Samples / NURS FPX 4045 / Assessment 3
Annotated Bibliography
NURS FPX 4045 · Assessment 3
Sample for study and reference. Ace My Assessment is an independent academic support service.
Nurses now use telehealth and patient portal technologies to provide care for patients as well as manage their health as more than just a significant technological advancement in nursing practice; these tools also allow practitioners greater access to information about their patient's status at any given time. My decision to research this area stems from my interest in improving patient engagement in managing their chronic illnesses using digital resources such as portals or telehealth. The approach I took when conducting my literature search consisted of searching within CINAHL, PubMed,JMIR and Sage Journals, and Science Direct databases with the following search terms; telehealth patient portal nursing, barriers to patient portal activation, disparities in telehealth access in rural communities, portal outreach for diabetic retinopathy, portal outreach for glaucoma and privacy issues associated with telehealth. Additionally, I was limited to those articles published after January 1, 2021 through December 31, 2025. The five articles I chose to include in this research represent a broad spectrum, but still cohesive body of evidence regarding access to telehealth services, patient portal usage/engagement, types of outreach methodologies used in telehealth settings and the privacy issues that exist between nurses and their multidisciplinary team members.
Annotation Elements
Francke, J. A., Groden, P., Ferrer, C., Bienstock, D., Tepper, D. L., Chen, T. P., Sanky, C., Grogan, T. R., & Weissman, M. A. (2022). Remote enrollment into a telehealth-delivering patient portal: Barriers faced in an urban population during the COVID-19 pandemic. Health and Technology, 12, 227–238. https://doi.org/10.1007/s12553-021-00614-x
In achieving access to telehealth for patients of different backgrounds, patient portal enrollment is an important foundational element. Researchers conducted a retrospective cohort study that assessed remote patient portal enrollment barriers at Mt Sinai Beth Israel Hospital in NYC from March 2020 through May 2020 during the initial stages of COVID-19. Students were recruited as volunteers to telephone 324 recently discharged patients and try to get them enrolled in the MyChart portal for telehealth follow-up after discharge. Of these 277 patients eligible for enrollment, only 39 patients (14%) were successfully enrolled remotely, where the most significant barrier was the inability to contact patients, representing 51% of all barriers to remote enrollment. Other remote enrollment barriers included lack of follow-up (29%), loss of interest (21%), technological limitations (9%), language barriers (7%), and health status preventing engagement. Males and patients aged 40 to 59 were significantly less likely to have been successfully enrolled. Of the successful remote enrollments, 72% of them were completed through a healthcare proxy rather than by the patient. Patient portal access supports telehealth capacity directly, and this study demonstrates that targeted support strategies are required in addition to remote enrollment alone. Nurses and the interdisciplinary team will find this study relevant because it will help them understand that in order to achieve equity in telehealth participation, nurses need to actively work to resolve barriers to digital access, especially among males, working age adults, and non-English speaking populations. This article provides an initial rigorously conducted examination of the barriers to remote portal enrollment in an urban population and gives nurses/health systems actionable demographic targets to improve telehealth infrastructure and reduce disparities in digital health.
Kyytsonen, M., Vehko, T., Jylha, V., & Kinnunen, U.-M. (2024). Privacy concerns among the users of a national patient portal: A cross-sectional population survey study. International Journal of Medical Informatics, 183, e105336. https://doi.org/10.1016/j.ijmedinf.2023.105336
Privacy issues are a major problem for healthcare organizations, but there has been very little research done recently to explore how patients feel about their health information being stored with a third party. This large cross-sectional study of the Finnish Commissioner of Health Services focused on whether people were concerned about their privacy when using the electronic patient portal "My Kanta Pages," which is a service provided by the Finnish government Libraries. Researchers analyzed population survey data collected from January 1, 2020, to December 31, 2021, on 3,731 patient portal users to answer the question: What factors influence how do patients view their privacy? They used logistic regression with population weights to examine the multiple variables associated with patient portal users experiencing privacy concerns. According to this analysis, 33% of patient portal users had privacy concerns. The presence of privacy concerns was highest among: those 50 to 59 years of age; those who cannot afford basic necessities and/or have had difficulty paying for health care; and those who lack digital skills and/or have never received assistance or guidance in using technology for telehealth services. Telehealth was perceived by some patients as being beneficial; therefore, those patients did not express concerns about privacy when using the patient portal system. In addition, patients with good digital skills had a 0.7 odds ratio for experiencing privacy concerns when compared to patients without digital skills. Privacy concern is not directly correlated to how frequently patients use the patient portal system because patients may continue to use the patient portal system while still having privacy concerns.
Rowe Ferrara, M., Intinarelli-Shuler, G., & Chapman, S. A. (2025). Video and telephone telehealth use and web-based patient portal activation among rural-dwelling patients: Retrospective medical record review and policy implications. Journal of Medical Internet Research, 27, e67226. https://doi.org/10.2196/67226
Due to its ability to eliminate certain barriers to healthcare such as clinician shortages, rising costs of transport, etc., telehealth has enormous potential to help close the gap associated with rural health disparities. However, significant barriers, continue to confront rural health patients and their ability to access telehealth / telemedicine services. A retrospective review of the medical records of 9,369 California residents over 18 who were seen by a large urban-based medical provider using telemedicine from December 2021 through December 2022 was performed. The study was able to assess demographic and telehealth encounter characteristics (e.g. use of videoconferencing vs. telephone format, and utilization of the patient portal). About 92.9% of encounters with this specific urban provider were conducted using the video format. However, a higher proportion of elderly (65+ years old), Latinx, primary Spanish speaking, and Medicaid patients used the telephone format instead of video. Latinx patients had the lowest video utilization rates even though they were the youngest and were also more likely to be in a less rural area and demonstrate the greatest number of compounding barriers (i.e. language, culture, socioeconomic status). Spanish speaking patients had the lowest patient portal activation rate (77.0%) as compared to English speaking patients (92.3%). Additionally, Medicaid patients had a lower patient portal activation rate (87.8%) than privately insured patients (95.0%). The disparity in utilization of video encounters has implications for patient safety and quality of care, thus compromising quality of care for many marginalized rural patients who are dependent upon telehealth for access to specialty services.
Yip, J. Y., Geckeler, K. C., Barton, K. M., Kim, B., Choudhry, N., & Ramsey, D. J. (2025). Impact of a patient portal-based telehealth outreach program on recall of patients with diabetic retinopathy. Telemedicine and e-Health, 31(4), 459–467. https://doi.org/10.1089/tmj.2024.0454
For chronic disease management to be effective, continuity of care requires consistent follow-up. Unfortunately, losing continuity of care can be a significant barrier in clinical practice. Therefore, a retrospective cross-sectional quality improvement study of 359 diabetic retinopathy patients with history of receiving intravitreal injection (IVT) was conducted at Lahey Hospital in Massachusetts, to look at how many had missed their follow-up appointments and how long overdue they were for them. Of the 359 patients, 22% were found to have lost continuity of care and had missed their appointments for a median of 362 days prior to the study. A telehealth physician extender made contact with 67 of these patients using either secure messaging through patient portal systems (for those with active portals) or mailing letters (for those without active portals). Scheduling rates for both groups were 13% for those contacted via the patient portal and 14% for those contacted via the U.S. Postal Service; however, 100% of patients who scheduled their appointment attended. Telehealth physician extender outreach through patient portals cost $0.35 per message sent, and $5.34 per appointment completed, while mail-based outreach cost $2.19 per letter sent, and $15.33 per appointment completed, thus demonstrating a cost advantage of three times for the use of patient portals. About 75% of the portal messages sent were opened (median of 7.8 days from sent to opened), and a patient who responded to the relevant symptom questionnaire reported developing new vision symptoms and made an appointment the next day. This visit prevented further vision loss from previously undiagnosed macular edema. Patients who are lost to follow-up are much less likely to have an active portal compared to patients who are not lost to follow-up, 54.4% vs 71.2%.
Ahmed, Z., Du, A., Barton, K. M., Kim, B., Roh, S., Anjum, S., El-Aswad, A. M., & Ramsey, D. J. (2025). Impact of a patient portal-based telehealth outreach program on recall of patients with open-angle glaucoma. Telemedicine and e-Health, 32(2). https://doi.org/10.1177/15305627251393842
The ability to bring patients back to care after they have been lost to follow up is critical in preventing irreversible disease progression for patients with chronic diseases such as glaucoma. This prospective trial of quality improvement at Lahey Hospital in Massachusetts evaluated the effectiveness of patient portal recall for open-angle glaucoma patients identified as lost to follow up (n=257) compared to standard operating procedure contacts (n=60). Of 2,250 total glaucoma patients reviewed, 11.4% of patients were found to be lost to follow up, and the presence of an active patient portal was the strongest correlated factor for loss to follow up (32.0%) vs. patients not lost to follow up (22.0%). Patients who received telehealth physician extender outreach through the patient portal were nearly two times more likely to return to care compared to patients who received standard operating procedure contact (23.0% vs 11.0%). Clinical metrics comparing those who returned to those who did not show that those who returned to care had better preserved visual field mean deviation (-2.14 dB vs -4.10 dB) and greater retinal nerve fiber layer thickness (77 μm vs 73 μm). The average labor cost of sending a portal message was $0.39, while the average cost of a completed appointment was $1.68, indicating strong economic value.
Artificial Intelligence
Telehealth and patient portal technology can be greatly improved through artificial intelligence, ultimately increasing patient safety, streamlining nursing workflows, and providing efficient healthcare delivery. AI algorithms can be used in conjunction with patient portals to analyze patient portal engagement patterns, allowing healthcare providers to predict which patients will be at the highest risk of missing follow-up care prior to a missed appointment. Evidence from Yip et al., 2025, and Ahmed et al. 2025, indicates that patients who have not activated or regularly accessed their portals are substantially more likely to miss essential follow-up care for sight-threatening diseases, such as diabetic retinopathy and glaucoma. AI would allow for the identification of patients at risk of missing follow-up care and serve as a means to generate automated and personalized outreach messages via the portal, eliminating the need for manual liaison time with the physician, thereby addressing care gaps on a large scale. Additionally, AI-enhanced language translation tools within portals could be used to address the disparities highlighted by Rowe Ferrara et al., 2025, indicating that Spanish-speaking rural patients had lower rates of portal activation and video visit use. By providing the ability to translate content on a real-time basis and providing culturally sensitive education material within the portals, AI could greatly diminish the existing gaps related to equal access to telehealth services among minority populations.
Kyytsonen et al. (2024) found that almost one-third of all portal users experience significant concerns about their privacy. AI technologies, such as privacy dashboards, can give patients an accurate, straightforward summary of how their health information is being used, providing transparency and eliminating gaps in information which fuel patients' concerns for protecting their personal health information (PHI). Just like the symptom questionnaires used in Yip et al. (2025) research, AI technologies such as natural language processing (NLP) tools can screen incoming messages from patients for urgent symptom reporting so that healthcare providers can triage and respond to those patients quickly. Additionally, AI can assist telehealth providers with optimizing broadband service and providing adaptive video quality tools to improve the reliability of video visits for rural patients who have been identified by Rowe Ferrara et al. (2025) as having barriers to accessing telehealth services.
Summary of Recommendation
Based on these five peer-reviewed studies, the recommendation is that telehealth and patient portal technology should be widely adopted as a technology for delivering direct patient care within nursing and interdisciplinary health care. There are still significant racial, ethnic and language barriers for access to the telehealth systems and patient portals in the form of demographics (e.g. older adults, non-English speaking patients, Latinx patients and patients with publically funded insurance) as identified by Francke et al. (2022) and by Rowe Ferrara et al. (2025); therefore, there is a need for outreach strategies that are culturally appropriate and that target specific populations. In addition to validating effective outreach through culturally tailored means, Yip et al. (2025) and Ahmed et al. (2025) also conducted studies indicating that telehealth through patient portals is clinically effective. Specifically, their findings indicated that telehealth outreach via patient portals is more than twice as likely to result in return to care and reduces the cost of outreach by up to three times compared to traditional mail methods. The privacy concerns associated with patient portals based on the findings from Kyytsonen et al. (2024), identify the need for additional outreach and education for patients who may have privacy concerns. Of the individuals who used patient portals, one out of every three had a privacy concern. Educating individuals on improving their digital skills in addition to educating the individual on the benefits of using the portal will reduce the individual's apprehension of using the telehealth system. When implementing telehealth and patient portal technology in an organization there are organizational factors that must be considered.
Conclusion
Telehealth technologies and patient portal add to hospital systems using evidence-based, cost-effective, and patient-centered technologies to enhance nursing practice and patient outcomes in health care agencies. The five publications reviewed offer a comprehensive, current base for recommending this technology as showing effects on healthcare quality and safety, cost savings, and health equity; thus, they can clearly be seen as a crucial part of 21st century nursing and interprofessional care delivery.
References
Ahmed, Z., Du, A., Barton, K. M., Kim, B., Roh, S., Anjum, S., El-Aswad, A. M., & Ramsey, D. J. (2025). Impact of a patient portal-based telehealth outreach program on recall of patients with open-angle glaucoma. Telemedicine and e-Health, 32(2). https://doi.org/10.1177/15305627251393842
Francke, J. A., Groden, P., Ferrer, C., Bienstock, D., Tepper, D. L., Chen, T. P., Sanky, C., Grogan, T. R., & Weissman, M. A. (2022). Remote enrollment into a telehealth-delivering patient portal: Barriers faced in an urban population during the COVID-19 pandemic. Health and Technology, 12, 227–238. https://doi.org/10.1007/s12553-021-00614-x
Kyytsonen, M., Vehko, T., Jylha, V., & Kinnunen, U.-M. (2024). Privacy concerns among the users of a national patient portal: A cross-sectional population survey study. International Journal of Medical Informatics, 183, e105336. https://doi.org/10.1016/j.ijmedinf.2023.105336
Rowe Ferrara, M., Intinarelli-Shuler, G., & Chapman, S. A. (2025). Video and telephone telehealth use and web-based patient portal activation among rural-dwelling patients: Retrospective medical record review and policy implications. Journal of Medical Internet Research, 27, e67226. https://doi.org/10.2196/67226
Yip, J. Y., Geckeler, K. C., Barton, K. M., Kim, B., Choudhry, N., & Ramsey, D. J. (2025). Impact of a patient portal-based telehealth outreach program on recall of patients with diabetic retinopathy. Telemedicine and e-Health, 31(4), 459–467. https://doi.org/10.1089/tmj.2024.0454