title: A multidisciplinary approach to designing and evaluating Electronic Medical Record portal messages that support patient self-care.
abstract: We describe a project intended to improve the use of Electronic Medical Record (EMR) patient portal information by older adults with diverse numeracy and literacy abilities, so that portals can better support patient-centered care. Patient portals are intended to bridge patients and providers by ensuring patients have continuous access to their health information and services. However, they are underutilized, especially by older adults with low health literacy, because they often function more as information repositories than as tools to engage patients. We outline an interdisciplinary approach to designing and evaluating portal-based messages that convey clinical test results so as to support patient-centered care. We first describe a theory-based framework for designing effective messages for patients. This involves analyzing shortcomings of the standard portal message format (presenting numerical test results with little context to guide comprehension) and developing verbally, graphically, video- and computer agent-based formats that enhance context. The framework encompasses theories from cognitive and behavioral science (health literacy, fuzzy trace memory, behavior change) as well as computational/engineering approaches (e.g., image and speech processing models). We then describe an approach to evaluating whether the formats improve comprehension of and responses to the messages about test results, focusing on our methods. The approach combines quantitative (e.g., response accuracy, Likert scale responses) and qualitative (interview) measures, as well as experimental and individual difference methods in order to investigate which formats are more effective, and whether some formats benefit some types of patients more than others. We also report the results of two pilot studies conducted as part of developing the message formats.
authors.affiliation: University of Illinois at Urbana-Champaign, Department of Educational Psychology, Champaign, IL, United States. Electronic address: dgm@illinois.edu.
authors.forename: Daniel
authors.initials: D
authors.lastname: Morrow
authors.affiliation: University of Illinois at Urbana-Champaign, Department of Electrical and Computer Engineering, Urbana, IL, United States.
authors.forename: Mark
authors.initials: M
authors.lastname: Hasegawa-Johnson
authors.affiliation: University of Illinois at Urbana-Champaign, Department of Electrical and Computer Engineering, Urbana, IL, United States.
authors.forename: Thomas
authors.initials: T
authors.lastname: Huang
authors.affiliation: Carle Foundation Hospital, Urbana, IL, United States.
authors.forename: William
authors.initials: W
authors.lastname: Schuh
authors.affiliation: University of Illinois at Urbana-Champaign, Department of Educational Psychology, Champaign, IL, United States.
authors.forename: Renato Ferreira Leitão
authors.initials: RFL
authors.lastname: Azevedo
authors.affiliation: University of Illinois at Urbana-Champaign, Department of Electrical and Computer Engineering, Urbana, IL, United States.
authors.forename: Kuangxiao
authors.initials: K
authors.lastname: Gu
authors.affiliation: University of Illinois at Urbana-Champaign, Department of Electrical and Computer Engineering, Urbana, IL, United States.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: University of Illinois at Urbana-Champaign, Department of Educational Psychology, Champaign, IL, United States.
authors.forename: Bidisha
authors.initials: B
authors.lastname: Roy
authors.affiliation: University of Granada, Department of Experimental Psychology, Granada, Spain.
authors.forename: Rocio
authors.initials: R
authors.lastname: Garcia-Retamero
mesh_terms: D000368:Aged; D057286:Electronic Health Records; D057220:Health Literacy; D006801:Humans; D033183:Interdisciplinary Communication; D008875:Middle Aged; D005791:Patient Care; D000072638:Patient Portals; D018802:Patient-Centered Care; D012648:Self Care
keywords: Aging; Cognition; Computer agent; Electronic Medical Record; Learning; Patient portal