Does Access to an EHR Patient Portal Influence Chronic Disease Outcomes?

The specific aims of the study are to determine if e-portal interventions influence:

- Measures of patient activation, patient self-management, treatment adherence, patient
satisfaction with care, and disease specific knowledge.

- Process measures relevant to appropriate care for CVD, CHF, and DM.

- Clinical markers of cardiovascular or diabetes morbidity and risk.

These aims will be evaluated in one-year prospective study. Patients who use the portal will
be randomized to control (i.e., access to routine portal-related information) and
intervention groups (i.e., targeted and periodic messages designed to capture data relevant
to self-management; to improve knowledge of their specific disease, tests, and risks; to
devise time-dependent goals; and to motivate self-efficacy). Outcomes including activation,
satisfaction, and adherence will be measured by telephone interview prior to and one year
after intervention, and by lab and clinical measures and data available from the EHR. We
will also evaluate potential selection issues among those who sign on to the e-portal by
administering the same baseline interview to a matched (by disease and by age) random
sample of patients who do not sign on to the e-portal.

Patients with chronic diseases are likely to experience particular benefit from online
e-health resources as they have greater information needs and participate in
self-management.(Camer, 2000) Unlike traditional office visits, online interactions
eliminate the need to travel, are always available and give the patient access to a broad
range of information, helping them actively participate in their own care.(Brown, 1999)
There is growing evidence that patient education and engagement using e-health applications
results in improved patient outcomes in the care of chronic illnesses, improved
patient-physician communication, and reduction of anxiety for caregivers.(Brennan et al.,
2001; Bronson et al., 1986; Bronson & O'Meara, 1986; Ross et al., 2003a, 2003b) We
anticipate demonstrating clinically meaningful improvements in chronic disease health
status, using evidence-based science delivered in behaviorally-validated ways.