JMIR Publications

ABSTRACT

Background:

Research exploring perspectives on inpatient portals reports patients desire the informational affordances of inpatient portals and clinicians recognize their value for improving patient experience but also express caution regarding sharing aspects of the medical record. This study that explores the psychosocial dimension of clinician resistance to informational affordances and considers the power dynamic associated with the clinician-patient information asymmetry, provides a significant contribution to existing literature on inpatient portals. Along with the informational affordances commonly discussed in this area, including access to notes and test results, this study explores perspectives on the option to audio record consultations via an inpatient portal. To our knowledge, this is the first study in Australia to explore patient, proxy, and clinician perspectives on an inpatient portal.

Objective:

This study aims to understand patient, proxy, and clinician perspectives on the value and impact of an inpatient portal within the Australian context. It explores clinician resistance and receptivity to sharing aspects of the medical record with patients and provides insight on the power dynamic that characterizes the relationship between clinician and patient. It highlights the potential of an inpatient portal to assist in the transformation of this relationship such that this relationship could be characterized by greater information symmetry.

Methods:

Interviews were conducted with patients (n=20), proxies (n=4) and clinicians (n=21) recruited from three areas within the Royal Melbourne Hospital where the portal would later be piloted. A largely inductive reflexive thematic analysis was conducted.

Results:

Patient and proxy participants reported that they need to understand what is happening in their care for peace of mind and that an inpatient portal could support this understanding. Clinician participants understood the benefit of the portal but also expressed caution regarding certain information sharing. Participants considered what types of information could be shared, and how this information could be shared via an inpatient portal. This study provided clinician participants the opportunity to reflect upon how they might transform their information sharing practice to provide greater transparency in their relationship with patients. Four key themes were generated: 1. Affording the patient/proxy awareness, control, and reassurance through sharing accessible and meaningful information; 2. Protecting the clinician and safeguarding quality healthcare in information sharing; 3. Flexibly deploying the functions depending upon clinician, patient/proxy, and context; 4. Towards person-centered care: empowerment and equity via an inpatient portal.

Conclusions:

An inpatient portal provides an opportunity to reconceptualize the medical record and how this information might be shared with the patient whilst they are admitted such that they have more understanding as to what is happening in their care, which ultimately supports their wellbeing. The transition to a more transparent information sharing culture in the Australian hospital context will take time. An inpatient portal is a critical step in facilitating this transition and in creating more information symmetry in the clinician-patient relationship.