Joslyn Levy

Consumers' Perceptions of Patient-Accessible Electronic Medical Records

Background Electronic health information (eHealth) tools for patients, including patient-accessible electronic medical records (patient portals), are proliferating in health care delivery systems nationally. However, there has been very limited study of the perceived utility and functionality of portals, as well as limited assessment of these systems by vulnerable (low education level, racial/ethnic minority) consumers. Objective The objective of the study was to identify vulnerable consumers’ response to patient portals, their perceived utility and value, as well as their reactions to specific portal functions. Methods This qualitative study used 4 focus groups with 28 low education level, English-speaking consumers in June and July 2010, in New York City. Results Participants included 10 males and 18 females, ranging in age from 21-63 years; 19 non-Hispanic black, 7 Hispanic, 1 non-Hispanic White and 1 Other. None of the participants had higher than a high school level education, and 13 had less than a high school education. All participants had experience with computers and 26 used the Internet. Major themes were enhanced consumer engagement/patient empowerment, extending the doctor’s visit/enhancing communication with health care providers, literacy and health literacy factors, improved prevention and health maintenance, and privacy and security concerns. Consumers were also asked to comment on a number of key portal features. Consumers were most positive about features that increased convenience, such as making appointments and refilling prescriptions. Consumers raised concerns about a number of potential barriers to usage, such as complex language, complex visual layouts, and poor usability features. Conclusions Most consumers were enthusiastic about patient portals and perceived that they had great utility and value. Study findings suggest that for patient portals to be effective for all consumers, portals must be designed to be easy to read, visually engaging, and have user-friendly navigation.

Public Health Detailing: A Strategy to Improve the Delivery of Clinical Preventive Services in New York City

To promote use of essential clinical preventive services, the New York City Department of Health and Mental Hygiene developed the Public Health Detailing Program, a primary care provider outreach initiative modeled on pharmaceutical detailing. Department representatives conducted topical campaigns, making unscheduled visits to health care practices and meeting with providers and office staff members. Representatives distributed “action kits” containing practice tools, provider information, and patient education materials; nicotine replacement therapy was distributed during the smoking cessation campaign. More than 2,500 interactions with practice staff members were completed by six health department representatives at approximately 200 sites. Physician visits lasted 10 minutes or longer, and by provider self-report, use of office systems for prevention and adherence to recommended practices increased. Public health detailing is an effective method of reaching providers to deliver key prevention messages, feasible for public health agencies and acceptable to practices. The effectiveness of this intervention in improving clinical prevention services requires further evaluation.

The Usability of Electronic Personal Health Record Systems for an Underserved Adult Population

Objective: The goals of this study were to identify the demands associated with using electronic personal health records (PHRs) and to evaluate the ability of adults of lower socioeconomic status and low health literacy to use PHRs to perform health management activities. Background: PHRs are proliferating in clinical practices and health care organizations. These systems offer the potential of increasing the active involvement of patients in health self-management. However, little is known about the actual usability of these tools for health consumers. Method: We used task analysis and health literacy load analysis to identify the cognitive and literacy demands inherent in the use of PHRs and evaluated the usability of three currently available PHR systems with a sample of 54 adults. Participants used the systems to perform tasks related to medication management, interpretation of lab/test results, and health maintenance. Data were also gathered on the participants’ perception of the potential value of using a PHR. Results: The results indicated that a majority of the participants had difficulty completing the tasks and needed assistance. There was some variability according to task and PHR system. However, most participants perceived the use of PHRs as valuable. Conclusions: Although considered a valuable tool by consumers, the use of PHR systems may be challenging for many people. Strategies are needed to enhance the usability of these systems, especially for people with low literacy, low health literacy, or limited technology skills. Application: The data from this study have implications for the design of PHRs.

The Primary Care Nutrition Training Program: An Approach to Communication on Behavior Change

The New York City Department of Health has designed a Primary Care Nutrition Training program for implementation in high-need neighborhoods that face growing diet-related epidemics of diabetes and obesity and a heavy burden of cardiovascular disease. Seven hundred fifty-six primary care team members complete pretest surveys and 665 complete posttest surveys at 45 training sessions between January and July 2007. Skills-building sessions center on the innovative application of visual aids and manipulatives and the provision of specific language for addressing nutritional issues with patients in busy primary care settings. Program evaluation data indicate that the training was well received by participants of all education levels, including medical assistants, physicians, nurses, and others, with 91% noting that the training content was pitched at about the right comprehension level for them. The Primary Care Nutrition Training Program offers a practical approach to continuing education for health professionals that may help to address the dearth of nutrition services currently in urban primary care.