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Background Comprehensive multi-institutional patient portals that provide patients with web-based access to their data from across the health system have been shown to improve the provision of patient-centered and integrated care. However, several factors hinder the implementation of these portals. Although barriers and facilitators to patient portal adoption are well documented, there is a dearth of evidence examining how to effectively implement multi-institutional patient portals that transcend traditional boundaries and disparate systems. Objective This study aims to explore how the implementation approach of a multi-institutional patient portal impacted the adoption and use of the technology and to identify the lessons learned to guide the implementation of similar patient portal models. Methods This multimethod study included an analysis of quantitative and qualitative data collected during an evaluation of the multi-institutional MyChart patient portal that was deployed in Southwestern Ontario, Canada. Descriptive statistics were performed to understand the use patterns during the first 15 months of implementation (between August 2018 and October 2019). In addition, 42 qualitative semistructured interviews were conducted with 18 administrative stakeholders, 16 patients, 7 health care providers, and 1 informal caregiver to understand how the implementation approach influenced user experiences and to identify strategies for improvement. Qualitative data were analyzed using an inductive thematic analysis approach. Results Between August 2018 and October 2019, 15,271 registration emails were sent, with 67.01% (10,233/15,271) registered for an account across 38 health care sites. The median number of patients registered per site was 19, with considerable variation (range 1-2114). Of the total number of sites, 55% (21/38) had ≤30 registered patients, whereas only 2 sites had over 1000 registered patients. Interview participants perceived that the patient experience of the portal would have been improved by enhancing the data comprehensiveness of the technology. They also attributed the lack of enrollment to the absence of a broad rollout and marketing strategy across sites. Participants emphasized that provider engagement, change management support, and senior leadership endorsement were central to fostering uptake. Finally, many stated that regional alignment and policy support should have been sought to streamline implementation efforts across participating sites. Conclusions Without proper management and planning, multi-institutional portals can suffer from minimal adoption. Data comprehensiveness is the foundational component of these portals and requires aligned policies and a key base of technology infrastructure across all participating sites. It is important to look beyond the category of the technology (ie, patient portal) and consider its functionality (eg, data aggregation, appointment scheduling, messaging) to ensure that it aligns with the underlying strategic priorities of the deployment. It is also critical to establish a clear vision and ensure buy-ins from organizational leadership and health care providers to support a cultural shift that will enable a meaningful and widespread engagement.

BACKGROUND Comprehensive multi-institutional patient portals that provide patients with web-based access to their data from across the health system have been shown to improve the provision of patient-centered and integrated care. However, several factors hinder the implementation of these portals. Although barriers and facilitators to patient portal adoption are well documented, there is a dearth of evidence examining how to effectively implement multi-institutional patient portals that transcend traditional boundaries and disparate systems. OBJECTIVE This study aims to explore how the implementation approach of a multi-institutional patient portal impacted the adoption and use of the technology and to identify the lessons learned to guide the implementation of similar patient portal models. METHODS This multimethod study included an analysis of quantitative and qualitative data collected during an evaluation of the multi-institutional MyChart patient portal that was deployed in Southwestern Ontario, Canada. Descriptive statistics were performed to understand the use patterns during the first 15 months of implementation (between August 2018 and October 2019). In addition, 42 qualitative semistructured interviews were conducted with 18 administrative stakeholders, 16 patients, 7 health care providers, and 1 informal caregiver to understand how the implementation approach influenced user experiences and to identify strategies for improvement. Qualitative data were analyzed using an inductive thematic analysis approach. RESULTS Between August 2018 and October 2019, 15,271 registration emails were sent, with 67.01% (10,233/15,271) registered for an account across 38 health care sites. The median number of patients registered per site was 19, with considerable variation (range 1-2114). Of the total number of sites, 55% (21/38) had ≤30 registered patients, whereas only 2 sites had over 1000 registered patients. Interview participants perceived that the patient experience of the portal would have been improved by enhancing the data comprehensiveness of the technology. They also attributed the lack of enrollment to the absence of a broad rollout and marketing strategy across sites. Participants emphasized that provider engagement, change management support, and senior leadership endorsement were central to fostering uptake. Finally, many stated that regional alignment and policy support should have been sought to streamline implementation efforts across participating sites. CONCLUSIONS Without proper management and planning, multi-institutional portals can suffer from minimal adoption. Data comprehensiveness is the foundational component of these portals and requires aligned policies and a key base of technology infrastructure across all participating sites. It is important to look beyond the category of the technology (ie, patient portal) and consider its functionality (eg, data aggregation, appointment scheduling, messaging) to ensure that it aligns with the underlying strategic priorities of the deployment. It is also critical to establish a clear vision and ensure buy-ins from organizational leadership and health care providers to support a cultural shift that will enable a meaningful and widespread engagement. CLINICALTRIAL

UNSTRUCTURED Large scale investments in patient portal implementations are increasing in prevalence in an effort to support the shift towards patient-centered care alongside system modernization. Patient portals are secure online platforms that allow patients access to their clinical information owned and maintained by a single or multiple healthcare organizations. They are related to but distinct from personal health records, which facilitate patient access to data owned and managed by patients. Despite the promise of improved patient satisfaction and widespread examination of the barriers and facilitators to adoption, realization of benefits is often precluded by suboptimal engagement. This viewpoint outlines core considerations for the design, development, and implementation of patient portals that stem beyond the technology itself and consider the influence of user priorities, organizational context, and the socio-political environment. We discuss key considerations for implementation which include: 1) Technology (the technology’s design and selection); 2) Implementation (the consideration of patient, provider, and organizational factors); and 3) System Enablers (the sociopolitical factors that influence sustainability). We conclude by outlining evidence-based recommendations for decision-makers and system administrators to guide the introduction and implementation of patient portals in their local setting.

Metaphors are cognitive instruments with the capacity to influence how humans think about the world. Guiding our representations and shaping our experiences, metaphor is of anthropological interest...

Anonymity, according to Tilley and Woodthorpe, refers to removing or obscuring participant information, whereas “confidentiality refers to the management of private information.” Both are major considerations for ethics review boards, but can be challenges when “studying up” in qualitative research because of the depth, precision, and uniqueness of the information, and the prominence of research participants. In anthropology, providing detailed and nuanced accounts of particular spaces, events, and conditions is essential. Actions taken to hide or gloss over these particulars would impede the ability to demonstrate authenticity, validity, and verisimilitude. As social science moves into field sites such as cutting-edge genomics, where when studying up, participants through their particular contributions might be identified, strategies to decrease the friction between descriptive methodologies and the requirement for anonymity need to be developed. We conclude with recommendations for researchers and members of research ethics boards regarding how to anticipate and mitigate this tension.

Advancements in biotechnology provoke fundamental questions about the relationship of humans to the natural world. A crisis arises as the knowledge, practice, and policies concerning biotechnology grow further out of step with each other. This paper examines the role of ritual performance as a means of resolving this crisis, uniting the organic with the socio-moral aspects of science, technology and regulatory policy. Ritual performance is evident in the public discussions of the United States’ Secretary’s Advisory Committee on Xenotransplantation (SACX). In an attempt to understand the cultural responses to new knowledge, this paper examines the transcripts of several SACX meetings for its ritual elements and references to authority. We find that time is used by scientists to structure ritual performance in a way that guides public policy and attitudes toward xenotransplantation.