title: Design and implementation of a web-based patient portal linked to an ambulatory care electronic health record: patient gateway for diabetes collaborative care.
abstract: BACKGROUND
  Despite the availability of expert guidelines and widespread diabetes quality improvement efforts, care of patients with diabetes remains suboptimal. Two key barriers to care that may be amenable to informatics-based interventions include (1) lack of patient engagement with therapeutic care plans and (2) lack of medication adjustment by physicians ("clinical inertia") during clinical encounters.
  
  
  METHODS
  The authors describe the conceptual framework, design, implementation, and analysis plan for a diabetes patient web-portal linked directly to the electronic health record (EHR) of a large academic medical center via secure Internet access designed to overcome barriers to effective diabetes care.
  
  
  RESULTS
  Partners HealthCare System (Boston, MA), a multi-hospital health care network comprising several thousand physicians caring for over 1 million individual patients, has developed a comprehensive patient web-portal called Patient Gateway that allows patients to interact directly with their EHR via secure Internet access. Using this portal, a specific diabetes interface was designed to maximize patient engagement by importing the patient's current clinical data in an educational format, providing patient-tailored decision support, and enabling the patient to author a "Diabetes Care Plan." The physician view of the patient's Diabetes Care Plan was designed to be concise and to fit into typical EHR clinical workflow.
  
  
  CONCLUSIONS
  We successfully designed and implemented a Diabetes Patient portal that allows direct interaction with our system's EHR. We are assessing the impact of this advanced informatics tool for collaborative diabetes care in a clinic-randomized controlled trial among 14 primary care practices within our integrated health care system.
authors.affiliation: Division of General Medicine, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. Rgrant@partners.org
authors.forename: Richard W
authors.initials: RW
authors.lastname: Grant
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Wald
authors.forename: Eric G
authors.initials: EG
authors.lastname: Poon
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Schnipper
authors.forename: Tejal K
authors.initials: TK
authors.lastname: Gandhi
authors.forename: Lynn A
authors.initials: LA
authors.lastname: Volk
authors.forename: Blackford
authors.initials: B
authors.lastname: Middleton
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration*; D020000:Decision Support Systems, Clinical; D003920:Diabetes Mellitus / Q000628:therapy*; D006801:Humans; D020407:Internet; D016347:Medical Records Systems, Computerized; D010358:Patient Participation / Q000379:methods*; D015397:Program Evaluation