Otte-Trojel Terese, de Bont Antoinette, Rundall Thomas G, van de Klundert Joris
Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands.
J Am Med Inform Assoc. 2016 Apr;23(e1):e162-8. doi: 10.1093/jamia/ocv114. Epub 2015 Sep 2.
Numerous articles have reported on the development of patient portals, including development problems and solutions. We review these articles to inform future patient portal development efforts and to provide a summary of the evidence base that can guide future research.
We performed a systematic review of relevant literature to answer 5 questions: (1) What categories of problems related to patient portal development have been defined? (2) What causal factors have been identified by problem analysis and diagnosis? (3) What solutions have been proposed to ameliorate these causal factors? (4) Which proposed solutions have been implemented and in which organizational contexts? (5) Have implemented solutions been evaluated and what learning has been generated? Through searches on PubMed, ScienceDirect and LISTA, we included 109 articles.
We identified 5 main problem categories: achieving patient engagement, provider engagement, appropriate data governance, security and interoperability, and a sustainable business model. Further, we identified key factors contributing to these problems as well as solutions proposed to ameliorate them. While about half (45) of the 109 articles proposed solutions, fewer than half of these solutions (18) were implemented, and even fewer (5) were evaluated to generate learning about their effects.
Few studies systematically report on the patient portal development processes. As a result, the review does not provide an evidence base for portal development.
Our findings support a set of recommendations for advancement of the evidence base: future research should build on existing evidence, draw on principles from design sciences conveyed in the problem-solving cycle, and seek to produce evidence within various different organizational contexts.
众多文章报道了患者门户网站的发展情况,包括发展中存在的问题及解决方案。我们回顾这些文章,为未来患者门户网站的开发工作提供参考,并总结可指导未来研究的证据基础。
我们对相关文献进行了系统综述,以回答5个问题:(1)已定义的与患者门户网站开发相关的问题类别有哪些?(2)通过问题分析和诊断确定的因果因素有哪些?(3)为改善这些因果因素提出了哪些解决方案?(4)哪些提议的解决方案已得到实施,实施的组织背景是什么?(5)已实施的解决方案是否经过评估,产生了哪些经验教训?通过在PubMed、ScienceDirect和LISTA上进行检索,我们纳入了109篇文章。
我们确定了5个主要问题类别:实现患者参与、提供者参与、适当的数据治理、安全性和互操作性以及可持续的商业模式。此外,我们确定了导致这些问题的关键因素以及为改善这些问题而提出的解决方案。在109篇文章中,约一半(45篇)提出了解决方案,但这些解决方案中不到一半(18篇)得到了实施,甚至更少(5篇)经过评估以了解其效果。
很少有研究系统地报告患者门户网站的开发过程。因此,该综述并未为门户网站的开发提供证据基础。
我们的研究结果支持一系列推进证据基础的建议:未来的研究应基于现有证据,借鉴解决问题循环中传达的设计科学原则,并寻求在各种不同的组织背景下产生证据。