Date of Award

Spring 2016

Project Type


Program or Major

Nursing Practice

Degree Name


First Advisor

Joanne G Samuels

Second Advisor

Paul R Clark

Third Advisor

Donna Pelletier


The American Recovery and Reinvestment Act (ARRA) of 2009 included the Health Information Technology for Economic and Clinical Health Act (HITECH) to provide stimulus for the provision of electronic access for consumers as a way to improve patient engagement. As described by the act, meaningful use of a tethered personal health record called a patient portal was theorized to improve patient engagement and result in improved clinical outcomes, reduced cost and increased patient satisfaction. Accordingly, financial incentives and penalties were to be awarded the eligible provider (EP) demonstrating meaningful use according to various stages with corresponding deadlines. A community medical group is striving to receive the financial incentives for meaningful use as well as address the national initiatives to improve patient engagement with the use of a patient portal.

The global aim of this two part research translation and healthcare improvement project is to promote patient engagement by identifying the factors that affect a patients’ decision to use a patient portal as well as to identify potential strategies to promote portal use. Phase I of the project involved surveying both patient portal users (n=235) and non-users (n=36) to determine the presence of any barriers or facilitators. The survey was based on the Health Information Technology Acceptance Model by Kim and Park (2012). In addition, baseline patient engagement was assessed using the Patient Activation Measure (PAM®). When comparing portal users to non-users with respect to the HITAM model variables, differences were identified in the perception of usefulness as well as the related outcomes of attitude and intent to use the technology. In addition, if a patient perceives that the patient portal is useful, they are 1.44 times more likely to register and use a patient portal. There were no differences in patient engagement levels between portal users and non-users.

In Phase II, the data analysis guided the selection of an intervention, a pilot of Open Notes by volunteer community medical group providers as a strategy to possibly increase the percentage of patients who access and use the patient portal. Patient perceptions as to benefits and risks of viewing their office visit note will guide facility decisions to optimize portal use.