title: The wired patient: patterns of electronic patient portal use among patients with cardiac disease or diabetes.
abstract: BACKGROUND
  As providers develop an electronic health record-based infrastructure, patients are increasingly using Web portals to access their health information and participate electronically in the health care process. Little is known about how such portals are actually used.
  
  
  OBJECTIVE
  In this paper, our goal was to describe the types and patterns of portal users in an integrated delivery system.
  
  
  METHODS
  We analyzed 12 months of data from Web server log files on 2282 patients using a Web-based portal to their electronic health record (EHR). We obtained data for patients with cardiovascular disease and/or diabetes who had a Geisinger Clinic primary care provider and were registered "MyGeisinger" Web portal users. Hierarchical cluster analysis was applied to longitudinal data to profile users based on their frequency, intensity, and consistency of use. User types were characterized by basic demographic data from the EHR.
  
  
  RESULTS
  We identified eight distinct portal user groups. The two largest groups (41.98%, 948/2258 and 24.84%, 561/2258) logged into the portal infrequently but had markedly different levels of engagement with their medical record. Other distinct groups were characterized by tracking biometric measures (10.54%, 238/2258), sending electronic messages to their provider (9.25%, 209/2258), preparing for an office visit (5.98%, 135/2258), and tracking laboratory results (4.16%, 94/2258).
  
  
  CONCLUSIONS
  There are naturally occurring groups of EHR Web portal users within a population of adult primary care patients with chronic conditions. More than half of the patient cohort exhibited distinct patterns of portal use linked to key features. These patterns of portal access and interaction provide insight into opportunities for electronic patient engagement strategies.
authors.affiliation: Research, Development and Dissemination, Sutter Health, Walnut Creek, CA, United States. jonesjb@sutterhealth.org.
authors.forename: James Brian
authors.identifier: http://orcid.org/0000-0001-8752-877X
authors.initials: JB
authors.lastname: Jones
authors.forename: Jonathan P
authors.identifier: http://orcid.org/0000-0002-8299-3995
authors.initials: JP
authors.lastname: Weiner
authors.forename: Nirav R
authors.identifier: http://orcid.org/0000-0003-2044-7865
authors.initials: NR
authors.lastname: Shah
authors.forename: Walter F
authors.identifier: http://orcid.org/0000-0001-9297-7422
authors.initials: WF
authors.lastname: Stewart
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D055991:Health Records, Personal; D006331:Heart Diseases / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data; D017216:Telemedicine / Q000379:methods / Q000706:statistics & numerical data*
keywords: eHealth; electronic health record; electronic patient portal; patient Web portal; personal health record