title: Implementation of the Integrated Electronic Patient Portal in the Pediatric Population: A Systematic Review.
abstract: BACKGROUND
  This study assessed the current state of knowledge regarding the use of the integrated electronic health record (EHR) patient portal for pediatric clinical care. A systematic examination of the research on implementation, utilization, and evaluation of the integrated EHR patient portal among pediatric patients has not been previously conducted. Therefore, the purpose of the present study was to systematically review existing research on the state of the science, describe the way others have defined the patient portal, and examine pediatric patient portal utilization.
  
  
  METHODS
  Covering a period from 1992 to 2014 a literature search was conducted on four electronic databases. Only articles in English were reviewed. Studies were included if they reported the use of a patient portal integrated with an electronic health record and captured pediatric medial encounters. Qualitative or quantitative studies of any design were eligible as long as they focused on patients (or parents) who access their health records through an electronic portal tied to an EHR and reported measures of satisfaction, attitudes on use, barriers and facilitators, adherence, or clinical and health outcomes. Content analysis of each article was performed independently by at least two authors using an extraction grid of study qualities, and quality and relevance of the studies were also assessed.
  
  
  RESULTS
  Of a total of 189 potentially relevant publications identified, 31 full-text publications were obtained after screening titles and abstracts. After a full review, 11 publications corresponding to seven studies met the inclusion criteria. The methodological approaches included cross-sectional surveys, retrospective analysis, qualitative studies, and usability testing. In general, feedback was positive. The most frequent negative comments about the portal reflected concern about teenager interaction with the portal and how that might affect communication among patient, parent, and provider. Some users were frustrated with the complexity of medical terminology used.
  
  
  CONCLUSIONS
  Reflecting the additional considerations of pediatric proxy access and fewer chronically ill patients, pediatric medicine has yet to use the patient portal as a modality for outcomes measurement. Given the paucity of studies within this age group, it is difficult to measure outcome improvements or the effect of patient record access on healthcare behaviors. This systematic review presents innovative research on the general acceptance of the patient portal among parents and highlights that the implementation of the portal is still in its early stages and has yet to be used widely in diverse populations or studies in a longitudinal manner. Further studies should confirm that protected access to health information and secure communication and information sharing with healthcare providers have an impact in the pediatric population on healthcare outcomes.
authors.affiliation: 1 Hahn School of Nursing and Health Science, University of San Diego , San Diego, California.|2 Rady Children's Hospital San Diego , San Diego, California.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Bush
authors.affiliation: 1 Hahn School of Nursing and Health Science, University of San Diego , San Diego, California.|2 Rady Children's Hospital San Diego , San Diego, California.
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Connelly
authors.affiliation: 1 Hahn School of Nursing and Health Science, University of San Diego , San Diego, California.
authors.forename: Martha
authors.initials: M
authors.lastname: Fuller
authors.affiliation: 1 Hahn School of Nursing and Health Science, University of San Diego , San Diego, California.
authors.forename: Alexa
authors.initials: A
authors.lastname: Pérez
keywords: adolescent; electronic health record; electronic medical record; electronic patient portal; pediatrics