The federal government has allocated $27 billion to fund a staged program to foster the meaningful use of electronic health records. Stage 3 of the meaningful use program (MU3) prioritizes that families have the ability to submit patient-generated health information to improve health care performance on priority conditions and improve engagement in care. Patient portals, online healthcare applications that allow patients to interact and communicate with their healthcare providers, offer an ideal tool to achieve these goals, but the feasibility of using portals to achieve this goal and the impact of use on clinical care across diverse pediatric practice settings has not been established. Focusing on asthma, an AHRQ priority condition, in three AHRQ priority populations, children, low income, and special health care needs, this protocol will directly address these critical knowledge gaps in order to inform MU3 policy and practice implementation. Drawing from implementation science, this study evaluates the determinants of implementation success, implementation outcomes, and health care outcomes resulting from implementing an asthma portal in a national, AHRQ-funded, Center for Pediatric Practice-Based Research and Learning. Technically, the portal will be implemented with 2 innovative approaches that facilitate rapid cycle evaluation in multiple electronic health record systems. Although many patient portals are simple vehicles for transferring information about upcoming appointments, test results or laboratory findings, the asthma portal in this project, already developed and tested through a rigorous user-centered design process, extends this basic functionality to provide asthma education, collect patient-reported outcomes, evaluate medication use and side effects, and track parents' preferences and goals. Policy relevance of this research will be assured through the collaboration of The Children's Hospital of Philadelphia's PolicyLab, which has particular expertise in synthesizing research findings to inform policy, and the AAP's Child Health Informatics Center, which already is actively engaged with the Office of the National Coordinator for Health Information Technology in establishing guidelines for MU in pediatrics and will employ the full dissemination capabilities of the AAP to ensure that findings reach all appropriate stakeholders. Both groups have informed the proposal's 3 specific aims that utilize mixed methods: (1) To study the feasibility for pediatric primary care practices of using an EHR-linked portal to provide education and enable families to communicate treatment concerns and goals and report symptom control, medication use and side effects for children with asthma;(2) For a subset of children with poorly controlled asthma or medication side effects, to assess the impact on asthma management resulting from gathering data from families through the portal and sharing them with the primary care clinical team;and, (3) To describe barriers and solutions to improve the adoption, sustainability, and impact on clinical care of implementing portals across practice settings.
The federal government has allocated $27 billion to fund a staged program to foster the meaningful use of electronic health records. Stage 3 of the meaningful use program prioritizes that families have the ability to submit patient-generated health information to improve health care performance on priority conditions and improve engagement in care, yet data are lacking on how best to achieve these goals in pediatric primary care settings. To inform stage 3 meaningful use policy and implementation, this proposal is designed to determine the feasibility and impact on pediatric asthma care of implementing in a national sample of practices a patient portal designed to provide education, collect patient-reported outcomes, and enable parents to report their treatment preferences and goals.