Embedding Authorship Identity into a Portal-Based Agenda Setting Intervention to Support Older Adults and Care Partners

Abstract

Background

Patients, families, and clinicians increasingly communicate through patient portals. Due to potential for multiple authors, clinicians need to know who is communicating with them. OurNotes is a portal-based pre-visit agenda setting questionnaire. This study adapted OurNotes to include a self-identification question to help clinicians interpret information authored by nonpatients.

Objectives

To describe adapted OurNotes use and clinician feedback to inform broader implementation.

Design

Evaluation of adapted OurNotes in a geriatric practice.

Participants

Older adults with a portal account and a clinic visit; eight clinicians were interviewed.

Intervention

OurNotes adaptation to clarify whether the author is the patient, the patient with help, or a nonpatient.

Approach

Cross-sectional chart review of OurNotes completion, patient characteristics, and visit topics by author type. Clinician interviews explored experiences with OurNotes.

Results

Out of 503 visits, 134 (26%) OurNotes questionnaires were completed. Most respondents (n = 92; 69%) identified as the patient, 18 (14%) identified as the patient with help, and 24 (17%) identified as someone other than the patient. On average, patients who authored their own OurNotes were younger (80.9 years) compared to patients who received assistance (85.8 years), or patients for whom someone else authored OurNotes (87.8 years) (p < 0.001). A diagnosis of cognitive impairment was present among 20% of patients who self-authored OurNotes vs. 79% of patients where someone else authored OurNotes (p < 0.001). Topics differed when OurNotes was authored by patients vs. nonpatients. Symptoms (52% patient vs. 83% nonpatient, p = 0.004), community resources (6% vs. 42%, p < 0.001), dementia (5% vs. 21%, p = 0.009), and care partner concerns (1% vs. 12%, p = 0.002) were more often mentioned by nonpatients. Clinicians valued the self-identification question for increasing transparency about who provided information.

Conclusions

A self-identification question can identify nonpatient authors of OurNotes. Future steps include evaluating whether transparency improves care quality, especially when care partners are involved.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11606-024-09056-3.

INTRODUCTION

Adults with complex health needs and their care partners are increasingly using the patient portal to communicate with clinical teams and for care coordination.^1,2 “OurNotes” is a pre-visit agenda setting intervention where patients receive a patient portal message with an electronic questionnaire prior to a clinic visit and are prompted to enter free-text responses on how they have been since their last visit, as well as up to three priorities they want to discuss.³ OurNotes responses are saved in the electronic health record (EHR) for clinicians to view prior to or during the visit and entered directly into the clinician’s visit documentation.^4,5 Patients and clinicians report that OurNotes increases information transparency, sharing of health-related information, and prioritization of patient-centered concerns.³

However, for older adults who receive support from or rely on family members or others (here forward: “care partners”), the identity of OurNotes authors may be unclear to clinicians, thus introducing confusion about the integrity of the information.^6,7 Notably, shared or proxy access, where the patient explicitly authorizes someone to share access to their portal account, allows care partners to receive their own identity credentials.⁶ However, shared access is an underused strategy; in fact, some care partners may continue to use the patient’s identity credentials, including to complete OurNotes, even when they have shared access.⁷

Because the originally developed OurNotes agenda setting questionnaire does not include a way to establish who is authoring OurNotes, it can be difficult for the clinician to know whether the information provided represents the patient and/or a care partner’s agenda. Such challenges can potentially compromise patient autonomy or result in disclosing information without patient consent.⁶ These potential negative implications may be heightened in the context of dementia when care partners are increasingly involved in patient care. Thus, we implemented a new self-identification question to clarify the author’s identity as part of OurNotes. This adaptation is based on a conceptual model that integrates relational coordination theory, the Systems Engineering Initiative for Patient Safety (SEIPS), and patient-clinician communication principles that argue for the importance of explicit engagement and support care partners in the care for older adults and other vulnerable populations.^8,9

This proof-of-concept study describes implementation of the adapted OurNotes questionnaire in an academic geriatric primary care practice. We specifically report on frequency of nonpatient authors, the agenda topics raised by patients vs. nonpatients, and clinician feedback on the feasibility and acceptability of the adapted OurNotes as part of clinical care. Our goal is to inform broader implementation of portal-based interventions that can differentiate authorship and support agenda setting for older adults and their care partners.

METHODS

Design

This study employed multiple methods to co-design, pilot, and implement the adapted OurNotes questionnaire as a proof-of-concept study in an academic geriatric practice within an integrated health system. The community of co-designers included a patient and family member advisory council, health system leaders and EHR developers, and an interdisciplinary research team. The evaluation aimed to describe who completed the adapted OurNotes intervention, compare agenda setting topics by author type, and elicit clinician feedback on the adapted OurNotes as part of clinical care to inform broader implementation. The study (#22–0606) was determined to be exempt by the institutional review board based on Category 2 (interview) and Category 4 (secondary data analysis).

Co-design of an Adapted OurNotes Questionnaire

The originally deployed OurNotes includes two questions: “What should your doctor/provider know about your health?” and “What are the top three questions you would like to ask at your visit?” with three text response boxes (Fig. 1).³ Patients receive a message through the portal three days before a visit, inviting them to complete OurNotes. The responses to OurNotes are auto-populated into the “History to Present Illness (HPI)” section of the clinician’s visit documentation; as such, the clinician can directly see the OurNotes responses and add documentation about the patient’s priorities and health status.

Figure 1.

Adapted OurNotes questionnaire. The original OurNotes agenda setting question sequence is presented in yellow. The self-identification question, shown in the blue area, is inserted before the agenda setting questions.

The need for a self-identification question was realized and co-designed through work with a patient and family advisory council named the “Memory Research Partners in Caring and Technology Council.”¹⁰ The Memory Tech Council was composed of 18 individuals, including three patient-care partner dyads with lived experience of dementia, two care partners of persons with dementia, and 10 community members with community engaged research experience and interest in caregiving. The Council met six times over a 7-month period in 2021–2022.

Council members suggested a need for care partners of older adults to be able to self-identify who was completing the pre-visit e-check-in process. The research team asked the Council to provide specific suggestions for how to adapt the existing OurNotes questionnaire. They suggested wording for a new self-identifying question: “Which of these applies to you?” As shown in Fig. 1, the three response options were (a) “I am the patient, and I am completing this form myself”; (b) “I am the patient, and someone else is helping me complete this form”; and (c) “I am not the patient.” When “I am not the patient” was selected, branched questions were asked, “What is your name?” and “What is your relationship to the patient?” Options of “adult child, spouse/partner, other” were available to the author. These changes were implemented on May 1, 2022.

Setting

The adapted OurNotes questionnaire was piloted in an academic geriatric practice that serves as the patient-centered medical home for more than 3300 patients, with an average of 82 years, of whom most (86%) have an activated patient portal account. The clinic includes 17 full- and part-time clinicians (physicians, nurse practitioners, and a physician assistant) and four geriatric medicine fellows, and trains internal medicine residents, medical students, and Doctor of Nursing Practice students.

Quantitative Data Collection and Analysis

We conducted a chart review for 10 clinic days between October 3 and October 14, 2022, to assess completion rates of OurNotes (yes/no), based on presence or absence of responses to the self-identification question and agenda setting questions in the clinical encounter documentation. Patient visits were included if they occurred during the study period and the patient had a patient portal account (n = 503), allowing them to be sent the pre-visit agenda setting questionnaire prior to the scheduled visit. Data collection included patient demographics, presence of proxy access, problem list and visit documentation of cognitive impairment, and documentation by the clinician of presence of a care partner at the visit. Data were managed using REDCap electronic data capture tools.¹¹ We compared patient demographic and other characteristics across the three self-identifying author types: “I am the patient; I am the patient and someone is helping me; or I am not the patient.”

Descriptive statistics were used to characterize the sample. We report measures of age, gender, ethnicity, race, marital status, insurance type, presence of proxy access with the patient’s portal account, problem list-based diagnosis of cognitive impairment/dementia, and whether a care partner was present. Analysis of variance (ANOVA) tests were used to compare patient characteristics by author response types (patient, patient with help, nonpatient). All tests for statistical significance were two-tailed, and a p value < 0.05 was considered statistically significant. All statistical analyses were performed using SAS version 9.4.

Qualitative Data and Analysis

Free-text responses to both agenda setting questions of the OurNotes questionnaire were abstracted and de-identified. Seven patients had more than one OurNotes response during the evaluation period; only the first response was included in the analysis. Using a qualitative content analysis approach where content is identified and quantified,¹² two coders with clinical backgrounds (H.L, K.G.) first read the OurNotes free-text responses in their entirety to familiarize themselves with the content. Given the goal of exploring the frequency of geriatric-related topics, the two coders inductively developed an initial codebook of clinical topics (e.g., chronic conditions, symptoms, medication concern, health care coordination, testing or procedures, transition of care, community resources coordination, dementia-related concern, or care partner concern). The coders then developed code definitions in an iterative process until reaching agreement. The two coders then independently coded free-text responses, meeting every 2 weeks for a total of three meetings to compare coding of free-text responses. Team meetings included a third clinical team member (J.S.) to resolve differences and reach consensus in coding. The frequency of each topic in the OurNotes questionnaires is reported for two groups of author types: (1) patients and/or someone helping the patient (n = 116 clinic visits, of whom 6 patients had two visits within the study period), and (2) nonpatients (n = 24 clinic visits). Frequencies of topics were compared using Chi-squared tests. Excerpts of representative content are provided.

To explore clinician perspectives about experiences knowing who authored the OurNotes questionnaire, two research assistants who were trained in qualitative research methods (J.C. and J.F.) conducted semi-structured interviews. The data examined in this study were extracted from a larger multisite dataset of 20 clinicians with experience using OurNotes and caring for patients with dementia. For this analysis, data were restricted to clinicians at the clinical site where the adapted OurNotes questionnaire was implemented (i.e., eight geriatric clinicians including physicians and advanced practice practitioners). Interviews lasted approximately 30 min, and were audio-recorded and professionally transcribed. The interview guide explored the feasibility and acceptability of adapted OurNotes in clinical practice, including whether and how identification of the OurNotes’ author affected clinical care (Supplemental File 1). Given how frequently care partners of a person with dementia communicate on the behalf of persons with dementia and the need for a self-identification question identified by the Memory Tech Council, some questions focused on potential advantages, drawbacks, and suggestions for improvements to support usability specific to care partners of persons with dementia. Demographic information was also collected. All data were de-identified prior to analysis.

The clinician interviews were analyzed using thematic analysis methods,¹³ where a qualitatively trained research team member independently read through the transcribed interviews (J.C.) to be immersed in the data and then used a deductive approach to develop a preliminary codebook with codes and definitions related to the domains of acceptability, usability, experience, and suggestions. The codebook was iteratively refined as new codes were generated and others collapsed according to underlying similarity. Once a final codebook was established, all transcripts were coded, and themes within categories of benefits, drawbacks, and suggestions were identified by searching for meaningful patterns in the coded data using an Excel spreadsheet. Themes were discussed as a team (J.C., H.L., C.D.) to describe the represented findings. Efforts to increase trustworthiness of the findings included interviewers completing field notes to document analytic reflections. The phases of the qualitative analysis were routinely shared with the broader research team to identify potential bias and gain additional insights.

RESULTS

Author Identity of Ournotes

Of eligible visits, 134/503 (26%) users completed at least some information in the adapted OurNotes questionnaire. Based on the self-identifying question, 69% of authors identified as the patient (n = 92/134), 14% identified as the patient with help (n = 18/134), and 17% identified as someone other than the patient (n = 24/134). Of the 24 visits in which OurNotes was authored by a nonpatient, the types of relationships to the patient were adult children (n = 18, 75%), “other” people (n = 4, 17%), and spouses or partners (n = 2, 8.3%).

Mean patient age differed by author type: patients who self-authored the note were 80.9 years old, patients who authored the note with help were 85.8 years old, and mean patient age when OurNotes was completed by someone else was 87.8 years (p < 0.001) (Table 1). Other patient demographics that were more common when OurNotes was authored by nonpatients were presence of cognitive impairment (20% patient-authored notes vs. 79% nonpatient-authored notes, p < 0.001) and having a care partner present at the clinic visit (20% patient-authored notes vs. 74% nonpatient-authored notes, p < 0.001).

Table 1.

Patient Demographics Based on Author Identity for the Adapted OurNotes Intervention (N = 134)

	Patient (N = 92)	Patient with someone else (N = 18)	Nonpatient (N = 24)	p-value
Age, years, mean (SD)	80.9 (4.8)	85.8 (7.1)	87.8 (6.4)	< .0001
Female	60 (65%)	12 (71%)	12 (50%)	0.56
Race				0.24
White	84 (91%)	14 (82%)	19 (79%)
Black or African American (n = 4)	TS	TS	0	N/A
Asian (n = 4)	TS	TS	TS
Other race, including American Indian or Alaskan Native (n = 8)	TS	TS	TS
Hispanic or Latino/a/X Ethnicity (n = 6)	0	TS	TS	N/A
Marital status*				0.09
Married	45 (49%)	7 (41%)	6 (25%)
Divorced/single	25 (25%)	0	6 (25%)
Widowed	20 (22%)	9 (53%)	10 (42%)
Insurance type: Dual Medicare/Medicaid (n = 13)	9 (9.8%)	TS	TS	N/A
Proxy access associated with patient account	10 (11%)	TS	TS	N/A
Diagnosis of cognitive impairment or dementia in problem list	18 (20%)	11 (65%)	19 (79%)	< .0001
Care partner present at visit	18 (20%)	13 (72%)	17 (74%)	< .0001
Completed Our Notes question #2: “How have you been since your last visit?”	69 (75%)	13 (77%)	24 (100%)	0.02
Completed Our Notes question #3: “What are the top three questions you would like to ask at your visit?”	71 (77%)	13 (77%)	14 (58%)	0.17

TS too small to report, as cell size is 5 or less; N/A not applicable

^*Data for unknown relationship status were less than 10% and are not shown

Agenda Setting Through Adapted OurNotes

When OurNotes was completed by a nonpatient, the author completed the second question — “What should your doctor/provider know about your health?” in 100% of visit notes, compared to only 75% of notes authored by patients (p = 0.028) (Table 1). The frequency of identified topics differed for patient/patient with help and nonpatient authors (Fig. 2). Chronic conditions, health care coordination, and transitions of care were mentioned in the agenda setting questions at similar rates. Nonpatient authors more frequently wrote about visit concerns, questions, or updates related to symptoms (83% non-patient authors vs. 52% patient authors; p = 0.004), medication concerns (67% vs. 46%; p = 0.061), coordination of community resources (42% vs. 6%; p ≤ 0.001), dementia-related concerns or questions (21% vs. 5%; p = 0.009), and care partner issues (12% vs. 1%; p = 0.002). Supplemental Table 1 includes de-identified examples of topics shared via OurNotes by patients or nonpatients for each category.

Figure 2.

OurNotes questionnaires topics. Frequency of topics mentioned in Adapted OurNotes, based on completion by the patient or the patient with help (blue bars) or someone other than the patient (orange bars).

Clinician Perspectives on OurNotes Self-identification Question

Clinicians identified as mostly women (n = 6), non-Hispanic White (n = 7), and 30–39 years of age (n = 5). Six of eight were physicians (n = 6); two others were a physician assistant and a nurse practitioner. Most (n = 6) had been in their position for less than 5 years. Within the category of benefits, a theme of the self-identifying question was increased transparency about who was providing the information. One clinician described, “I think it is important to know who’s filling out the [OurNotes questionnaire], whether it’s the patient or caregiver. There are definitely scenarios in which a patient with dementia might still be using [health system’s portal] to some extent, so knowing the source of the information is really important.” Another clinician described how knowing the authorship helps them navigate sensitive issues, “They will write down who it is, or they’ll designate that it’s not the patient, and I love that. That clues me into thinking, ‘Does the patient know that this is being discussed?’ and just that I may have to tread a little bit more carefully when I bring up the concern.” Transparency was also described as providing insight into dementia-related issues.

Within the category of drawbacks, clinicians described a theme related to the self-identifying question (and OurNotes overall) not being required, and therefore, users can bypass providing authorship identity credentials. One clinician noted, “If people say they aren’t the patient, they aren’t required to fill out the other fields [name and relationship to the patient], and so they just don’t usually. I very rarely have seen people actually type in their name and have it be who’s actually filling it out, … usually that part’s just blank.” Clinicians also described that the self-identification question did not ensure the patient had consented to having a care partner share about them (Table 2). Related to category of suggestions to improve OurNotes, clinicians described a theme related to the need to empower care partners to self-identify themselves when using OurNotes and potential questions that would help communicate the patient’s agenda and the care partner’s agenda.

Table 2.

Clinician Perspectives on Benefits, Drawbacks, and Suggestions Related to the OurNotes Self-identification Question

Description	Example quotations
Benefits of increased transparency in knowing who is completing OurNotes	I like it. I think if it didn't tell me who was writing the information it would be harder to interpret. (Clinician 19) It’s something that’s really important, just so I know where the information’s coming from, and then, how to proceed forward with these concerns. (Clinician 16) It may also provide some enlightenment about any progression of their dementia if they are no longer able to fill out those forms themselves, whereas they may have been able before. (Clinician 12)
Drawbacks of the self-identification question	Sometimes it will say “not patient” or caregiver, but it still won't say their name of who's filling it out, or it will still say “patient” even though I know the patient's not the one who filled it out. It seems like that's just not being used regularly in the way that it was intended to. (Clinician 11) We’re talking about the privacy issues involved in some of these forms of communication, so having a way for someone to self-identify: Are they the medical power of attorney? Or some other check of patient’s consent for this person to communicate on their behalf, could be a good thing. (Clinician 18)
Suggestions to improve usability by care partners	Maybe just empowering the caregivers to know that we want them to be doing this stuff as the agent of their parent or caregiver person they're care giving for, such that they feel comfortable also filling out this stuff, and then the language is adapted accordingly. (Clinician 20) When it is used, I don't always know who's writing it. If it was clear—what the patient's concerns were, what the caregiver’s were, and what their agenda was for the visit before I went in—I think I could better manage my limited time. (Clinician 4)

^*Data reflect interviews with eight geriatric clinicians and were extracted from a larger dataset of 20 clinicians

DISCUSSION

This real-world implementation of a portal-based, pre-visit agenda setting intervention demonstrates the feasibility and acceptability of a specific adaptation to elicit patient portal authorship identity, based on use of the OurNotes questionnaire and clinician perspectives. In the context of a geriatric primary care clinic with a high rate of older patients with patient portal accounts, one in six users who completed OurNotes agenda setting identified as a nonpatient. This study found that nonpatients completing OurNotes agenda setting commonly assisted patients who were older and/or had cognitive impairment. While findings should be interpreted with caution given the small number of patient visits evaluated in this cross-sectional study, supporting transparency related to who is completing a pre-visit agenda setting tool may increase clinicians’ clarity related to patient and/or care partner needs. With respect to potential for broader use, clinicians described the benefits of knowing the identity of who is completing OurNotes agenda setting and suggested the need to further empower care partners to use the tool, especially related to supporting persons with dementia.

Importance of Engaging Nonpatients in Ournotes

Agenda setting includes identifying relevant topics, agreeing on shared priorities, and establishing a conversational focus to facilitate collaboration and engagement.¹⁴ Agenda setting during clinical visits is particularly important for older adults and their care partners, especially in the context of dementia and other complex medical or social needs. For example, patients with multiple chronic conditions and their care partners often each have several questions, needs, and updates related to their health, medications, functional needs, social support, and well-being. An effective agenda setting tool that can accommodate patient and nonpatient (i.e., care partner) input may help patient-care partner-clinician communication and result in person- and family-centered care. For example, in this OurNotes evaluation, nonpatient authors more commonly raised symptom and medication-related questions. They also brought up non-medical needs related to community resources or shared information related to dementia or memory issues. Especially for vulnerable populations, we see the importance of facilitating input from knowledgeable care partners in the clinical visit. Relatedly, the SAME Page intervention is a structured process to clarify the expected role of an older patient and their visit companion.¹⁵ Here, engagement of the patient and their visit companion facilitated identification of distinct individual priorities for the visit agenda, and shifted the conversation toward more patient-oriented concerns.

Potential Application to Dementia Care

Patient portal use is increasing among persons diagnosed with dementia and their care partners.¹ Consistent with emerging evidence, we found that nonpatients of patients with cognitive impairment were more likely to complete OurNotes.^1,16 Clinicians noted specific advantages to knowing the care partners’ perspectives for patients with dementia, though some also noted concerns related to balancing information from a patient with cognitive impairment and information from care partners.¹⁷ There is suggestion that patient portals may offer value to dementia care due to the ability to increase communication directly with care partners.² The findings of this study suggest a self-identification question embedded in OurNotes to understand authorship may leverage the value of direct communication with care partners while ensuring patient autonomy during visits. Importantly, future iterations of the OurNotes questionnaire could consider the benefits and drawbacks of potential modifications such as (1) requiring the user to complete the self-identification question (instead of ability to opt-out); (2) adding questions to understand if the patient has consented to a nonpatient author sharing information via the OurNotes questionnaire; and/or (3) including separate sections for patient and care partners to complete when a nonpatient author is completing OurNotes.

Revisiting the Integrative Framework and Opportunities for Sustainable Interventions

This study describes the refinement, piloting, and early feasibility of an adaptation of the OurNotes intervention as a portal-based pre-visit questionnaire that enables the person completing the questionnaire to self-identify. Findings suggest that OurNotes can be an important method for enhancing Relational Coordination.^8,9 As shown in Fig. 3, the health system patient portal messaging function (a technology) is the conduit to portal users who engage with the message and its structured pre-visit questionnaire (a tool) to identify who is reporting on behalf of the patient in the context of agenda setting (a task). Our adaptation — identifying who is completing the form — seeks to improve interpersonal processes to facilitate accurate communication by information sharing regarding who completes the OurNotes agenda setting questions, thus producing shared knowledge about who is involved in visit agenda setting. These impacts on interpersonal processes between clinicians, care partners, and patients may have subsequent impacts on multi-level outcomes relevant to care quality that may be measured in future research.

Figure 3.

Integrative framework for consumer health information technology. A description of the adapted OurNotes agenda setting questionnaire is mapped to an integrative framework for Consumer Health Information Technology.⁹

More broadly, sustainable health system interventions are needed that can increase care partner opportunities for agenda setting, communication, and care coordination, especially as part of person-centered dementia care.¹⁸ In cases where the care partner is part of the support network of a patient with dementia, their input is critical. Care partners hold information that the patient may not be able to convey and that may be invisible to the clinician. Care partners may have information about care received outside of the health care system, new or worsening symptoms, or other major life changes. These blind spots can result in care that is fragmented and fundamentally unsafe.¹⁹ Establishing reliable and easily accessible avenues for care partners to communicate with clinicians can help ensure that the care team has the information it needs to provide person-centered care.

Potential Clinical Implications and next Steps

The findings that nonpatient authors provided more information and/or initiated questions related to a broader range of health, functional, social support, and caregiving topics suggest that the adapted OurNotes could be a feasible and effective means of engaging care partners in the care of older adults. A next step is to evaluate whether older adults with care partners who help fill out the agenda setting questionnaire have more comprehensive care discussions during visits, longitudinal care coordination, or improvement in other patient- or care partner-relevant outcomes. Future work will also consider the potential opportunities of expanding this self-identification approach to other patient populations for whom shared access to the patient portal is especially relevant, such as those aged 14–18 years¹⁶ and those with higher medical complexity across the life span. Additional practical education and support within health care systems should also focus on engaging patients to help trusted care partners obtain their own patient portal identity credentials (i.e., proxy/shared access to the patient’s portal account).

Limitations

This is a single clinic study at one integrated health system that has implemented a system-wide agenda setting questionnaire and has clinicians who have some baseline experience with OurNotes. The evaluation included a cross-sectional review of adapted OurNotes use, and thus is not able to assess changes in use of the self-identification question over time. Additionally, as described above, a drawback to OurNotes is that portal users (including both patients and/or care partners) may choose to skip over some or all OurNotes questions, which affects the potential reach of OurNotes. Future analyses of OurNotes should evaluate whether there are systematic patterns among users (patients or non-patient authors) who choose to leave the self-identification question blank. The study did not survey all clinicians in the clinic to assess how often clinicians viewed the OurNotes information, either prior to or during the clinical visit. Additionally, we did not audio-record clinical visits to determine whether patients (and care partners, when present), and clinicians discussed information provided via OurNotes. Especially in the context of dementia, a close examination of the triadic communication between patients with dementia, care partners, and clinicians could inform whether and how clarifying the identity of involved parties in a portal-based agenda setting intervention effects the quality of communication, dementia care, and patient- and care partner-level outcomes.

CONCLUSION

Most patient portal tools and agenda setting interventions do not explicitly engage care partners.²⁰ With patient and care partner input, we refined a portal-based pre-visit questionnaire to add a self-identification question that allows the person completing the questionnaire to provide their identity to the clinical team. Findings indicate that this new self-identification question improved transparency and engagement of care partners who accompany older adults to primary care visits and highlight the important role that care partners can play in increasing sharing of information as part of patient care through use of the patient portal.

Supplementary Information

Below is the link to the electronic supplementary material.

Funding

This work was supported by the National Institute on Aging R35AG072310 to JLW, K01AG61275 to CAR, and T32AG066576 which supported the effort of AW, DSP, and JMS. HDL was supported by the National Institute on Aging (NIA) of the National Institutes of Health under Award Number K24AG084999 and U54AG063546, which funds NIA Imbedded Pragmatic Alzheimer’s Disease and AD-Related Dementias Clinical Trials Collaboratory (NIA IMPACT Collaboratory). Use of REDCap was supported through NCATS Colorado CTSA Grant Number UL1 TR002535. Its contents are the authors’ sole responsibility and do not necessarily represent official NIH views.

Declarations:

Conflict of Interest:

CT Lin reports serving as an unpaid advisory board member to Doximity Telehealth and Epic Physician Advisory Council. Hillary Lum reports serving as Editor-in-Chief of Palliative Medicine Reports. The remaining authors have nothing to disclose.