JMIR Publications

ABSTRACT

Background:

Comprehensive multi-institutional patient portals that enable patients’ online access their data from across the health system have been shown to improve the provision of patient-centered and integrated care. However, several factors hinder their implementation. While barriers and facilitators to patient portal adoption are well documented, there is a dearth of evidence examining how to effectively implement multi-institutional patient portals that transcend traditional boundaries and disparate systems.

Objective:

This study sought to explore how the implementation approach of a multi-institutional patient portal impacted adoption and utilization of the technology. In addition, lessons learned were identified to guide the implementation of similar patient portal models.

Methods:

This multi-methods study included an analysis of quantitative and qualitative data collected during an evaluation of the multi-institutional MyChart patient portal that was deployed in Southwestern Ontario, Canada. Descriptive statistics were performed to understand utilization patterns during the first fifteen months of implementation (between August 2018 to October 2019). In addition, 42 qualitative semi-structured interviews were conducted with 18 administrative stakeholders, 16 patients, 7 healthcare providers and 1 informal caregiver to understand how the implementation approach influenced user experiences and to identify strategies for improvement. Qualitative data were analyzed using an inductive thematic analysis approach.

Results:

Between August 2018 and October 2019, 15,271 registration emails were sent with 67% (10,233 patients) registering for an account across 38 healthcare sites. The median number of patients registered per site was 19 with considerable variation (range of 1-2,114). Fifty-five percent of sites had less than 30 registered patients while 8% had over 1,000 registered patients. Interview participants perceived that the patient experience of the portal would have been improved by enhancing the data comprehensiveness of the technology. They also attributed lack of enrolment to the absence of a broad roll-out and marketing strategy across sites. Participants emphasized that provider engagement, change management support and senior leadership endorsement was central to foster uptake. Finally, many stated regional alignment and policy supports should have been sought to streamline implementation efforts across participating sites.

Conclusions:

Without proper management and planning, multi-institutional portals can suffer from minimal adoption. Data comprehensiveness is the foundational component of these portals and requires aligned policies and a key base of technology infrastructure across all participating sites. It is important to look beyond the category of the technology (i.e., patient portal) and consider its functionality (e.g., data aggregation, appointment scheduling, messaging) to ensure it aligns with the underlying strategic priorities of the deployment. It is also critical to establish a clear vision and ensure buy-in from organizational leadership and healthcare providers to support a culture shift that will enable meaningful and widespread engagement. Clinical Trial: N/A