Understanding cancer patients’ use and perceptions of inpatient portal: A case study at a tertiary hospital in Saudi Arabia

Abstract

Background

Inpatient portals have been introduced into tertiary hospitals to meet patients’ information and communication needs, to increase their awareness of health care, and to facilitate their transition after discharge. However, there is inadequate knowledge about hospitalised oncology patients’ use and perceptions of these technologies.

Objective

To explore cancer patients’ use and perceptions of an inpatient portal in a tertiary hospital and to identify the main benefits and barriers for patients in using the portal.

Method

A qualitative case study was conducted in a tertiary hospital in Riyadh, Saudi Arabia. Only cancer patients were invited to participate. Twenty-two semi-structured interviews were conducted in the patient’s room in a cancer care centre in January 2020. Interviews were audio-recorded, fully transcribed, and analysed using a thematic analysis method.

Results

Most patients used the portal for the first time. The most used features were entertainment, watching fall prevention videos and viewing medication lists. Although the majority of patients were positive towards the portal, and considered it to be useful and easy to use, only a small number of them used the key clinical feature of the system such as pain assessment, health education, and discharge preparation. The patients would like to see further improvement in usability of the portal, appropriate user training, adding further information, and incorporating more services and features in the portal.

Conclusion

The introduction of the inpatient portal is successful in improving cancer patients’ hospitalisation experience. It helped cancer patients to acquire knowledge about their own health, to actively engage in their care processes, and to request and acquire electronic services, in addition to providing entertainment. Future research on which factors inspire patients’ use of the portal and how the influence is achieved is needed for the successful integration of the portal into the patients’ hospital care process.

Introduction

The patient-centred hospital care model aims to involve patients in the care delivery process, to inform and empower them to ask questions and make critical decisions, and to gain ownership of their hospital care [1]. Digital health information technologies, including inpatient portals, provide promise for the implementation of this model in a cost-effective and convenient manner [2].

An inpatient portal is a secure, web-based application that can be linked to a patient’s electronic medical record (EMR), which is documented and managed by a health care institution [3]. It allows patients to access clinical information in real-time, to communicate directly with healthcare providers, and to perform self-management activities during hospitalisation [4]. The major functions include viewing, downloading, and sharing clinical data (including lab results, clinical summaries, and medication lists), browsing trustworthy educational resources, sending secure messages and preparing for discharge [2,3]. Other functions, such as preventive care services, specific administrative services, or entertainment services, can also be integrated into the portal or be offered as a stand-alone platform [5].

There has been growing evidence for the positive impact of an inpatient portal on patient adherence to medications [6], and on patient safety during hospitalisation [6,7]. Two studies found that the inpatient portals in hospitals brought many benefits for patient care such as addressing patients’ care needs, supporting daily health management and ultimately improving patient experience with hospitalisation [8,9]. However, a systematic review by Dendere et al. [6] reported that there were mixed findings about the impact of inpatient portals on improvement of patient engagement in their care. Other studies that evaluated patients, caregivers, and team care members perspectives about the enhancement of patient-provider communication after using the inpatient portal reported a mix of positive and negative perspectives [8,10,11]. The positive perspectives were mainly related to the improvement of patients’ health outcomes after using the portal [12]. While, the negative perspectives were mainly because of an increase on the providers’ workload [12]. Prior studies also found that some inpatients had concerns about privacy and security of their personal and clinical information in electronic format using the portal inside the hospital [6] and were anxious of their inability to understand medical results [6,8].

To date, there is little knowledge about the adoption of inpatient portals by hospitalised cancer patients. An earlier study explored the information and communication needs for an interactive patient portal proposed for an oncology setting in the Netherlands [13]. Thirty-five cancer survivors and 31 health professionals suggested that the most important clinical information needed by cancer patients was diagnosis, treatment, medication side-effects, and discharge information. They expected the portal to offer patients instant access to their own electronic medical record (EMR) and treatment care plan. They suggested that the portal should be linked with the hospital appointment system, providing online rehabilitation programs and tele-monitoring programs, and allowing patients to self-report their clinical outcomes.

A two-year retrospective study found that 51.2 % of 4594 hospitalised cancer patients successfully registered with the inpatient portal prior to their admission to the Mayo Clinic in the United States [14]. Most registered patients were young, female, married, with higher income and more frequent hospitalizations. Only 26.8 % of them continued to use the portal during their hospital stay. A literature review on the use of web-based portals by cancer patients found that the use of the portal in outpatient and intensive care settings was associated with patient characteristics including younger age, white race, and higher socioeconomic status [15]. Alpert et al. [16] found that the use of a portal in oncology primary care centres enabled cancer patients to improve preparation for their consultation, to better exchange their clinical information with other health providers, to take better control of their conditions, and to make them more acceptable and comfortable in communicating risk information.

Although there is growing interest to implement inpatient portals to improve the overall experience of cancer patients during hospitalisation, most studies were performed in academic medical centres in developed countries, e.g. the US and Canada, with limited generalizability of the findings to other hospitals with different demographics, culture, and medical practices [6,15]. There is a lack of information about their use and perceptions of inpatient portals in developing countries such as Saudi Arabia. Therefore, this study aimed to understand hospitalised cancer patients’ use and perceptions of an inpatient portal in a tertiary hospital in Saudi Arabia.

The research questions were: 1) Did the cancer patients use the inpatient portal during their hospitalisation? 2) Which functions did they use more, less, or not at all? 3) What were their perceptions about the inpatient portal? and 4) Were there differences in usage and perceptions between patients with different characteristics such as age, sex, or education level?