title: Improving health care proxy documentation using a web-based interview through a patient portal.
abstract: Health care proxy (HCP) documentation is suboptimal. To improve rates of proxy selection and documentation, we sought to develop and evaluate a web-based interview to guide patients in their selection, and to capture their choices in their electronic health record (EHR).
  
  
  
  We developed and implemented a HCP interview within the patient portal of a large academic health system. We analyzed the experience, together with demographic and clinical factors, of the first 200 patients who used the portal to complete the interview. We invited users to comment about their experience and analyzed their comments using established qualitative methods.
  
  
  
  From January 20, 2015 to March 13, 2015, 139 of the 200 patients who completed the interview submitted their HCP information for their clinician to review in the EHR. These patients had a median age of 57 years (Inter Quartile Range (IQR) 45-67) and most were healthy. The 99 patients who did not previously have HCP information in their EHR were more likely to complete and then submit their information than the 101 patients who previously had a proxy in their health record (odds ratio 2.4, P = .005). Qualitative analysis identified several ways in which the portal-based interview reminded, encouraged, and facilitated patients to complete their HCP.
  
  
  
  Patients found our online interview convenient and helpful in facilitating selection and documentation of an HCP. Our study demonstrates that a web-based interview to collect and share a patient's HCP information is both feasible and useful.
authors.affiliation: Division of Clinical Informatics, Beth Israel Deaconess Medical Center, 1330 Beacon St., Suite 400, Brookline, MA 02446, USA adarsha@bidmc.harvard.edu.
authors.forename: Adarsha S
authors.initials: AS
authors.lastname: Bajracharya
authors.affiliation: Division of Clinical Informatics, Beth Israel Deaconess Medical Center, 1330 Beacon St., Suite 400, Brookline, MA 02446, USA.
authors.forename: Bradley H
authors.initials: BH
authors.lastname: Crotty
authors.affiliation: Division of Clinical Informatics, Beth Israel Deaconess Medical Center, 1330 Beacon St., Suite 400, Brookline, MA 02446, USA.
authors.forename: Hollis B
authors.initials: HB
authors.lastname: Kowaloff
authors.affiliation: Division of Clinical Informatics, Beth Israel Deaconess Medical Center, 1330 Beacon St., Suite 400, Brookline, MA 02446, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Safran
authors.affiliation: Division of Clinical Informatics, Beth Israel Deaconess Medical Center, 1330 Beacon St., Suite 400, Brookline, MA 02446, USA.
authors.forename: Warner V
authors.initials: WV
authors.lastname: Slack
mesh_terms: D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D004282:Documentation; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D020407:Internet; D007407:Interviews as Topic / Q000379:methods*; D008297:Male; D008875:Middle Aged; D000072638:Patient Portals; D019727:Proxy; D055815:Young Adult