OBJECTIVES:

Evaluate provider experiences with a bedside tablet inpatient portal application given to hospitalized patients and families across a children’s hospital.

METHODS:

In this cross-sectional study, English-speaking parents of children <12 years old and adolescents ≥12 years admitted between February and June 2017 to a 111-bed tertiary children’s hospital were given an inpatient portal application (MyChart Bedside; Epic Systems Corporation, Verona, WI) on a tablet (iPad) to use during their stay. The portal included real-time vital signs, test results, medication and problem lists, a daily schedule, educational materials, and provider names and photographs. Portal use was described from electronic health record data, and provider (physician, nurse, and pharmacist) experiences were assessed from surveys.

RESULTS:

Of 1892 admissions given a tablet over 5 months, 1502 (79.4%) logged in to view their inpatient health record at least once during their hospital stay. No tablets were lost or stolen. Of 101 providers, 96 completed the survey (a response rate of 95%). They reported that patients and/or parents asked them questions about information they found, including laboratory results (45% of respondents), medications (13%), diagnoses (13%), and errors and/or mistakes in care (3%). Few perceived spending more time answering questions related to portal use (8%) or that it increased their workload (11%). In all, 92% of providers wanted patients and parents to continue to be able to use the portal.

CONCLUSIONS:

Almost 80% of hospitalized patients and parents given a tablet accessed real-time information from the inpatient health record. The portal facilitated communication about test results, diagnoses, and medications and providers overwhelmingly supported its ongoing use.

Inpatient portals are bedside tablet applications that provide hospitalized patients and their families with real-time access to clinical information from their inpatient electronic health record (EHR).1  By increasing information transparency, these portals are intended to improve patient and family engagement in care during hospitalization. Findings from small, pilot studies suggest that families of hospitalized children are enthusiastic and willing to use these portals.24  In one study, parents of children admitted to a general medical and surgical unit described that access to this clinical information improved their ability to monitor their child’s progress, identify inaccuracies, and communicate and make decisions about their child’s care with inpatient providers.5  Almost all parents (94%) felt that the information in the portal reduced or did not change the number of questions they had for their child’s doctors and nurses.

Although these portals may have provided benefits for patients and families in this single-unit study, inpatient providers express concerns that their broader adoption could lead to a dramatic increase in time spent answering questions and increase their already demanding workload.6  The implications of expanded portal use on the work of pediatric inpatient providers after hospital-wide implementation are unknown.

The objective of this study was to evaluate provider experiences with an inpatient portal offered to hospitalized patients and/or parents on bedside tablet computers after its use across an entire children’s hospital. These findings will inform the feasibility of using an inpatient portal as a tool to augment the care of hospitalized children across our health care organization and others.

In this cross-sectional study, English-speaking adolescent patients ≥12 years and parents of children <12 years old admitted between February and June 2017 to any unit of a 111-bed tertiary children’s hospital were offered an inpatient portal application (MyChart Bedside) on a hospital-provisioned bedside tablet computer (iPad; Apple, Cupertino, CA) to use throughout their hospitalization. Patient and parent use of the inpatient portal was assessed by using tablet EHR login data. Inpatient pediatric faculty physicians, bedside nurses, and pharmacists were surveyed on their experience with the inpatient portal after its implementation. This study was deemed exempt from full review by the University of Wisconsin-Madison Institutional Review Board.

The MyChart Bedside (Epic Systems Corporation, Verona, WI; Fig 1) portal provided patients and parents with real-time access to information directly from the inpatient EHR, including a list of hospital diagnoses and medications (name, dose, route, frequency, and side effects), vital signs, test results, a daily schedule (times for medication administration, physical and occupational therapy appointments, blood draws, radiographs, and procedures), and names, role descriptions, and photographs of hospital providers.

FIGURE 1

Inpatient portal home screen and descriptions of portal features adapted from Kelly et al.4  NaCl, sodium chloride; UW, University of Wisconsin-Madison. (Reprinted with permission from Kelly MM, Hoonakker PLT, Dean SM. Using an inpatient portal to engage families in pediatric hospital care. J Am Med Inform Assoc. 2017;24:154.)

FIGURE 1

Inpatient portal home screen and descriptions of portal features adapted from Kelly et al.4  NaCl, sodium chloride; UW, University of Wisconsin-Madison. (Reprinted with permission from Kelly MM, Hoonakker PLT, Dean SM. Using an inpatient portal to engage families in pediatric hospital care. J Am Med Inform Assoc. 2017;24:154.)

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Inpatient portal access metrics were obtained from EHR tablet metadata. In June 2017, a paper survey was administered to all physicians, nurses, and pharmacists present at each unit’s monthly staff council meetings, which included representatives from each of the general medical and surgical, neonatal, intensive, and intermediate care units.

Survey items from the literature were used to assess the provider’s role and experiences with the portal.6,7  Five-point Likert response items were used to assess provider satisfaction with the portal and their perceptions of the impact of its use on their workload. Items assessing provider communication with parents about information found in the portal were also included in the survey:6  (1) “Did parents ask you questions or express concerns about laboratory results, medications and/or diagnoses they found on the portal? If yes, please explain,”(2) “Did parents notify you of errors or mistakes in care they found using [the portal]? If yes, please explain,” and (3) “Did you spend more time responding to parent questions, concerns, or requests?” Finally, providers were asked whether they would like patients and/or parents to continue to be able to use the portal. The complete survey can be found at: www.hipxchange.org/InpatientPortal.8  EHR and survey data were imported into Microsoft Excel. Data were summarized by using descriptive statistics and illustrative quotes.

Of the 2361 patients admitted over 5 months, 1892 received a bedside tablet. Of these, 1502 (79.4%) logged on to the inpatient portal application at least once to view clinical information from their child’s health record during their hospitalization. Reasons for not issuing a tablet documented by staff included the following: patient or parent declined (n = 66), sensitive diagnosis (eg, nonaccidental trauma; n = 30), language barrier (n = 27), or other (n = 19); 327 had no reason documented. No tablets were damaged, lost, or stolen.

Of 101 eligible inpatient providers, 96 completed the survey (a response rate of 95%), including 47 physicians (49%), 41 nurses (43%), and 8 pharmacists (8%). Of these, 38 identified as working on multiple units, whereas 20 had a primary role on a general medical and/or surgical unit, 18 in the pediatric intensive care, 11 in the neonatal intensive care, and 9 in the intermediate care unit. In all, 55% of providers agreed or strongly agreed that they were satisfied with the portal, and 41% neither agreed nor disagreed. Few providers indicated that portal use by patients and families increased their workload (11%) or that they were not satisfied with it (4%).

Providers reported that patients and/or families asked them questions about information they found in the portal (Table 1). Few providers perceived spending more time answering questions related to inpatient portal use (8%). In all, 92% of providers wanted hospitalized patients and families to continue to have access to the portal during their hospital stay.

TABLE 1

Types of Questions Patients and Families Asked Providers Based on Information They Found in the Portal

Type of Questionn (%)Illustrative Quote
Test results 47 (45) “[Parent] noticed lab was abnormal, facilitated discussion.” 
Medications 12 (13) “[Medication] timing was clarified - very helpful.” 
Diagnosis 12 (13) “One parent saw something in their problem list that they were unsure of and asked for clarification.” 
Errors or mistakes in care 2 (3) “[Parent identified] wrong dosing. Pharmacy intervened, changed dosing.” 
Type of Questionn (%)Illustrative Quote
Test results 47 (45) “[Parent] noticed lab was abnormal, facilitated discussion.” 
Medications 12 (13) “[Medication] timing was clarified - very helpful.” 
Diagnosis 12 (13) “One parent saw something in their problem list that they were unsure of and asked for clarification.” 
Errors or mistakes in care 2 (3) “[Parent identified] wrong dosing. Pharmacy intervened, changed dosing.” 

Almost 80% of families of hospitalized children given a bedside tablet accessed information from their child’s inpatient health record during their inpatient stay. Increased information transparency through inpatient portal use prompted communication about test results, diagnoses, medications, and potential patient safety issues. Few providers had concerns that the inpatient portal increased their workload, and >90% supported ongoing use after it was implemented with >1500 families.

These findings expand results of our pilot study6  and support the feasibility of hospital-wide inpatient portal use. Compared with providers in our pilot study, an even higher proportion in this study were satisfied with the portal, and fewer reported that portal use increased their workload. Although >40% in this study were neutral about their satisfaction with the portal, all but 1 of these providers supported ongoing portal use. Although our findings could reflect the opinions of a more engaged group of providers in comparison to our pilot study, they could also be attributed to improvements in the integration of the technology into hospital-wide workflows, organizational culture of transparency, and/or acceptance of the technology over time.

The acute hospital setting may provide a unique opportunity to invite patients and families to access their health information. A much higher proportion of hospitalized patients and families in this study accessed their health record than those in the ambulatory setting. In 2017, an estimated 52% of US individuals were offered online access to their health record, and only about one-half viewed it in the previous year, which represents 28% of individuals nationwide.9  Patients and/or their families may be a captive audience during their hospital stay and more likely to access health records because of illness acuity and/or availability of tablet computers and continuous Internet access while admitted. The full extent of bedside portal use by parents and adolescents and whether use translates to more engaged outpatients are unknown and areas for future research. Although our organization chose not to share provider notes during its initial implementation of the portal, it is also an important next step for investigation.

The single-center nature of this observational study may limit the generalizability of findings. Given that 20% of patients and their families were not provisioned a tablet (including 327 without a documented reason) and an additional 16% did not use the portal, it is also possible that selection bias could have influenced provider experiences. For example, providers may have received more questions about portal use if the population not receiving the tablet had lower digital health literacy.

Future studies using experimental designs are needed to evaluate the influence of inpatient portal use on pediatric health outcomes. There is mixed evidence on the beneficial effects of use on clinical outcomes in hospitalized adults.1013  Despite these knowledge gaps, health care organizations are rapidly adopting this technology, with >140 already using or planning to implement the commercially available portal described in this study (Epic Systems Corporation, personal communication, 2019). In future research efforts, researchers should also consider evaluating the patterns of inpatient portal use and influence of use on measures of health care use (eg, length of stay and readmissions), provider workload (eg, time spent documenting in the EHR and face-to-face with patients at the bedside), and patient safety (eg, diagnostic errors, medication reconciliation, and adverse drug events). Research and policy efforts should be focused on the development of optimal content and implementation strategies to most effectively engage not only the families of young children but hospitalized adolescents and underserved populations, such as those with limited-English proficiency and lower health literacy. Ensuring the necessary security specifications are in place to protect patient confidentiality and privacy is also critical.14,15 

Our experience reveals that inpatient portal use across a children’s hospital is feasible, with high rates of uptake by patients and families and support for ongoing use by providers. Portals may be used as innovative tools to support patients and families during critical times of acute hospitalization and partner with them to improve hospital-based care.

Dr Kelly conceptualized and designed the study, coordinated data collection and analysis, and drafted the initial manuscript; Drs Coller and Dean assisted with study design and interpretation of findings and made critical revisions; Dr Hoonakker assisted with the design of data collection instruments, conducted the initial data analysis, and made critical revisions; Ms Nacht assisted with interpretation of study findings and made critical revisions; and all authors approved the final manuscript as submitted.

FUNDING: Partially supported by the National Institutes of Health Clinical and Translational Science Award at University of Wisconsin-Madison (grant 1UL1TR002373) and the University of Wisconsin School of Medicine and Public Health’s Wisconsin Partnership Program and Institute for Clinical and Translational Research (grant 3086). The funders had no role in decisions regarding the study design, data collection, analysis, or interpretation of findings. Funded by the National Institutes of Health (NIH).

1
Kelly
MM
,
Coller
RJ
,
Hoonakker
PLT
.
Inpatient portals for hospitalized patients and caregivers: a systematic review
.
J Hosp Med
.
2018
;
13
(
6
):
405
412
2
Runaas
L
,
Hanauer
D
,
Maher
M
, et al
.
BMT roadmap: a user-centered design health information technology tool to promote patient-centered care in pediatric hematopoietic cell transplantation
.
Biol Blood Marrow Transplant
.
2017
;
23
(
5
):
813
819
3
Weyand
SA
,
Frize
M
,
Bariciak
E
,
Dunn
S
.
Development and usability testing of a parent decision support tool for the neonatal intensive care unit
.
Conf Proc IEEE Eng Med Biol Soc
.
2011
;
2011
:
6430
6433
4
Kelly
MM
,
Hoonakker
PLT
,
Dean
SM
.
Using an inpatient portal to engage families in pediatric hospital care
.
J Am Med Inform Assoc
.
2017
;
24
(
1
):
153
161
5
Kelly
MM
,
Thurber
AS
,
Coller
RJ
, et al
.
Parent perceptions of real-time access to their hospitalized child’s medical records using an inpatient portal: a qualitative study
.
Hosp Pediatr
.
2019
;
9
(
4
):
273
280
6
Kelly
MM
,
Dean
SM
,
Carayon
P
,
Wetterneck
TB
,
Hoonakker
PLT
.
Healthcare team perceptions of a portal for parents of hospitalized children before and after implementation
.
Appl Clin Inform
.
2017
;
8
(
1
):
265
278
7
Hoonakker
PLT
,
Cartmill
RS
,
Carayon
P
,
Walker
JM
.
Development and psychometric qualities of the SEIPS survey to evaluate CPOE/EHR implementation in ICUs
.
Int J Healthc Inf Syst Inform
.
2011
;
6
(
1
):
51
69
8
Kelly
MM
,
Hoonakker
PLT
,
Dean
SM
.
Partnering with Parents of Hospitalized Children Using an Inpatient Portal
.
Madison, WI
:
University of Wisconsin School of Medicine and Public Health Department of Pediatrics and Center for Quality and Productivity Improvement
;
2017
. Available at: https://www.hipxchange.org/InpatientPortal. Accessed September 26, 2020
9
Patel
V
,
Johnson
C
.
Individual’s Use of Online Medical Records and Technology for Health Needs
.
Washington, DC
:
The Office of the National Coordinator for Health Information Technology
;
2018
10
O’Leary
KJ
,
Lohman
ME
,
Culver
E
,
Killarney
A
,
Randy Smith
G
 Jr
,
Liebovitz
DM
.
The effect of tablet computers with a mobile patient portal application on hospitalized patients’ knowledge and activation
.
J Am Med Inform Assoc
.
2016
;
23
(
1
):
159
165
11
Masterson Creber
RM
,
Grossman
LV
,
Ryan
B
, et al
.
Engaging hospitalized patients with personalized health information: a randomized trial of an inpatient portal
.
J Am Med Inform Assoc
.
2019
;
26
(
2
):
115
123
12
McAlearney
AS
,
Fareed
N
,
Gaughan
A
,
MacEwan
SR
,
Volney
J
,
Sieck
CJ
.
Empowering patients during hospitalization: perspectives on inpatient portal use
.
Appl Clin Inform
.
2019
;
10
(
1
):
103
112
13
Pell
JM
,
Mancuso
M
,
Limon
S
,
Oman
K
,
Lin
C-T
.
Patient access to electronic health records during hospitalization
.
JAMA Intern Med
.
2015
;
175
(
5
):
856
858
14
Bourgeois
FC
,
Nigrin
DJ
,
Harper
MB
.
Preserving patient privacy and confidentiality in the era of personal health records
.
Pediatrics
.
2015
;
135
(
5
).
15
Collins
S
,
Dykes
P
,
Bates
DW
, et al
.
An informatics research agenda to support patient and family empowerment and engagement in care and recovery during and after hospitalization
.
J Am Med Inform Assoc
.
2018
;
25
(
2
):
206
209

Competing Interests

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.