In this implementation of a shared, practice-linked, pre-visit eJournal, patients could review EHR data, respond to tailored and untailored health questions, document goals for the visit, and submit the eJournal to their provider. Providers could discuss eJournal information with their patients and document it in the EHR. Despite limitations in overall patient portal adoption, eJournal invitations to study consenters, and eJournal use by study patients and physicians, valuable experience was gained from patient and physician use of the eJournal.
Many patients reported eJournal use improved visit preparation, communication with providers, and the accuracy of information they gave their provider. Providers reported the eJournal helped patients prepare for the visit, learn more about their health records, and ask more questions. Findings specific to the diabetes eJournal are reported elsewhere.24
Many but not all patients or providers reported benefits of the eJournal, with more benefits associated with medications, allergies, and diabetes topics.
Greater adoption of the eJournal tool will require increases in PG enrollment, in eJournal topics and visit types triggering an eJournal, and in physician engagement. Vigorous marketing of PG led to enrollment growth within study practices of more than 270% between September 2005 and August 2009. Enhanced scheduling system integration and eJournal topics in primary, specialty, and pediatric care will improve the ability to offer tailored eJournal content based on patient, visit, provider, practice, and EHR characteristics. Reducing physician liability concerns (eg, if the patient submits an eJournal but misses the appointment) requires additional study.
Further work is also needed to improve eJournal integration into practice style, workflow, and documentation, including physician notifications and coordinating the use of electronic and non-electronic tools. Higher provider satisfaction with the medication, allergies, and diabetes eJournal topics may reflect better fit with provider workflow given the relevance of these topics at each visit and the LMR shortcuts to document these patient-entered eJournal items. In contrast, submitted family history eJournal information was not reviewed at every visit, was more tedious to view, and was less easily documented into the LMR. Additional work to determine how eJournal information that already appears in the EHR should be displayed (or suppressed) from physician view will be needed.
Factors that limit the generalizability of this work include the narrow set of eJournal topics and the non-response bias given the small percentage of respondents (patients and physicians). Assessment of the eJournal among low literacy or less-educated patients, more specialized physicians, and a greater variety of practice settings was not done. Accuracy of patient-reported data was not addressed in this study.
Future work should also focus on how eJournals can coexist with other technologies to improve the flow of structured and unstructured data while serving the varied needs of patients, providers, and the health system. While a basic eJournal may be useful as a patient data entry tool, advanced eJournal capabilities—including tailored chart information, instructional reference information, and communication tools—may offer additional benefits for enhanced patient–provider collaboration.