JMIR Publications

ABSTRACT

Background:

Digital patient portals have been shown to play an important role in connecting patients with their medical care team which improves patient engagement in treatment plans, decreases unnecessary visits, and reduces costs. During natural disasters, patients’ needs increase while available resources, specifically access to care, become limited.

Objective:

This study aims to examine patients’ health needs during a time of natural crisis by analyzing electronic messages from patients to providers via a patient portal interface during Hurricane Harvey to inform intentional planning for future natural disasters.

Methods:

We explored patient portal usage data from a large Greater Houston area healthcare system, Houston Methodist, focusing on the initial week of the Hurricane Harvey event, beginning with the date of landfall, August 25, 2017, to August 31, 2017. A mixed methods approach was used to assess patients’ immediate health needs and concerns during the disruption of access to routine and emergent medical care. Quantitative analysis utilized logistic regression models to assess the predictive characteristics of patients utilizing the portal during the Harvey disaster. This study also included encounter by type (emergency, inpatient, observation, outpatient, and outpatient surgery) and time (pre, during, and post disaster). For qualitative analysis, the content of these messages was examined utilizing the constant comparative method to identify emerging themes found within sent message text.

Results:

From a total of 557,024 patients, 4079 patients messaged during Hurricane Harvey while 31,737 patients used the portal. Age, gender, race, and ethnicity were predictive factors of using the portal and sending a message during the natural disaster. We also found that prior use of the patient portal increased the likelihood of portal use during Harvey (OR = 13.688) and of sending a portal message during Harvey (OR= 14.172). Encounters 4 weeks before and 4 weeks after Hurricane Harvey were positively associated with increased use of both the portal and sending a portal message during the initial disaster week. Patients with encounters during that main Harvey week had a higher increased likelihood of use across all five encounter types. The qualitative results revealed the following themes: access, prescription requests, medical advice (chronic conditions, acute care, urgent needs, Harvey-related injuries), mental health, technical difficulties, and provider constraints.

Conclusions:

The patient portal can be a useful tool for communication between patients and providers to address the urgent needs and concerns of patients as a natural disaster unfolds. This was the first study to include encounter data to understand portal use relative to care provisioning. Prior use was found to be highly predictive of both portal use and message sending during Hurricane Harvey. These findings could help to inform the types of demands that may arise in future disaster situations and can serve as the first step in intentionally optimizing patient portal usability for emergency healthcare management during natural disasters. Clinical Trial: N/A