Meaningful use in the safety net: a rapid ethnography of patient portal implementation at five community health centers in California
Meaningful use in the safety net: a rapid ethnography of patient portal implementation at five community health centers in California
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DOI：
10.1093/jamia/ocx015
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发表时间：
2017-09-01
影响因子：
6.4
通讯作者：
Lyles, Courtney
中科院分区：
文献类型：
--
作者：
Ackerman, Sara L.;Sarkar, Urmimala;Lyles, Courtney
目的：美国卫生保健机构正在实施安全网站（患者门户），以获得联邦有意义使用（MU）认证。我们试图了解在为低收入人群提供服务的“安全网”卫生保健系统中实施门户的努力。材料和方法：我们的快速人种志包括访问4个加州安全网卫生系统和深入访谈的第五个。访问包括与临床医生和行政人员的访谈（n = 12），与一线工作人员的非正式焦点小组（n = 35），对患者门户网站注册程序和临床工作的观察，对营销材料和门户网站使用数据的审查，以及简短的调查（n = 45）。结果：我们的研究结果表明，卫生系统投入了相当大的努力来争取员工支持门户网站的采用，并将门户网站相关工作整合到诊所日常工作中。尽管所有卫生系统都达到或接近达到MU基准，但患者在使用门户网站时面临许多障碍，我们的参与者不确定如何实现和维持由患者定义的“有意义的使用”。讨论：卫生系统为获得MU认证所做的努力将诊所工作人员团结在提高护理质量的共同精神下。然而，MU关于患者对电子获取健康信息的需求和使用能力的假设，将诊所的注意力引向了登记和信息路由，而不是工具的相关性和可用性，这种工具对安全网环境的适应性最低。结论：我们发现基于mu的患者参与指标与安全网患者群体的优先级和需求之间存在不匹配。
Objective: US health care institutions are implementing secure websites (patient portals) to achieve federal Meaningful Use (MU) certification. We sought to understand efforts to implement portals in "safety net" health care systems that provide services for low-income populations.Materials and Methods: Our rapid ethnography involved visits at 4 California safety net health systems and in-depth interviews at a fifth. Visits included interviews with clinicians and executives (n = 12), informal focus groups with front-line staff (n = 35), observations of patient portal sign-up procedures and clinic work, review of marketing materials and portal use data, and a brief survey (n = 45).Results: Our findings demonstrate that the health systems devoted considerable effort to enlisting staff support for portal adoption and integrating portal-related work into clinic routines. Although all health systems had achieved, or were close to achieving, MU benchmarks, patients faced numerous barriers to portal use and our participants were uncertain how to achieve and sustain "meaningful use" as defined by and for their patients.Discussion: Health systems' efforts to achieve MU certification united clinic staff under a shared ethos of improved quality of care. However, MU's assumptions about patients' demand for electronic access to health information and ability to make use of it directed clinics' attention to enrollment and message routing rather than to the relevance and usability of a tool that is minimally adaptable to the safety net context.Conclusion: We found a mismatch between MU-based metrics of patient engagement and the priorities and needs of safety net patient populations.