Bush Ruth A, Connelly Cynthia D, Fuller Martha, Pérez Alexa
1 Hahn School of Nursing and Health Science, University of San Diego , San Diego, California.
2 Rady Children's Hospital San Diego , San Diego, California.
Telemed J E Health. 2016 Feb;22(2):144-152. doi: 10.1089/tmj.2015.0033. Epub 2015 Aug 10.
This study assessed the current state of knowledge regarding the use of the integrated electronic health record (EHR) patient portal for pediatric clinical care. A systematic examination of the research on implementation, utilization, and evaluation of the integrated EHR patient portal among pediatric patients has not been previously conducted. Therefore, the purpose of the present study was to systematically review existing research on the state of the science, describe the way others have defined the patient portal, and examine pediatric patient portal utilization.
Covering a period from 1992 to 2014 a literature search was conducted on four electronic databases. Only articles in English were reviewed. Studies were included if they reported the use of a patient portal integrated with an electronic health record and captured pediatric medial encounters. Qualitative or quantitative studies of any design were eligible as long as they focused on patients (or parents) who access their health records through an electronic portal tied to an EHR and reported measures of satisfaction, attitudes on use, barriers and facilitators, adherence, or clinical and health outcomes. Content analysis of each article was performed independently by at least two authors using an extraction grid of study qualities, and quality and relevance of the studies were also assessed.
Of a total of 189 potentially relevant publications identified, 31 full-text publications were obtained after screening titles and abstracts. After a full review, 11 publications corresponding to seven studies met the inclusion criteria. The methodological approaches included cross-sectional surveys, retrospective analysis, qualitative studies, and usability testing. In general, feedback was positive. The most frequent negative comments about the portal reflected concern about teenager interaction with the portal and how that might affect communication among patient, parent, and provider. Some users were frustrated with the complexity of medical terminology used.
Reflecting the additional considerations of pediatric proxy access and fewer chronically ill patients, pediatric medicine has yet to use the patient portal as a modality for outcomes measurement. Given the paucity of studies within this age group, it is difficult to measure outcome improvements or the effect of patient record access on healthcare behaviors. This systematic review presents innovative research on the general acceptance of the patient portal among parents and highlights that the implementation of the portal is still in its early stages and has yet to be used widely in diverse populations or studies in a longitudinal manner. Further studies should confirm that protected access to health information and secure communication and information sharing with healthcare providers have an impact in the pediatric population on healthcare outcomes.
本研究评估了关于使用集成电子健康记录（EHR）患者门户进行儿科临床护理的知识现状。此前尚未对儿科患者中集成EHR患者门户的实施、利用和评估研究进行系统审查。因此，本研究的目的是系统回顾现有科学状况的研究，描述其他人定义患者门户的方式，并考察儿科患者门户的利用情况。
对四个电子数据库进行了1992年至2014年期间的文献检索。仅审查英文文章。如果研究报告了与电子健康记录集成的患者门户的使用情况并记录了儿科医疗会诊，则纳入研究。只要定性或定量研究聚焦于通过与EHR相关联的电子门户访问其健康记录的患者（或家长），并报告满意度、使用态度、障碍与促进因素、依从性或临床及健康结果的测量指标，任何设计的此类研究均符合条件。至少两名作者使用研究质量提取网格对每篇文章进行独立的内容分析，并评估研究的质量和相关性。
在总共识别出的189篇潜在相关出版物中，筛选标题和摘要后获得31篇全文出版物。全面审查后，与七项研究对应的11篇出版物符合纳入标准。方法学方法包括横断面调查、回顾性分析、定性研究和可用性测试。总体而言，反馈是积极的。对该门户最常见的负面评论反映了对青少年与门户互动以及这可能如何影响患者、家长和提供者之间沟通的担忧。一些用户对所使用的医学术语的复杂性感到沮丧。
鉴于儿科代理访问的额外考量以及慢性病患者较少，儿科学尚未将患者门户用作结果测量的方式。鉴于该年龄组的研究匮乏，难以衡量结果改善情况或患者访问记录对医疗行为的影响。本系统评价展示了关于家长对患者门户普遍接受度的创新性研究，并强调该门户的实施仍处于早期阶段，尚未在不同人群中广泛使用或进行纵向研究。进一步的研究应证实，受保护地访问健康信息以及与医疗服务提供者进行安全通信和信息共享对儿科人群的医疗结果有影响。
