Analyzing online patient-to-provider communication via a multi-specialty patient portal

As providers adopt health information technology solutions through electronic health record systems and patient portal systems, patients' access to their online medical records offers the potential to enhance the delivery of patient-centered care and improve patient satisfaction and clinical outcomes. These systems allow patients to electronically access their health information, schedule appointments, review test results, and interact with clinicians through messaging. However, published research conducted on patient portal usage, specifically what needs are patients wanting to address through secure messaging, is limited. Current information is based on self-reported patient attitudes and opinion. We performed a review of the literature to date, including previously published systematic reviews, randomized controlled trials, and relevant individual studies. After conducting the review, we collected and analyzed local patient portal data to address what we found to be a significant gap in the literature. Our aim was to analyze EHR-based secure communication in our academic, ambulatory, multi-specialty physician organization. Through retrospective analysis of patient-initiated messages within the Weill Cornell Connect patient portal, we conducted a mixed methods study to analyze the patient population and determine the patterns of use within a web-based patient portal among primary care and specialty medicine. We completed sequential methods of quantitative and qualitative thematic analysis of patient-initiated messages and quantified the use of patient to provider messaging based on message generation, volume of messages with general summaries and statistical correlations. Consequently, we discovered topics and general themes from the content of the messages and analyzed the intent of the patient-initiated messages. We also evaluated whether patients appropriately categorized their messages based on what we assessed to be their true intent. Our results provided insight in creating/restructuring portal systems to increase usability for the patients by offering more specific subject categories in order to better characterize the their needs, this will allow for better triage services within the practice and may lead to increase response time. As many of the patients fell within the middle-age range, offering some form of support or training on how to use the portal system will increase usage.