Pediatric Patient Engagement as a Criteria for Meaningful Use Stage 3

The Agency for Healthcare Research and Quality funded this project to inform Stage 3 Meaningful Use (MU3) requirements. Patient portals, electronic health record (EHR)-linked applications that allow patients and providers to communicate, are potential tools to achieve MU3 patient engagement goals. Pediatric asthma is an ideal condition in which to evaluate the effect of patient portals on health care, as asthma is the most common pediatric illness in the United States.

While patient portal use has increased in recent years, portal adoption has not been rapid, and overall rates of use remain low. Research suggests that several important barriers at the practice and patient levels need to be overcome for MU3 patient engagement incentives to be effective. Practice-level barriers include leadership concerns, marketing difficulties, and lack of staff engagement. At the patient level, those with a greater disease burden are more likely to use a portal than others. This study evaluated the feasibility of collecting patient-generated health information using portals and its impact on pediatric primary care.

The specific aims of the project were as follows:

• Study the feasibility for pediatric primary care practices of using MyAsthma—an EHR-linked portal—to provide education and enable families to communicate treatment concerns and goals and report symptom control, medication use, and side effects for children with asthma. 
• For a subset of children with poorly controlled asthma or medication side effects, assess the impact on asthma management resulting from gathering data from families through MyAsthma and sharing them with the primary care clinical team. 
• Describe barriers and solutions to improve the adoption, sustainability, and impact on clinical care of implementing portals across practice settings. 

Researchers conducted a mixed-methods implementation study for 20 practices in 11 States. They performed baseline and followup surveys to capture preferences, goals, asthma control, and medication use. Parents of children with asthma aged 6-12 completed monthly surveys via MyAsthma to communicate treatment concerns and goals and report symptom control, medication use, and side effects. They also evaluated child characteristics associated with portal adoption and changes to asthma management associated with portal use. Finally, they carried out clinician focus groups and parent interviews to explore barriers and facilitators of use.

Researchers found overall low rates of portal adoption and sustained use across study practices. Parents of children with uncontrolled asthma were more motivated to use the portal because it facilitated a better understanding and tracking of asthma control. Both clinicians and families highlighted the importance of coordinated and responsive workflows to implementation success. Results suggest that achieving high-levels of portal adoption will likely require improved care coordination, redesigned workflows, and targeted outreach to families.