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In the United States, sensitive health information is protected under the Health Insurance Portability and Accountability Act (HIPAA). This act limits the disclosure of Protected Health Information (PHI) without the patient’s consent or knowledge. However, as medical care becomes web-integrated, many providers have chosen to use third-party web trackers for measurement and marketing purposes. This presents a security concern: third-party JavaScript requested by an online healthcare system can read the website’s contents, and ensuring PHI is not unintentionally or maliciously leaked becomes difficult. In this paper, we investigate health information breaches in online medical records, focusing on 459 online patient portals and 4 telehealth websites. We find 14% of patient portals include Google Analytics, which reveals (at a minimum) the fact that the user visited the health provider website, while 5 portals and 4 telehealth websites con- tained JavaScript-based services disclosing PHI, including medications and lab results, to third parties. The most significant PHI breaches were on behalf of Google and Facebook trackers. In the latter case, an estimated 4.5 million site visitors per month were potentially exposed to leaks of personal information (names, phone numbers) and medical information (test results, medications). We notified healthcare providers of the PHI breaches and found only 15.7% took action to correct leaks. Healthcare operators lacked the technical expertise to identify PHI breaches caused by third-party trackers. After notifying Epic, a healthcare portal vendor, of the PHI leaks, we received a prompt response and observed extensive mitigation across providers, suggesting vendor notification is an effective intervention against PHI disclosures.
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Patient-provider Engagement and its Impact on Health Outcomes: A longitudinal study of patient portal use
Hospitalization of patients with chronic diseases poses a significant burden on the healthcare system. Frequent hospitalization can be partially attributed to the failure of healthcare providers to engage effectively with their patients. Recently, patient portals have become popular as information technology (IT) platforms that provide patients with online access to their medical records and help them engage effectively with healthcare providers. Despite the popularity of these portals, there is a paucity of research on the impact of patient–provider engagement on patients’ health outcomes. Drawing on the theory of effective use, we examine the association between portal use and the incidence of subsequent patient hospitalizations, based on a unique, longitudinal dataset of patients’ portal use, across a 12-year period at a large academic medical center in North Texas. Our results indicate that portal use is associated with improvements in patient health outcomes along multiple dimensions, including the frequency of hospital and emergency visits, readmission risk, and length of stay. This is one of the first studies to conduct a large-scale, longitudinal analysis of a health IT system and its effect on individual level health outcomes. Our results highlight the need for technologies that can improve patient–provider engagement and improve overall health outcomes for chronic disease management.
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- Award ID(s):
- 1636933
- PAR ID:
- 10202429
- Date Published:
- Journal Name:
- MIS quarterly
- Volume:
- 44
- Issue:
- 2
- ISSN:
- 2162-9730
- Page Range / eLocation ID:
- 699-723
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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Laurencin, Cato (Ed.)Abstract Effective communication is critical for equitable healthcare delivery. In situations where there is language discordance between patients and providers, with one person speaking a shared language more proficiently, communication challenges may exacerbate disparities, particularly for racially or ethnically minoritized patients. Even when patients and providers are both fluent enough in English to not need interpretation, communication challenges intensify when patients are required to use their second language (L2) to interact with a native English (L1) speaking healthcare provider. Communication accommodation encompasses speech adjustments used to mitigate these barriers. Because communication accommodation strategies are not explicitly taught in healthcare training, it is unknown how healthcare providers adjust and the role a patient’s English proficiency plays in guiding provider language choices. This experimental study tested how L1 physician assistant students modify their communication during intake interviews with Latine L2 avatar patients of varying English proficiency, using the mixed-reality simulation platform Mursion. Data from 41 physician assistant students in 2023–2024 were analyzed for acoustic (i.e., speech rate, pitch modulation) and lexical adjustments (i.e., word frequency, contextual diversity). Results revealed significant accommodations: students reduced their speech rate, narrowed their pitch range, and used higher-frequency vocabulary when interacting with lower-proficiency L2 avatars. The results demonstrate that communication accommodation occurs and could be a potential mechanism for the widening or narrowing of healthcare disparities in patient outcomes. Future work should consider identifying which accommodations improve patients’ comprehension of medical advice and their relationships with healthcare providers.more » « less
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Abstract ObjectiveOnline patient portals become important during disruptions to in-person health care, like when cases of coronavirus disease 2019 (COVID-19) and other respiratory viruses rise, yet underlying structural inequalities associated with race, socio-economic status, and other socio-demographic characteristics may affect their use. We analyzed a population-based survey to identify disparities within the United States in access to online portals during the early period of COVID-19 in 2020. Materials and MethodsThe National Cancer Institute fielded the 2020 Health and Information National Trends Survey from February to June 2020. We conducted multivariable analysis to identify socio-demographic characteristics of US patients who were offered and accessed online portals, and reasons for nonuse. ResultsLess than half of insured adult patients reported accessing an online portal in the prior 12 months, and this was less common among patients who are male, are Hispanic, have less than a college degree, have Medicaid insurance, have no regular provider, or have no internet. Reasons for nonuse include: wanting to speak directly to a provider, not having an online record, concerns about privacy, and discomfort with technology. DiscussionDespite the rapid expansion of digital health technologies due to COVID-19, we found persistent socio-demographic disparities in access to patient portals. Ensuring that digital health tools are secure, private, and trustworthy would address some patient concerns that are barriers to portal access. ConclusionExpanding the use of online portals requires explicitly addressing fundamental inequities to prevent exacerbating existing disparities, particularly during surges in cases of COVID-19 and other respiratory viruses that tax health care resources.more » « less
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- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.25300/MISQ/2020/14180
