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Introduction: The coronavirus disease 2019 (COVID-19) pandemic has caused significant global disruption, especially for chronic care like hemodialysis treatments. Approximately 10,000 end-stage kidney disease (ESKD) patients are receiving maintenance hemodialysis (MHD) at 174 dialysis centers in Greater Mumbai. Because of the fear of transmission of infection and inability to isolate patients in dialysis centers, chronic hemodialysis care was disrupted for COVID-19-infected patients. Hence, we embarked on a citywide initiative to ensure uninterrupted dialysis for these patients. Materials and Methods: The Municipal Corporation of Greater Mumbai (MCGM) designated 23 hemodialysis facilities as COVID-positive centers, two as COVID-suspect centers, and the rest continued as COVID-negative centers to avoid transmission of infection and continuation of chronic hemodialysis treatment. Nephrologists and engineers of the city developed a web-based-portal so that information about the availability of dialysis slots for COVID-infected patients was easily available in real time to all those providing care to chronic hemodialysis patients. Results: The portal became operational on May 20, 2020, and as of December 31, 2020, has enrolled 1,418 COVID-positive ESKD patients. This initiative has helped 97% of enrolled COVID-infected ESKD patients to secure a dialysis slot within 48 hours. The portal also tracked outcomes and as of December 31, 2020, 370 (27%) patients died, 960 patients recovered, and 88 patients still had an active infection. Conclusions: The portal aided the timely and smooth transfer of COVID-19-positive ESKD patients to designated facilities, thus averting mortality arising from delayed or denied dialysis. Additionally, the portal also documented the natural history of the COVID-19 pandemic in the city and provided information on the overall incidence and outcomes. This aided the city administration in the projected resource needs to handle the pandemic.

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BACKGROUND: Improving a patient's experience with their care through an online interface for communication (an eHealth patient portal) has been shown to be beneficial in some studies of chronic disease populations. However, little is known about the effectiveness of an eHealth portal for delivery of care to home dialysis patients. OBJECTIVES: Primary: To determine whether an eHealth portal is effective at improving a patient's experience with their home dialysis care. Secondary: (1) To determine whether an eHealth portal improves health-related quality of life for home dialysis patients, (2) to assess patient satisfaction with an eHealth portal and perceived impact on aspects of their home dialysis therapy and health, (3) to determine the acceptability of the eHealth portal software, and (4) to determine the change in telephone usage for communication after patient adoption of an eHealth portal. DESIGN: Single-arm pilot trial with recruitment over a 4-month period. SETTING: The multidisciplinary home dialysis clinic in Halifax Nova Scotia Canada. PATIENTS: Adults (>18 years) receiving either home hemodialysis or peritoneal dialysis. MEASUREMENTS: Consumer quality index (CQI), health-related quality of life using the EuroQol Five Dimensions Questionnaire (EQ-5D), acceptability of the eHealth portal software (using the Acceptability E-scale), and satisfaction/perceived impact (using a modified questionnaire). METHODS: A web-based application (McKesson, Canada, RelayHealth®) allowed patients and health care workers to communicate through a secure, password-protected online portal that permitted visualization of the messaging history by patient and provider. Patients and the home dialysis health care team had the ability to send messages related to patient care at any time including proposed changes to medication, instructions after a clinic visit, times of new appointments, upcoming investigations, or questions about care. Patient experience with home dialysis care using the CQI, health-related quality of life using the EQ-5D, acceptability of the eHealth portal software, and satisfaction/perceived impact were assessed at baseline, 6, and 12 months of follow-up (where applicable). Total minutes of telephone communication was assessed prior to and after adoption of the portal. RESULTS: Of the 41 patients who consented to join the portal, 27 (66%) created an online account. At baseline, patients had a positive experience for the care and communication provided by their nephrologist (CQI: 3.63, 95% confidence interval [CI]: 3.50-3.76) and this did not change significantly over the study period. Similar results were observed for the care provided by other nephrology health care team members. Health-related quality of life using the EQ-5D score was 0.80 (interquartile range [IQR]: 0.71-0.83) at baseline and this also did not significantly change over the study period. Patients were satisfied with the eHealth portal (mean Likert scale score of 6.5 ± 0.6 in overall satisfaction, scale ranging from 1 completely dissatisfied to 10 completely satisfied), but only a minority (N = 12) completed a satisfaction questionnaire. Median monthly phone usage decreased from 12.5 to 10 minutes (P = .02) after adoption of the portal. LIMITATIONS: The study is limited by the small sample size, high rate of patient dropout, and limited response rate. CONCLUSIONS: In this study of home dialysis patients, we identified that an eHealth communication did not lead to significant improvements in patient experience with home dialysis care. TRIAL REGISTRATION: ClinicalTrials.gov number NCT02128347.

CONTEXTE: Le recours à un outil de communication en ligne (un portail santé destiné aux patients) pour améliorer l'expérience des patients en regard de leurs soins s'est avéré bénéfique dans quelques études sur des populations de patients atteints de maladies chroniques. Cependant, on en sait peu sur l'efficacité d'un tel portail pour la prestation de soins aux patients dialysés à domicile. OBJECTIFS: Principal ­ Déterminer si un portail de santé en ligne se montre efficace pour améliorer l'expérience des patients en matière de soins de dialyse à domicile. Secondaires ­ a. Déterminer si ce portail améliore la qualité de vie liée à la santé des patients dialysés à domicile; b. évaluer la satisfaction des patients à l'égard de l'outil en ligne et connaître son incidence sur certains aspects de leur santé générale et de leurs traitements; c. avoir une idée du niveau d'acceptation du logiciel du portail; d. évaluer les changements dans l'usage du téléphone comme outil de communication, une fois le portail en ligne adopté par le patient. TYPE D'ÉTUDE: Un essai pilote à un seul bras pour lequel le recrutement s'est étalé sur une période de quatre mois. CADRE: La clinique multidisciplinaire de dialyse à domicile d'Halifax (Nouvelle-Écosse) au Canada. SUJETS: Des patients adultes recevant des traitements de dialyse à domicile (hémodialyse ou dialyse péritonéale). MESURES: La qualité de l'expérience des patients à l'égard de leurs soins a été évaluée avec le Consumer Quality Index ou CQI (norme néerlandaise mesurant l'expérience des patients à l'égard des soins de santé). On a mesuré le score de qualité de vie liée à la santé à l'aide du questionnaire EQ-5D (EuroQol Five Dimensions Questionnaire); et l'acceptation du logiciel du portail de santé par l'entremise de l'AES (Acceptability E-scale). Enfin, la satisfaction des patients et l'incidence perçue sur la santé et les traitements ont été évaluées à l'aide d'un questionnaire modifié. MÉTHODOLOGIE: Une application sur le Web (McKesson, Canada, RelayHealth®) a permis aux patients et aux professionnels de la santé de communiquer par le biais d'un portail en ligne sécurisé et protégé par un mot de passe. L'historique des messages envoyés par le patient et le fournisseur de soins était visible sur le portail. Les patients et les membres de l'équipe de soins avaient en tout temps la possibilité d'envoyer des messages liés aux soins du patient. Les messages concernaient notamment des changements proposés dans la médication, des instructions à la suite d'une visite en clinique, les dates et heures de rendez-vous, les enquêtes à venir ou des questions générales relatives aux soins. L'expérience du patient en regard de la dialyse à domicile, évaluée par le CQI; la qualité de vie liée à la santé, évaluée par le questionnaire EQ-5D; l'acceptation du logiciel, de même que la satisfaction générale et l'incidence perçue sur la santé et les traitements ont été mesurées au début de l'étude et après six mois et douze mois de suivi (lorsque possible). La durée des communications téléphoniques a été évaluée avant et après l'adoption du portail. RÉSULTATS: Des 41 patients ayant accepté de joindre le portail, 27 (66 %) ont créé un compte en ligne. Au début de l'étude, les patients disaient avoir une expérience positive en regard des soins offerts et de la communication avec leur néphrologue (CQI : 3,63; IC 95 % : 3,50-3,76) et cette perception est demeurée sensiblement la même tout au long de l'étude. Des résultats similaires ont été observés pour les soins offerts par les autres membres de l'équipe de soins en néphrologie. Le score de la qualité de vie relative à la santé, mesuré par le questionnaire EQ-5D, était de 0,80 (ÉIQ : 0,71-0,83) au début de l'étude et n'a pas varié de façon significative au cours de la période de l'étude. De manière générale, les répondants se sont dits satisfaits du portail de santé en ligne, avec un score moyen de 6,5 ±0,6 sur l'échelle de Likert pour la satisfaction générale (échelle allant de 1, pour « pas du tout satisfait ¼, à 10, pour « entièrement satisfait ¼). Par contre, seule une minorité de patients (n=12) a rempli le questionnaire évaluant la satisfaction. L'utilisation mensuelle médiane du téléphone pour les communications avait diminué à la suite de l'adoption du portail, passant de 12,5 minutes initialement, à 10 minutes après l'adoption. LIMITES: Les constatations de cette étude sont limitées par le très faible échantillon de sujets, par le faible taux de réponse aux questionnaires et par le taux élevé d'abandon des patients. CONCLUSION: Dans cette étude, menée auprès de patients dialysés à domicile, nous avons constaté que le recours à un outil de communication en ligne n'a pas amélioré de façon significative l'expérience des patients en matière de soins de dialyse à domicile.

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BACKGROUND: The recent trend of increasing health care costs in the United States is likely not sustainable. To make health care more economically sustainable, attention must be directed toward improving the quality while simultaneously reducing the cost of health care. One of the recommended approaches to provide better care at a lower cost is to develop high-quality data collection and reporting systems, which support health care professionals in making optimal clinical decisions based on solid, extensive evidence. OBJECTIVE: The objective of this project was to develop an integrated mobile health Augmentative and Alternative Communication (AAC) platform consisting of an AAC mobile app and a Web-based clinician portal for supporting evidence-based clinical service delivery. METHODS: A questionnaire and interviews were used to collect clinicians' ideas regarding what constitutes their desired "clinically relevant" data. In response, a Web-based portal was designed by combining mobile and Web technologies with an AAC intervention to create an integrated platform for supporting data collection, integration, and reporting. Finally, a usability study was conducted with health care professionals. RESULTS: A Web-based portal was created and integrated with a tablet-based AAC mobile app and data analysis procedures. In the usability study, all participants agreed that the integrated platform provided the ability to collect comprehensive clinical evidence, automatically analyze collected data in real time, and generate clinically relevant performance measures through an easily accessible Web-based portal. CONCLUSIONS: The integrated platform offers a better approach for clinical data reporting and analytics. Additionally, the platform streamlines the workflow of AAC clinical service delivery.

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BACKGROUND: Understanding and addressing the needs of frail persons is an emerging health priority for Nova Scotia and internationally. Primary healthcare (PHC) providers regularly encounter frail persons in their daily clinical work. However, routine identification and measurement of frailty is not standard practice and, in general, there is a lack of awareness about how to identify and respond to frailty. A web-based tool called the Frailty Portal was developed to aid in identifying, screening, and providing care for frail patients in PHC settings. In this study, we will assess the implementation feasibility and impact of the Frailty Portal to: (1) support increased awareness of frailty among providers and patients, (2) identify the degree of frailty within individual patients, and (3) develop and deliver actions to respond to frailtyl in community PHC practice. METHODS: This study will be approached using a convergent mixed method design where quantitative and qualitative data are collected concurrently, in this case, over a 9-month period, analyzed separately, and then merged to summarize, interpret and produce a more comprehensive understanding of the initiative's feasibility and scalability. Methods will be informed by the 'Implementing the Frailty Portal in Community Primary Care Practice' logic model and questions will be guided by domains and constructs from an implementation science framework, the Consolidated Framework for Implementation Research (CFIR). DISCUSSION: The 'Frailty Portal' aims to improve access to, and coordination of, primary care services for persons experiencing frailty. It also aims to increase primary care providers' ability to care for patients in the context of their frailty. Our goal is to help optimize care in the community by helping community providers gain the knowledge they may lack about frailty both in general and in their practice, support improved identification of frailty with the use of screening tools, offer evidence based severity-specific care goals and connect providers with local available community supports.

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This article presents a case study in the redesign, development, and implementation of a web-based healthcare clinic search tool for virtual patient navigation in underserved populations in Texas. It describes the workflow, assessment of system requirements, and design and implementation of two online portals: Project Safety Net and the Breast Health Portal. The primary focus of the study was to demonstrate the use of health information technology for the purpose of bridging the gap between underserved populations and access to healthcare. A combination of interviews and focus groups was used to guide the development process. Interviewees were asked a series of questions about usage, usability, and desired features of the new system. The redeveloped system offers a multitier architecture consisting of data, business, and presentation layers. The technology used in the new portals include Microsoft .NET Framework 3.5, Microsoft SQL Server 2008, Google Maps JavaScript API v3, jQuery, Telerik RadControls (ASP.NET AJAX), and HTML. The redesigned portals have 548 registered clinics, and they have averaged 355 visits per month since their launch in late 2011, with the average user visiting five pages per visit. Usage has remained relatively constant over time, with an average of 142 new users (40 percent) each month. This study demonstrates the successful application of health information technology to improve access to healthcare and the successful adoption of the technology by targeted end users. The portals described in this study could be replicated by health information specialists in other areas of the United States to address disparities in healthcare access.

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