HIM 200 Module 4 Project One Example

Project One: Who Uses Brennan County's Patient Portal, and Who Is Left Out?

[Student Name]

Southern New Hampshire University

HIM 200: Introduction to Health Information Technology

Project One

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Project One: Who Uses Brennan County's Patient Portal, and Who Is Left Out?

Brennan County Medical Center's patient portal lets patients see test results, read visit notes, message their care team, request appointments and pay bills. Federal rules and patients' expectations make it more important every year. Yet the hospital has never evaluated how well the portal works or for whom. This project does so, using system data, a registration audit, a patient survey and published research, and organizes the results with a sociotechnical framework.

Evaluation Questions

Four questions guide the evaluation. How many patients have activated accounts, and does activation differ by age, insurance or language? How actively do activated patients use the portal, and for what? How well does the hospital support portal use, including offering accounts and answering messages? And what prevents patients from signing up?

Methods

The information technology department supplied de-identified reports of activations, logins and feature use for the past twelve months. The HIM department supplied message volumes and response times. Over two weeks, the author observed 120 registrations at the main desk and outpatient clinics, recording whether staff offered portal activation. A short paper survey, available in English and Spanish, was given to 150 patients without accounts in waiting areas, and 112 completed it. The hospital's privacy officer approved the approach as an internal quality review.

Who Has Activated

Of patients seen in the past year, 31% have activated accounts. Activation falls with age, from 38% among patients 18 to 39 to 19% among those 65 and older. It varies sharply by insurance: 44% of commercially insured patients have accounts, compared with 22% of Medicare, 18% of Medicaid and 12% of uninsured patients. Only 9% of patients who prefer Spanish have accounts, compared with 33% of English speakers. Table 1 summarizes.

Table 1. Portal Activation by Patient Group

Note. Hospital portal reports, most recent twelve months.

How the Portal Is Used

Among activated patients, 58% logged in at least once in the past 90 days. Viewing test results was by far the most common activity, used by 71% of active users, followed by secure messaging at 34%, appointment requests at 22% and bill payment at 18%. The portal generates about 1,900 patient messages a month. The median response time is 1.8 days, but 14% of messages wait more than three days, mostly those routed to busy specialty clinics.

The Registration Audit

Staff offered portal activation at only 46% of the 120 observed registrations. Offers were more common during quiet periods and at the outpatient clinics than at the busy main desk. Registration staff explained that the activation step added about two minutes and that they skipped it when lines grew. No staff member offered activation in Spanish during the observation, although two bilingual registrars were on duty part of the time.

What Patients Said

Among the 112 survey respondents without accounts, the most common reason was not knowing the portal existed, cited by 41%. Another 22% had no email address or reliable internet, 17% had tried but gave up on password or login problems and 14% preferred to call. Several Spanish-speaking respondents wrote that they assumed the portal was only in English, which is correct for about half of its screens.

What Research Says

Brennan County's gaps mirror published findings. Ancker et al. (2011) studied a network of community health centers serving disadvantaged populations and found lower portal use among Black and Hispanic patients and among those with public insurance or none. Goel et al. (2011) found that Black and Latino patients in an academic primary care practice were less likely than White patients to enroll. Irizarry et al. (2015) reviewed research on portals and patient engagement and concluded that health literacy, usability and encouragement from clinicians shape whether patients adopt and use portals, while evidence on health outcomes remains mixed.

A Sociotechnical View

Sittig and Singh (2010) propose eight connected dimensions for understanding health IT. Applying them shows that the portal's problems lie mostly outside the software. The technology works reliably, but the human-computer interface is partly English-only and has a difficult password reset. People and workflow are the largest problems: activation is skipped when registration is busy. Internal policy offers no target or accountability for activation, and nobody monitors disparities. Table 2 lays out what each dimension revealed.

Table 2. Findings by Sociotechnical Dimension

Note. Analysis by the author using Sittig and Singh (2010).

Strengths

The portal has real strengths. It is stable, results appear promptly, patients who use it value it, and the message service answers most questions within two days. Its test result feature is heavily used, which suggests that patients who find the portal see clear value in it.

Weaknesses

Its main weaknesses are uneven reach and inconsistent support. Older, publicly insured, uninsured and Spanish-speaking patients are far less likely to have accounts, activation depends on whether registration is busy and the interface creates avoidable obstacles. Nobody is responsible for fixing these problems because nobody measures them.

Priorities for Project Two

Three priorities emerge. The hospital should make activation a routine, measured step that does not depend on registration desk traffic. It should close language and access gaps, including full Spanish screens, bilingual help and options for patients without email. And it should assign ownership of portal performance, with regular reporting of activation and use by patient group. Project Two will build these into an improvement plan, together with steps to reduce faxed records.

Limitations

The registration audit lasted only two weeks, and registrars who knew they were being watched may have offered the portal more often than usual. The survey reached only patients in waiting areas, missing those who use telehealth. Portal reports cannot show whether patients share accounts with family members. These limits do not change the main findings but should be kept in mind.

Conclusion

Brennan County's portal works well for the patients who use it but reaches too few, and the gaps fall along age, insurance and language lines documented in national research. The sociotechnical analysis shows the causes are workflow, policy and interface choices the hospital controls. That makes them fixable.

References

Ancker, J. S., Barrón, Y., Rockoff, M. L., Hauser, D., Pichardo, M., Szerencsy, A., & Calman, N. (2011). Use of an electronic patient portal among disadvantaged populations. Journal of General Internal Medicine, 26(10), 1117-1123. https://doi.org/10.1007/s11606-011-1749-y

Goel, M. S., Brown, T. L., Williams, A., Hasnain-Wynia, R., Thompson, J. A., & Baker, D. W. (2011). Disparities in enrollment and use of an electronic patient portal. Journal of General Internal Medicine, 26(10), 1112-1116. https://doi.org/10.1007/s11606-011-1728-3

Irizarry, T., DeVito Dabbs, A., & Curran, C. R. (2015). Patient portals and patient engagement: A state of the science review. Journal of Medical Internet Research, 17(6), Article e148. https://doi.org/10.2196/jmir.4255

Sittig, D. F., & Singh, H. (2010). A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Quality and Safety in Health Care, 19(Suppl. 3), i68-i74. https://doi.org/10.1136/qshc.2010.042085