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Bajracharya, Adarsha

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Bajracharya

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Adarsha

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Bajracharya, Adarsha

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Author's Publications: search.filters.isAuthorOfPublication.2720e1f4-9cab-4442-b01a-cfc6ffd1b5e8

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    Improving Health Care Proxy Documentation Using a Web-Based Interview Through a Patient Portal
    (2015-09-29) Bajracharya, Adarsha; Slack, Warner V.; Safran, Charles; Wright, Adam
    Objective: Health care proxy (HCP) documentation is suboptimal. To improve rates of proxy selection and documentation, we sought to develop and evaluate a web-based interview to guide patients in their selection, and to capture their choices in their electronic health record (EHR). Methods: We developed and implemented a HCP interview within the patient portal of a large academic health system. We analyzed the experience, together with demographic and clinical factors, of the first 200 patients who used the portal to complete the interview. We invited users to comment about their experience and analyzed their comments using established qualitative methods. Results: From January 20, 2015 to March 13, 2015, 139 of the 200 patients who completed the interview submitted their health care proxy information for their clinician to review in the EHR. These patients had a median age of 57 years (IQR 45-67) and most were healthy. The 99 patients who did not previously have health care proxy information in their electronic health record were more likely to complete and then submit their information than the 101 patients who previously had a proxy in their health record (Odds Ratio 2.4, P= 0.005). Qualitative analysis identified several ways in which the portal-based interview reminded, encouraged, and facilitated patients to complete their HCP. Discussion and conclusion: Patients found our online interview convenient and helpful in facilitating selection and documentation of an HCP. Our study demonstrates that a web-based interview to collect and share a patient’s HCP information is both feasible and useful.
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    Prevalence and Risk Profile Of Unread Messages To Patients In A Patient Web Portal
    (Schattauer GmbH, 2015) Mostaghimi, Arash; O'Brien, Jane; Bajracharya, Adarsha; Safran, Charles; Landon, Bruce; Crotty, B.H.
    Background: Excitement around the adoption of electronic communication between physicians and patients is tempered by the possibility of increased clinical and legal risk. If patients do not read messages in a timely fashion, duplicative communication efforts may be required and patient safety may be jeopardized. Objective: We sought to assess the prevalence and risk profile of unread messages in a mature patient portal. Methods: We analyzed six years of messages (2005–2010) from physicians to patients to determine the prevalence and associated characteristics of unread messages in a patient portal. We focused on clinical messages, and excluded announcements. Because some physicians sent clinical messages to groups of patients, we labeled messages sent to more than 5 patients as “outreach” messages and excluded them from general analyses. We performed a chart review of 75 clinical messages to assess for harm. Results: We found that 3% of clinical messages were unread after 21 days. Messages arriving outside of business hours were slightly more likely to go unread (RR 1.15 95% CI 1.11–1.19). Patients who were male (OR 1.14 CI 1.04–1.26) African American (OR 1.69 CI 1.29–2.22) or Hispanic (OR 1.74 CI 1.17–2.59), or in the lowest income group (OR 1.72 CI 1.19–2.49) were more likely to have unread messages. Chart review showed no evidence of harm, but 13% of sampled unread messages were associated with potential delays in care. Incidentally, we found 50% of the physician-initiated outreach messages were unread. Conclusions: Overall, secure messaging appears a safe form of communication, but systems to notify senders when messages are unread may have value. While most clinical messages were read, many outreach messages were not, providing caution for relying on such systems for information dissemination. Similar to other studies, differences by race and income were observed and require further study.