Medical Decision Making, Patient Generated Images and Patient Portals

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Electronic health record (EHR) patient portals are a secure electronic method of communicating with health care providers. In addition to sending secure messages, images and videos generated by families can be sent to providers securely. All communications sent via patient portals are stored in the EHR. With the widespread use of smart phones, there has been an increase in patient generated images [PGI] sent to providers via patient portals. There are few studies that have evaluated the role of PGIs in medical decision making, especially in pediatrics.


Our objectives were to 1) Characterize PGI sent to providers via a patient portal, 2) Determine how often PGI affected medical decision making, and 3) Determine the rate of irrelevant PGI sent via patient portal.


A retrospective chart review of PGI uploaded to Dayton Children’s Hospital’s patient portal from Jan 2011 to Nov 2016 was conducted. Data collected included patient demographics, number and type of images sent, person sending images (patient or parent/guardian), and whether an image affected medical decision making. Images were classified as medical related (e.g. blood glucose readings, skin rashes), non-medical or administrative related (e.g. medical clearance or insurance forms), and irrelevant (e.g. self-portraits, camp pictures).


Sixty-one patients/parents used the portal a total of 204 times, sending 277 images over the study period. Mean (SD) patient age was 11.1 (5.6) years, 54% were female, 95% were white, and 84% had private insurance. Sixteen percent of images were sent directly by patients and the rest by parents/guardians. A total of 222 (80%) images were sent for medical related reasons, 18% for non-medical, and 2% were deemed irrelevant images. Of the 222 medical related images, 161 (73%) affected medical decision making, while 31 (14%) did not. For the remaining 13% it was unclear if medical decision making was affected.


PGI affected medical decision making in the majority of cases. Racial and SES differences may exist regarding use and access to patient portals. Additional studies are needed to characterize use of PGI in the pediatric population. This knowledge may be helpful in leveraging technology to reduce health care costs, promote patient engagement, improve health outcomes and reduce disparities.


Abstract for this presentation can be found in this back catalog.