The number of unnecessary clinic visits of patients in both primary and urgent care clinics has increased for the last few years. It is easy to meet the needs of pediatric patients by maximum utilization of online access portals which enables direct communication to service providers. Currently, the field of information technology is drastically changing and offers a variety of challenges to the healthcare field. The invention of internet and EHR (electronic health record) have given opportunities to the patients to participate in their healthcare actively. According to the United States Department of Health and Human Services (HHS), an online portal is a secure online website where patients can conveniently access their health information from any geographical location by the help of internet (Peacock et al., 2017). Besides, the online portals can be accessed via any device.
There are various advantages presented by online portals in the healthcare field. The patients can use the portals to ask questions regarding their health, and this reduces the costs of making appointments in medical clinics. The online portals present one of the most secure ways of sharing clinical information, and they have been found to strengthen the relationship between the clients and the service providers. The use of online portals saves time and reduces overcrowding in hospitals. The portals enhance the degree to which the patients get actively involved in matters relating to their health hence improving patient engagement. The online portals are convenient because they can be accessed from any geographical location. They also improve the accuracy of information by eliminating handwritten medication errors which were common before their invention. The paper reviews the benefits of online access portals by analyzing the perceptions of mothers of pediatric patients of age 0-11 years attending private and public clinics in the same geographical area, specifically Bay area.
The current issue in the outpatient clinics in the Bay area is the increasing number of clinic visits of the patients in both primary and urgent care clinics. Optimal utilization of online portal access can meet pediatric patient needs by communicating directly with the providers. However, many clients prefer visiting clinics to enquire simple queries which could have been done through online portals. The visiting of the clinics is costly, creates overcrowding, and decreases satisfaction on both consumers and providers.
The paper analyzes the benefits of online portals by reviewing the perceptions of the mothers of pediatric patients, age 0-11 years, attending private and public clinics in the same geographical area, Bay region. The aims of the research will be accomplished by searching articles from well-known databases such as PubMed, Google Scholar, CINAHL, and Cochrane. The literature from these databases will be analyzed to determine the benefits of online portals. The research will use an experimental group which used online portals and a control group which preferred physical visitation of the clinics to the use of web-based portals. The outcomes of these two groups will be analyzed to determine which method is more effective.
A search strategy refers to any organized method of searching information in the literature which plays a crucial role in identifying information suitable for the topic under study. The search strategy performs an essential task in supporting medical professionals who want to remain updated with the growth of evidence-based practices in the healthcare field. Evidence-based practice is a collection of evidence which enhances the quality of medical data and information related to the interests of the patients (Alfirevic et al., 2016). A correct search technique is important because it aids in the efficient retrieval of data and information.
Formulation of a question is crucial for conducting an active literature search. The question assists in sourcing of answers from the selected databases. The database is a term which refers to a system of reviews containing electronic data collections which are well organized and can be easily accessed (Alfirevic et al., 2016). There are numerous search engines which facilitate literature search. Each of the search engines has a unique approach to identifying data and data information.
Various search engines were used for this study. These include PubMed, Google Scholar, Cochrane, and CINAHL. However, among the databases mentioned, PubMed was commonly used in most parts of the research. The main reason for depending on this particular database is because it offers a variety of information. PubMed is one of the primary sources of clinical data connected to a central medical database known as MEDLINE. The database can easily be accessed via the National Library of Medicine, and hence it’s a trustable site which can be relied in most of the times (Alfirevic et al., 2016). Furthermore, it does not charge people to access its information hence unlimited quantities of information can be retrieved. Moreover, PubMed contains evidence-based articles and this justifies why this research used it as the primary source of information.
There are various strategies for searching data and information from the databases. A search strategy technique is made up of a list of databases and appropriate terms which form vital elements of the study (Alfirevic et al., 2016). As previously mentioned, formulating a suitable research question composes an essential component of the search strategy. The problem, in this case, is “In mothers of pediatric patients, age 0-11 years old, what are the benefits of online access portals as compared to physically attending a clinic to obtain crucial information related to the health of their children? The problem only affects nursing only, and thus challenge does not impact other disciplines. According to Alfirevic et al (2016) PICOT is the most suitable technique for managing the question. PICOT is an acronym for Problem/population/patient, Intervention, Comparison, Outcome and Time respectively. In our case, the population is the mothers of pediatric patients; the intervention is the use of online portals, the comparison is physical attendance to a medical clinic, the outcome is the results which arise from the use of online portals, for instance obtaining timely information and the time frame is 0-11 years.
Inclusion, exclusion and operating delimiters were used to set the boundary for the research. After formulating the research question, the next step was to determine the inclusion, exclusion and operating delimiters criteria. Some of the things considered in the inclusion/exclusion criteria include date, geographical location, participants, type of journals that is whether it is peer-reviewed or not, setting, study design, exposure of interest, language, reported outcomes, and kind of publication (LoBiondo-Wood & Haber 2014).
The study used the articles that are less than five years old hence date was a crucial component of the inclusion criteria. The study was limited to Bay area. Therefore, geographical location formed a vital element for the inclusion criteria. Regarding exposure of interest, the mothers of pediatric patients had numerous experiences with the use of online portals and physical attendance of the clinics, and thus they were considered in the inclusion criteria. The participants of the study used in the inclusion criteria were mothers of the pediatric patients. The CINAHL and MEDLINE databases proved useful in this case because their articles contained subject headings specifying the age group under study. Therefore, it was easy to retrieve materials for the mothers of pediatric patients. Most of the literature used in the research include peer-reviewed journals because they contain reliable information. Regarding reported outcomes, the inclusion criteria considered results of using online portals. The study included the study designs reviewing the participants at one point in time. The language of the participants was not crucial in the research hence it was excluded. The type of publication was vital, and the study excluded letters, reviews, and editorials. The study also excluded non-peer reviewed articles.
The operating delimiters were used to refine the search. Various limiters assisted in narrowing the search. For instance, the “Full Title” option aided in limiting results to articles with full text only. The “Cover Story” button was clicked to restrict the results to articles which were only available in the library. The “Abstract Available” button was used to limit the search results to materials that include abstracts which summarize the contents of the article. The research used the “Peer Reviewed” option to limit the results of the search to peer-reviewed journals only. Furthermore, the “Date published” button was utilized in obtaining materials that are only less than five years old.
There are various methods of searching for articles in a database. Some of the search strategies employed in this research include the use of keywords, thesaurus, exact phrases, Boolean logic, truncated and wildcard searches, citation searching and subject headings. A keyword is a combination of free text words and phrases. The search strategy applies a combination of subject headings and free text words (Alfirevic et al., 2016). The method of searching using keywords looks for the search terms in the title and abstract of reference material. Some of the keywords used in the search include online portals, benefits of online portals, and pediatric patient mothers’ perceptions on online portals. Thesaurus search entails searching of words with an associated set of phrases and synonyms in locating the most suitable search articles. For instance, in this research paper, the use of the words such as “web-based portals” was used instead of online portals because the two phrases are closely related. Thesaurus search technique significantly reduces the results of the search, and this improves the chances of locating the required articles (Alfirevic et al., 2016).
Quotation marks helped in ensuring words appeared next to each other in an exact phrase. For instance “online portals,” “web-based portals” employed exact phrase search. The technique proved useful in decreasing the number of results hence producing more relevant materials. The search also used Boolean logic which involves the combination of words (Alfirevic et al., 2016). The approach aided in improving the relevance of words in the PICOT question by the use of joining words like and, not, or, with, inverted commas and brackets. The conjunction AND helps in displaying articles composed of both words. For instance online portals and its advantages. On the other hand, the use of OR portrays the materials that constitute of either word or both of them. For example, online portals or web-based portals. The joining word NOT restricts the search to the specified terms. For instance, searching for Bay area NOT other geographical regions.
Wildcard and truncation search saves time in conducting the literature search. Truncation involves the utilization of symbols such as asterisks (*) which minimizes the number of steps in the search. On the other hand, wildcard search is the use of question mark (?) and this assists in differentiating English spellings and handling plurals (Alfirevic et al., 2016). The study employed truncation search in various ways. For instance, keying the character child* in the search helped in displaying articles related to pediatric patients, child, children, childhood among others. Above all, the inclusion, exclusion and operating delimiters were used to refine the materials which met the required criteria. After the refinement, the search displayed only 16 articles. The documents were used to facilitate the rest of the research.
Materials regarded as robust evidence in the study include CPG (clinical practice guidelines), individual RCT (randomized control trials), systematic reviews combined with meta-analyses, systematic reviews alone, and well-designed non-randomized control trials. The need to control bias and the notion of causation were the basis of the hierarchy of evidence (Dang & Dearholt, 2017).
Figure 1: Hierarchy of the study and the levels of evidence
Validity refers to the degree to which a particular measurement, concept or conclusion is well founded and relevant to the real world. According to research, the scientific validity concept has proved useful in addressing the nature of reality and thus it is a philosophical and epistemological issue as well as a question of measurement (Dang & Dearholt, 2017). There were various factors considered in determining the validity of the references used. Some of these include the author, source of information and the age of the publication (LoBiondo-Wood & Haber 2014). The research mostly used peer-reviewed journals related to the topic which were less than five years old.
According to GRADE (Grading of Recommendations Assessment Development and Evaluation), the quality of evidence is a reflection of the extent to which confidence in an estimate of the effect is sufficient enough to support a specific recommendation. Various factors were considered in determining the quality of evidence for this study. Some of the factors which reduce the quality of evidence include imprecision, limitations of the study, indirectness of evidence, publication bias and inconsistency of the results (LoBiondo-Wood & Haber 2014). Others increase the quality of evidence and include dose-recipient gradient and large magnitude of the effect. Study designs are crucial in evaluating the quality of evidence. RCTs present stronger evidence than observational studies hence RCT articles were considered in writing the project. However, rigorous observational studies offer more robust evidence as compared to uncontrolled case studies. According to GRADE, RCTs without limitations provide high-quality evidence as these were also important in handling the paper. Besides, observational studies without unique strengths were ignored because they present low quality of evidence (Dang & Dearholt, 2017).
Initially, the database search displayed 3457 articles. However, after using inclusion, exclusion and operating delimiters criteria, the articles were reduced to 16 which is a manageable number. Most of the materials were excluded by considering the information displayed by the title and the abstracts. The process led to presenting only full-text articles which were analyzed to determine the benefits of online portals.
According to Sarkar & Bates (2014), the United States is making some good progress towards adopting the use of EHRs. A recent survey shows that 72% of physicians based in offices are using EHR, which is an increase from 48% who were using the EHRs in 2009. Most of the EHRs are linked to personal health records usually known as patient portals. The portals help in the online management of healthcare through email messaging with physicians. The portals give an opportunity to the patients to access the results of laboratory tests, online booking of appointments and prescription of drugs for specific illnesses (Sarkar & Bates, 2014). Research shows that 20% of the healthcare provider offices have ‘live’ patient portals. Besides, another report points that by 2014, 5% of the total patient population were using patient portals to make queries concerning their health status, book appointments, access laboratory diagnostic tests among other things (Sarkar & Bates, 2014).
Studies show that full implementation on the use of online portals is yet to be achieved. However, the portals might soon become a standard component of healthcare (Kruse et al., 2015). The patient portals have various benefits. Research shows that patient portals improve communication between the patients and the healthcare practitioners (Griffin et al., 2016). Moreover, the patient portals enhance greater access to a patient’s healthcare information and improve the engagement of the patient on the matters to do with his or her health (Sarkar & Bates, 2014). A recent study has pointed out that patients become more engaged in their health and medical care when they can easily access their health information online, especially for the low-income earners (Emont, 2014). Additionally, patients can use the portals to pay bills, access their medical records and refill prescriptions. Patient portals also lead to longer pay-offs like increasing the efficiency of the administration by reducing the volume of calls and improving the degree of responding to the needs of the patients (Emont, 2014).
Although the patient portals can significantly result in longer-term payoffs, only a few peer-reviewed journals and other books have documented their effects (Emont, 2014). This is true mostly for the safety net-population, where the health centers and community clinics are adopting the use of patient portals at a low rate. Therefore, this is one critical gap future research needs to focus on; to determine why healthcare institutions are taking a bit longer duration than expected to employ the use of patient portals.
According to research, patients have the capability of scheduling appointments, viewing laboratory tests and reviewing personal health records via the use of patient portals (Otte-Trojel et al., 2014). The ability to access this information at ease assists in bonding the patients more closely to the healthcare practice. Patients employing the use of patient portals achieve more satisfaction with the healthcare practitioner communication than those not utilizing the portal. The mothers of pediatric patients in Bay area who used online portals expressed more comfort with the healthcare services as compared to the ones who physically attended clinics. Furthermore, the use of patient portals appears to have gained popularity among the middle-aged patients, and this was well exemplified by mothers of pediatric patients who were using patient portals in the Bay area. The increased use shows how information technology has contributed in encouraging patients and their caregivers to be more active in their healthcare.
A study conducted in California, specifically the Bay area reported that 90% of the patients prefer that physicians should access the test results electronically because in that way they can be able to share the results with other medical specialists (Vodicka et al., 2014).
A patient portal gives the opportunity to the patients, consulting and referring clinicians to exchange information, and this promotes collaboration. It offers a separate section where the referring physician can be able to check the patient’s status. The option speeds communication and has been proven to be popular with the referring health practitioner (Kruse et al., 2014). For instance, a systematic review conducted in Bay area showed that 40% of the referring physicians were utilizing the patient portals to view data and information related to the health of their patients. A similar case was observed at Michigan where a cardiology practitioner, Ann Arbor pointed that most of the referring physicians in the community have embraced the use of patient portals (Kruse et al., 2014).
The mothers of pediatric patients who were using patient portals in Bay area reported cost savings to the medical practice as compared to visiting health clinics physically. The online portal can accept the input of the patient unlike a telephone call and provides patients with the self-selected information without requesting the response of the health specialist (Redelmeier & Kraus, 2018). Moreover, the use of patient patients have reduced unnecessary visits to medical clinics, and this has significantly assisted in lowering the costs of appointments as reported by the mothers of the pediatric patients in Bay area who were using the patient portals. Besides, their use saves time which is a non-renewable resource.
A portal speeds timeliness as well enhancing the efficiency of completing the forms required by the patients. The portals give a chance to the patients to complete various forms online that were formally written using the hand. In so doing, the portals help in approving data and information concerning demographics, medical history of the patient, insurance coverage and known allergies (Lyles et al., 2015). The portals reduce handwritten errors as reported by the mothers of pediatric patients in Bay area who employed the use of the online portals. The use of patient portals gives an opportunity to the patients to customize forms such as medical history to request for additional information when required. For instance, a patient who fills “Yes” when asked “Do you drink alcohol” would be presented with more health questions which can assist a physician make a proper clinical judgment. Additionally, form customization can be done by gender, the status of chronic illness, age and other factors which appear essential to the healthcare specialist (Tieu et al., 2017).
The process of making online appointments allows the clients to select the most appropriate time that matches their needs. The survey conducted in Bay area showed that 72% of mothers of pediatric patients prefer using online portals because they make scheduling time convenient. According to research, online scheduling is one of the tools that has proven to be the primary differentiator between healthcare professionals chosen by the patients for their care (Turvey et al., 2014).
According to research, patient portals can meet the needs of Americans who are demanding faster and more personalized services from the healthcare industry. It allows even little medical practices to provide self-service options and methods of sharing information in the same manner as the most massive healthcare systems offer to the patients (Peacock et al., 2017). It is essential that practices provide both quality and cost-effective services as the world shifts towards giving patients more responsibilities for their healthcare costs. Portals offer the most transparent method expected by the healthcare consumers demanding value and access to health matters (Peacock et al., 2017). The mothers of pediatric patients who were using patient portals pointed transparency as one of the benefits of the patient portals.
Action plan refers to a series of cyclical steps followed in accomplishing a particular goal. The objective, in this case, is to encourage healthcare professionals and patients to adopt the use of patient portals due to the potential merits associated with their use.
|Goals||Education Needed||Changes to Documentation||Outcome Metric||Timeline||Person(s) Responsible|
|To ensure full implementation of the use of patient portals among healthcare practitioners by the year 2020.||Physicians and referring nurses need to be trained on how to use patient portals.||Future research needs to focus on the advantages of using patient portals among the healthcare professionals and encourage more to adapt their use.||Improved accuracy resulting from the use of patient portals due to the elimination of handwritten medication errors.||2018- 2020||Healthcare management officers, government trained officials.|
|To increase the use of patient portals among the patients by 2020.||Patients need to be educated on how to use the patient portals.||Future research needs to emphasize on the advantages of using patient portals among the patients.||Improved relationship between the patients and the healthcare professionals due to the use of patient portals.||2018-2020||Government trained officials.|
|To implement laws mandating the use of patient portals to reduce overcrowding and unnecessary visits in healthcare institutions by 2020.||All people need to be educated on the use of patient portals to access medical information, laboratory tests, refill prescriptions and pay medical bills.||Available literature should be amended to encourage more and more people to adopt the use of patient portals.||Saving of medical costs and enhancing convenience in accessing clinicians.||2018-2020||Government trained officials.|
I would recommend that patients should adopt widespread use of portals because they improve communication between them and the physicians. The online portals are also convenient and reduce overcrowding in medical clinics. On the other hand, the physicians and nurses should prefer using the portals because they minimize handwritten medication errors and thus enhance accuracy. Besides, the government officials entrusted with the health department should implement some training programs that will educate the general public on the advantages of online portals. The process will ensure that the online portals will be widely accepted by the society as the current research shows that only a few populations have adopted the use of online portals in the healthcare. Moreover, future research should focus on determining the reasons why healthcare institutions are taking long to employ the use of online portals. It should then come up with ways of solving these challenges to encourage more people to use the portals.
According to the United States Department of Health and Human Services, an online portal is a secure online website where patients can conveniently access their health information from any geographical location with the help of internet. The patients can use the online portals to obtain medical records, laboratory examination tests, pay medical bills, and refill prescriptions. The portals enhance proper means of communication between the patient and the healthcare professionals. They present one of a secure method of sharing information and improves the interaction between the patient and the clinician. Also, the portals save the cost of medications because they reduce unnecessary visits and appointments with medical specialists. The portals improve accuracy by eliminating the handwritten medication errors which were common in clinical practice before they were invented. Thus, the healthcare professionals should employ extensive use of the patient portals because they are more accurate than the manual methods of treatment.
The portals allow the patients to select the most convenient time which matches his or her need when booking for appointments. As a result, they enhance access and are advantageous because they can be used at any geographical location. Portals provide the most transparent method expected by the healthcare consumers demanding value and access to health matters. Therefore, it is recommended that all people should employ the largescale use of patient portals due to their potential benefits. The members of the general public need to be sensitized on the merits associated with the portals as this will ensure widespread use of the web-based portals. Finally, the future research should focus on identifying the problems related to the use of patient portals and come up with ways of solving them for maximum utilization.
Alfirevic, Z., Keeney, E., Dowswell, T., Welton, N. J., Medley, N., Dias, S., & Caldwell, D. M. (2016). Search strategy: Cochrane Pregnancy and Childbirth Group.
Dang, D., & Dearholt, S. L. (2017). Johns Hopkins Nursing Evidence-Based Practice: Model and Guidelines. Sigma Theta Tau.
Emont, S. (2014). Measuring the impact of patient portals: What the literature tells us. 2011. URL: http://www. chcf. Org/~/media/MEDIA% 20LIBRARY% 20Files/PDF/M/PDF% 20MeasuringImpactPatientPortals. Pdf [accessed 2013-06-11] [Web Cite Cache].
Griffin, A., Skinner, A., Thornhill, J., & Weinberger, M. (2016). Patient portals. Applied clinical informatics, 7(02), 489-501.
Kruse, C. S., Argueta, D. A., Lopez, L., & Nair, A. (2015). Patient and provider attitudes toward the use of patient portals for the management of chronic disease: a systematic review. Journal of medical Internet research, 17(2).
Kruse, C. S., Bolton, K., & Freriks, G. (2015). The effect of patient portals on quality outcomes and its implications to meaningful use: a systematic review. Journal of medical Internet research, 17(2).
LoBiondo-Wood, G., & Haber, J. (2014). Nursing Research-E-Book: Methods and Critical Appraisal for Evidence-Based Practice. Elsevier Health Sciences.
Lyles, C. R., Sarkar, U., Schillinger, D., Ralston, J. D., Allen, J. Y., Nguyen, R., & Karter, A. J. (2015). Refilling medications through an online patient portal: consistent improvements in adherence across racial/ethnic groups. Journal of the American Medical Informatics Association, 23(e1), e28-e33.
Otte-Trojel, T., de Bont, A., van de Klundert, J., & Rundall, T. G. (2014). Characteristics of patient portals developed in the context of health information exchanges: early policy effects of incentives in the meaningful use program in the United States. Journal of medical Internet research, 16(11).
Peacock, S., Reddy, A., Leveille, S. G., Walker, J., Payne, T. H., Oster, N. V., & Elmore, J. G. (2017). Patient portals and personal health information online: perception, access, and use by US adults. Journal of the American Medical Informatics Association, 24(e1), e173-e177.
Redelmeier, D. A., & Kraus, N. C. (2018). Patterns in Patient Access and Utilization of Online Medical Records: Analysis of My Chart. Journal of medical Internet research, 20(2).
Sarkar, U., & Bates, D. W. (2014). Care partners and online patient portals. Jama, 311(4), 357-358.
Tieu, L., Schillinger, D., Sarkar, U., Hoskote, M., Hahn, K. J., Ratanawongsa, N., & Lyles, C. R. (2017). Online patient websites for electronic health record access among vulnerable populations: portals to nowhere? Journal of the American Medical Informatics Association, 24(e1), e47-e54.
Turvey, C., Klein, D., Fix, G., Hogan, T. P., Woods, S., Simon, S. R., & Wakefield, B. (2014). Blue Button use by patients to access and share health record information using the Department of Veterans Affairs’ online patient portal. Journal of the American Medical Informatics Association, 21(4), 657-663.
Vodicka, E., Mejilla, R., Leveille, S. G., Ralston, J. D., Darer, J. D., Delbanco, T., … & Elmore, J. G. (2014). Online access to doctors’ notes: patient concerns about privacy. Journal of medical Internet research, 15(9).