HI510 Unit 7 Patient Portal Evaluation Example

A Daughter Signs In and Finds Nothing From the Past Three Weeks: A Unit 7 Patient Portal Evaluation Asking, Setting by Setting, What Patients and Proxies Can See and Who Replies

[Student Name]

Purdue University Global

HI510: Health Information Applications and Systems

Unit 7 Patient Portal Evaluation

[Instructor Name]

[Date]

The patient, his daughter, Ostervale Health and all test results are composite; the regulations and studies cited are real.

Criteria

Three questions were set before the portal was opened, drawn from what patients and families in each Ostervale setting need. Can a patient or authorized proxy see the information that matters in that setting: notes, results, medications, appointments and the plan? When they send a message, does it reach someone who can see the relevant record and answer? And can a proxy be set up for a patient who cannot manage the portal alone, with access that matches the patient's wishes and the law? Federal privacy rules give patients a right of access to their health information and generally extend it to their personal representatives (45 C.F.R. § 164.502). Portals are one of the main ways health systems now meet that expectation, and reviews of the evidence suggest they can support engagement when patients find them usable and relevant (Irizarry et al., 2015).

Instrument 1: Visibility Matrix

Each setting was checked for five kinds of content, marked visible, delayed, partial or absent.

1. Hospital: notes visible; results visible; medications visible; appointments not applicable; messaging to the inpatient team absent, by design.

2. Clinics: notes visible; results visible; medications visible; appointments visible; messaging visible.

3. Nursing facility: notes absent; results partial, only those run in the hospital laboratory; medications absent; appointments absent; messaging absent.

4. Home health: notes absent; visit schedule absent; medications absent; messaging absent.

The nursing facility and home health agency run separate applications with no connection to the portal. A resident's portal therefore shows the hospital stay that came before admission and the clinic visits that will come after discharge, with almost nothing about the weeks in between. For a family, the portal goes dark at exactly the point when they are least able to visit and most in need of news.

Instrument 2: Message Test

Eight scripted messages were sent from a test patient account with an active proxy, covering common questions in each setting. Each was tracked for routing, time to first reply and whether the reply answered the question.

1. Question about a clinic medication refill: routed to the clinic, answered in 4 hours, answered fully.

2. Question about a clinic test result: routed to the clinic, answered in 19 hours, answered fully.

3. Question about the hospital discharge instructions: routed to the clinic, answered in 22 hours, answered fully from the discharge summary.

4. Question about therapy progress in the nursing facility: routed to the clinic, answered in 26 hours with advice to call the facility.

5. Question about a medication change in the nursing facility: routed to the clinic, answered in 31 hours with advice to call the facility.

6. Question about a care plan meeting at the nursing facility: routed to the clinic, answered in 2 days with a facility phone number.

7. Question about the home health visit schedule: routed to the clinic, answered in 25 hours with advice to call the agency.

8. Question about a home health wound care supply: routed to the clinic, no reply after 3 business days.

Three of eight messages received a full answer, all of them about clinic or hospital care. Every question about the nursing facility or home health went to clinic staff who could not see those records and could only redirect the family to a phone call.

Instrument 3: Proxy Access Review

Proxy access is granted at the clinic or hospital through a signed form, and it covers the portal account as a whole. The daughter's proxy access was set up when her father was a clinic patient, so she sees everything the portal holds. The nursing facility has its own process for designating a responsible party, recorded in its own application, which has no link to the portal. As a result, the facility cannot tell whether a family member writing about a resident has proxy rights, and the portal cannot show the facility's information to a proxy even when the resident would want it. Research on shared access to notes has found that patients often want care partners to read their records and that formal proxy accounts work better than shared passwords (Wolff et al., 2017), which is what families tend to use when proxy setup is confusing.

Findings

1. Visibility follows the application, not the path the patient actually takes through the system. Two of four settings are effectively absent from the portal.

2. Messaging routes by default to primary care, whose staff cannot see the records the questions concern.

3. Proxy designations exist in two unconnected places, so neither can be trusted for the other's purposes.

What the Daughter Experienced

The three instruments describe the portal from the outside. The daughter's three weeks show what the findings mean from the inside. Her father, recovering from a stroke in the nursing facility, could not use the portal himself, and she lives two hours away. She checked the portal most evenings, found the same discharge summary each time and sent two messages about his speech therapy, both of which came back from the clinic asking her to call the facility. When she called, the unit's phone was answered by whoever was free, often a nursing assistant who could not discuss the therapy plan. She learned the date of his care plan meeting the day after it happened. None of this came from bad intentions. The clinic staff answered promptly within what they could see, and the facility staff were busy with residents. The design sent her questions to people without the answers, and nobody in the system could see that it was happening.

Recommendations

1. Route portal messages about a current nursing facility or home health episode to a monitored pool in that setting, using the patient's active episode to decide routing.

2. Publish a short facility summary to the portal weekly: the care plan meeting date, current medications and therapy goals, as a document even before full integration.

3. Align proxy designations so that a portal proxy is visible to the facility and a facility-designated responsible party can be offered portal proxy access with the resident's consent.

4. Re-run the message test after changes, with a target of seven of eight questions answered fully within one business day.

Limits

The message test used scripted questions and a test account during weekday hours, and real families may write differently. The visibility matrix reflects one configuration at one point in time.

References

45 C.F.R. § 164.502 (2024). https://www.ecfr.gov/current/title-45/section-164.502

Irizarry, T., DeVito Dabbs, A., & Curran, C. R. (2015). Patient portals and patient engagement: A state of the science review. Journal of Medical Internet Research, 17(6), Article e148. https://doi.org/10.2196/jmir.4255

Wolff, J. L., Darer, J. D., Berger, A., Clarke, D., Green, J. A., Stametz, R. A., Delbanco, T., & Walker, J. (2017). Inviting patients and care partners to read doctors' notes: OpenNotes and shared access to electronic medical records. Journal of the American Medical Informatics Association, 24(e1), e166-e172. https://doi.org/10.1093/jamia/ocw108