Evaluation of an electronic patient portal for chronically ill patients in a rural integrated delivery system

Background and Objective. Ehealth technologies such as electronic patient portals and web-based self-management tools may be beneficial for patients with chronic disease, the majority of care for which is managed on a day-to-day basis by patients. The first objective of this dissertation is to describe who uses an ehealth application, how it is used, and to develop a typology of ehealth users. This dissertation also evaluates whether a "prescribing model", in which the physician plays a role in recommending the ehealth tool to the patient, is effective in engaging patients in the use of ehealth applications.;Methods. Twelve months of portal usage data were analyzed to create a comprehensive description of participants' portal use. Cluster analysis was used to develop a typology of portal users based on their usage characteristics. To determine the effectiveness of a prescribing model, a series of mail/email communications were sent to patients from their primary care physician and an alert was triggered in the electronic record during office visits. The alert reminded physicians to "prescribe" a web-based self-management tool to patients.;Results. Eight distinct clusters of users were identified and a preliminary typology summarizing these clusters is described. The eight types of users identified by the typology were termed: eDabblers, old friends, electronic messengers, appointment preparers, lab trackers, biometric monitors, proxy moms, and record updaters. Enrollment increased more than three-fold (hazard ratio: 3.7) among patients whose physician discussed the self-management tool with the patient after receiving the alert.;Conclusion. When combined with both self-reported and medical record data, server log files promise to provide a rich understanding of the relationship between patterns of ehealth use and patient outcomes. Use of a prescribing model is effective in increasing adoption. However, it is difficult to engage physicians in the use of electronic alerts that may perturb their workflow. Further research is needed to determine how to increase physician awareness of ehealth intervention options so that, when appropriate, these interventions can be prescribed to patients who are likely to benefit from their use.