title: Awareness and Use of the After-Visit Summary Through a Patient Portal: Evaluation of Patient Characteristics and an Application of the Theory of Planned Behavior.
abstract: BACKGROUND
  Patient portals are being used to provide a clinical summary of the office visit or the after-visit summary (AVS) to patients. There has been relatively little research on the characteristics of patients who access the AVS through a patient portal and their beliefs about the AVS.
  
  
  OBJECTIVE
  The aim was to (1) assess the characteristics of patients who are aware of and access the AVS through a patient portal and (2) apply the Theory of Planned Behavior (TPB) to predict behavioral intention of patients toward accessing the AVS provided through a patient portal.
  
  
  METHODS
  We developed a survey capturing the components of TPB (beliefs, attitude, perceived norm, and perceived behavioral control). Over a 6-month period, patients with a patient portal account with an office visit in the previous week were identified using our organization's scheduling system. These patients were sent an email about the study and a link to the survey via their portal account. We applied univariate statistical analysis (Pearson chi-square and 1-way ANOVA) to assess differences among groups (aware/unaware of AVS and accessed/did not access AVS). We reported means and standard deviations to depict belief strengths and presented correlations between beliefs and attitude, perceived norm, and perceived behavioral control. We used hierarchical regression analysis to predict behavioral intention toward accessing the AVS through the patient portal.
  
  
  RESULTS
  Of the 23,336 patients who were sent the survey, 5370 responded for a response rate of 23.01%. Overall, 76.52% (4109/5370) were aware that the AVS was available through the patient portal and 54.71% of those (2248/4109) accessed the AVS within 5 days of the office visit. Patients who accessed the AVS had a greater number of sessions with the portal (mean 119, SD 221.5) than those who did not access the AVS (mean 79.1, SD 123.3, P<.001); the difference was not significant for awareness of the AVS. The strongest behavioral beliefs with accessing the AVS were being able to track visits and tests (mean 2.53, SD 1.00) followed by having medical information more readily accessible (mean 2.48, SD 1.07). In all, 56.7% of the variance in intention to access the AVS through the portal was accounted for by attitude, perceived norm, and perceived behavioral control.
  
  
  CONCLUSIONS
  Most users of a patient portal were aware that the AVS was accessible through the portal. Patients had stronger beliefs about accessing the AVS with the goal of timely and efficient access of information than with engaging in their health care. Interventions to improve patient access of the AVS can focus on providers promoting patient beliefs about the value of the AVS for tracking tests and visits, and timely and efficient access of information.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States. semani1@partners.org.
authors.forename: Srinivas
authors.identifier: http://orcid.org/0000-0002-6217-5792
authors.initials: S
authors.lastname: Emani
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0002-4714-0436
authors.initials: M
authors.lastname: Healey
authors.forename: David Y
authors.identifier: http://orcid.org/0000-0001-5291-8161
authors.initials: DY
authors.lastname: Ting
authors.forename: Stuart R
authors.identifier: http://orcid.org/0000-0003-2619-1389
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Harley
authors.identifier: http://orcid.org/0000-0002-5719-6679
authors.initials: H
authors.lastname: Ramelson
authors.forename: Vladimir
authors.identifier: http://orcid.org/0000-0002-9309-6907
authors.initials: V
authors.lastname: Suric
authors.forename: David W
authors.identifier: http://orcid.org/0000-0003-4850-2360
authors.initials: DW
authors.lastname: Bates
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001292:Attitude to Computers; D057286:Electronic Health Records / Q000706:statistics & numerical data; D034742:Electronic Mail; D005260:Female; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D009819:Office Visits; D012044:Regression Analysis; D011795:Surveys and Questionnaires
keywords: after-visit summary (AVS); beliefs; electronic health records (EHRs); meaningful use; patient portal