Patients’ experience and understanding of E-portals in rural general practice: an ethnographic explorationJenny Carryer 1 , Sarah Kooienga 2
1 School of Nursing/College of Health, Massey University, Palmerston North, New Zealand
2 Fay W. Whitney School of Nursing, University of Wyoming, Laramie, USA
Correspondence to: Jenny Carryer, School of Nursing/College of Health, Massey University, Palmerston North, New Zealand. Email: J.B.Carryer@massey.ac.nz
Journal of Primary Health Care 9(4) 262-268 https://doi.org/10.1071/HC17016
Published: 24 October 2017
Journal Compilation © Royal New Zealand College of General Practitioners 2017.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
AIM: This exploratory qualitative study provides insight into E-portal use in rural primary care.
INTRODUCTION: As of February 2017, almost 300,000 New Zealanders were using E-portals, offered in over 455 general practices. Patient portals are intended to give patients convenient and secure electronic access to their health information and increase their ability to manage their own health care. Early patient experience of E-portal use in New Zealand has not yet been studied.
METHODS: Thirty-three patients from three rural general practice sites were interviewed between December 2015 and June 2016. Eleven patients were not using a portal. Data were analysed using ethnograph and comparative analysis between two researchers.
RESULTS: Four major themes emerged from the data: (i) technology acceptance, (ii) activation to full engagement with E-portals, (iii) benefits and concerns, and (iv) the impact of rural contextual understandings for these 33 patients.
DISCUSSION: Portal use in New Zealand is in its infancy, but signs suggest that New Zealanders are ready and enthusiastic adopters of such technology. Engagement levels are variable and it is too soon to fully explore the impact of E-portals on the general practice culture, provider relationships and the degree to which portals increase personal self-efficacy in relation to health care.
References Patient Portals [press release]. Wellington: NZ National Health IT Board; 2015.
 National Health IT Board (NZ). Patient Portals. Wellington, NZ: Ministry of Health; 2017. [cited 2017 February 20]. Available from: http://healthitboard.health.govt.nz/patient-portals.
 National Health IT Board (NZ). eHealth Ambassadors-Patient Portals. City: Publisher; 2015. [cited 2016 February 12]. Available from: http://ithealthboard.health.nz/our-programmes/patient-portals/ehealth-ambassadors-patient-portals.
 Fearnley D, Nixon G, Lawrenson R. Unknown unknowns in New Zealand rural health. N Z Med J. 2016; 129 77–81.
 London M. Rural General Practice and Retention in New Zealand. Christchurch, New Zealand: Centre for Rural Health; 2001. Report No.: ISBN 0-9582474–2-0.
 Scott-Jones J. What is rural health and why does it matter. J Prim Health Care. 2016; 8 187–8.
 Goel M, ed. Patient Portal Implementation in a Federally Qualified Community Health Center (FQHC): Patient-reported Facilitators and Barriers. 143rd APHA Annual Meeting and Exposition (October 31–November 4, 2015). Chicago, IL: American Public Health Association; 2015.
 Otte-Trojel T, Rundall TG, de Bont A, et al. The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente. BMC Health Serv Res. 2015; 15 559
| The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente.CrossRef |
 Ministry of Health. New Zealand Health Strategy update 2015. Wellington, New Zealand: Ministry of Health. [cited 2017 February 06]. Available from: http://www.health.govt.nz/about-ministry/what-we-do/new-zealand-health-strategy-update.
 Spradley JP. Participant Observation. New York: Holt, Rinehart and Winston; 1980.
 Stange KC, Zyzanski SJ, Jaen CR, et al. Illuminating the ‘black box’: a description of 4454 patient visits to 138 family physicians. J Fam Pract. 1998; 46 377–89.
| 1:STN:280:DyaK1c3mtVartA%3D%3D&md5=df375829fb4de26d9b1dbdf843b5f244CAS |
 Ayres L, Kavanaugh K, Knafl KA. Within-case and across-case approaches to qualitative data analysis. Qual Health Res. 2003; 13 871–83.
| Within-case and across-case approaches to qualitative data analysis.CrossRef |
 Creswell J. Qualitative inquiry and research design. Los Angeles: SAGE; 2013.
 Nahm E-S, Diblasi C, Gonzales E, et al. Patient-centered personal health record and portal implementation toolkit for ambulatory clinics: a feasibility study. CIN: Computers, Informatics, Nursing. 2017; 35 176–85.
 Holden RJ, Karsh B. The Technology Acceptance Model: its past and its future in health care. J Biomed Inform. 2010; 43 159–72.
| The Technology Acceptance Model: its past and its future in health care.CrossRef |
 Goldzweig CL. Pushing the envelope of electronic patient portals to engage patients in their care. Ann Intern Med. 2012; 157 525–6.
| Pushing the envelope of electronic patient portals to engage patients in their care.CrossRef |
 Lake Research Partners. Consumer and health information technology: a national survey. Oakland, CA: California Health Care Foundation; 2010.
 Kruse CS, Bolton K, Freriks G. The effect of patient portals on quality outcomes and its implications to meaningful use: a systematic review. J Med Internet Res. 2015; 17 e44
| The effect of patient portals on quality outcomes and its implications to meaningful use: a systematic review.CrossRef |
 Wright A, Poon EG, Wald J, et al. Randomized controlled trial of health maintenance reminders provided directly to patients through an electronic PH. J Gen Intern Med. 2012; 27 85–92.
| Randomized controlled trial of health maintenance reminders provided directly to patients through an electronic PH.CrossRef |
 Klein JW, Jackson SL, Bell SK, et al. Your patient is now reading your note: opportunities, problems, and prospects. Am J Med. 2016; 129 1018–21.
| Your patient is now reading your note: opportunities, problems, and prospects.CrossRef |
 Wolff JL, Darer JD, Berger A, et al. Inviting patients and care partners to read doctors’ notes: Open Notes and shared access to electronic medical records. J Am Med Informat Assoc. 2016; 24 e166–72.
| Inviting patients and care partners to read doctors’ notes: Open Notes and shared access to electronic medical records.CrossRef |
 Wynia MK, Williams Torres G, Lemieux J. Many physicians are willing to use patient’s electronic personal health records, but doctors differ by location, gender and practice. Health Aff (Millwood). 2011; 30 266–73.
| Many physicians are willing to use patient’s electronic personal health records, but doctors differ by location, gender and practice.CrossRef |
 Neuner J, Fedders M, Caravella M, et al. Meaningful use and the patient portal patient enrollment, use, and satisfaction with patient portals at a later-adopting center. Am J Med Qual. 2015; 30 105–13.
| Meaningful use and the patient portal patient enrollment, use, and satisfaction with patient portals at a later-adopting center.CrossRef |