lower portal use. Understanding the relationship between the use of outpatient and inpatient portals can help direct targeted implementation strategies that encourage individuals to use these tools to better manage their health across care settings.