{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T10:10:08Z","timestamp":1775124608645,"version":"3.50.1"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"5","funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01LM012355"],"award-info":[{"award-number":["R01LM012355"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Objective:US health care institutions are implementing secure websites (patient portals) to achieve federal Meaningful Use (MU) certification. We sought to understand efforts to implement portals in \u201csafety net\u201d health care systems that provide services for low-income populations.<\/jats:p>\n               <jats:p>Materials and Methods:Our rapid ethnography involved visits at 4 California safety net health systems and in-depth interviews at a fifth. Visits included interviews with clinicians and executives (n\u2009=\u200912), informal focus groups with front-line staff (n\u2009=\u200935), observations of patient portal sign-up procedures and clinic work, review of marketing materials and portal use data, and a brief survey (n\u2009=\u200945).<\/jats:p>\n               <jats:p>Results:Our findings demonstrate that the health systems devoted considerable effort to enlisting staff support for portal adoption and integrating portal-related work into clinic routines. Although all health systems had achieved, or were close to achieving, MU benchmarks, patients faced numerous barriers to portal use and our participants were uncertain how to achieve and sustain \u201cmeaningful use\u201d as defined by and for their patients.<\/jats:p>\n               <jats:p>Discussion:Health systems\u2019 efforts to achieve MU certification united clinic staff under a shared ethos of improved quality of care. However, MU\u2019s assumptions about patients\u2019 demand for electronic access to health information and ability to make use of it directed clinics\u2019 attention to enrollment and message routing rather than to the relevance and usability of a tool that is minimally adaptable to the safety net context.<\/jats:p>\n               <jats:p>Conclusion:We found a mismatch between MU-based metrics of patient engagement and the priorities and needs of safety net patient populations.<\/jats:p>","DOI":"10.1093\/jamia\/ocx015","type":"journal-article","created":{"date-parts":[[2017,2,15]],"date-time":"2017-02-15T08:56:51Z","timestamp":1487149011000},"page":"903-912","source":"Crossref","is-referenced-by-count":42,"title":["Meaningful use in the safety net: a rapid ethnography of patient portal implementation at five community health centers in California"],"prefix":"10.1093","volume":"24","author":[{"given":"Sara L","family":"Ackerman","sequence":"first","affiliation":[{"name":"Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA"}]},{"given":"Urmimala","family":"Sarkar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Zuckerberg San Francisco General Hospital and University of California, San Francisco, CA, USA"}]},{"given":"Lina","family":"Tieu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Zuckerberg San Francisco General Hospital and University of California, San Francisco, CA, USA"}]},{"given":"Margaret A","family":"Handley","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA"}]},{"given":"Dean","family":"Schillinger","sequence":"additional","affiliation":[{"name":"Department of Medicine, Zuckerberg San Francisco General Hospital and University of California, San Francisco, CA, USA"}]},{"given":"Kenneth","family":"Hahn","sequence":"additional","affiliation":[{"name":"Department of Medicine, Zuckerberg San Francisco General Hospital and University of California, San Francisco, CA, USA"}]},{"given":"Mekhala","family":"Hoskote","sequence":"additional","affiliation":[{"name":"Department of Medicine, Zuckerberg San Francisco General Hospital and University of California, San Francisco, CA, USA"}]},{"given":"Gato","family":"Gourley","sequence":"additional","affiliation":[{"name":"Department of Medicine, Zuckerberg San Francisco General Hospital and University of California, San Francisco, CA, USA"}]},{"given":"Courtney","family":"Lyles","sequence":"additional","affiliation":[{"name":"Department of Medicine, Zuckerberg San Francisco General Hospital and University of California, San Francisco, CA, USA"}]}],"member":"286","published-online":{"date-parts":[[2017,3,15]]},"reference":[{"key":"2020110612444682300_ocx015-B1","doi-asserted-by":"crossref","first-page":"e162","DOI":"10.2196\/jmir.2238","article-title":"The impact of electronic patient portals on patient care: a systematic review of controlled trials","volume":"14","author":"Ammenwerth","year":"2012","journal-title":"J Med Internet Res."},{"key":"2020110612444682300_ocx015-B2","unstructured":"Centers for Medicare and Medicaid Services. Stage 2 Overview Tip Sheet. 2012. https:\/\/www.cms.gov\/regulations-and-guidance\/legislation\/ehrincentiveprograms\/downloads\/stage2overview_tipsheet.pdf. Accessed July 15, 2016."},{"key":"2020110612444682300_ocx015-B3","unstructured":"Patel\n              V\n            , BarkerW, SiminerioE.\nDisparities in individuals\u2019 access and use of health IT in 2013. Office of the National Coordinator for Health IT. Washington, DC; 2015. https:\/\/www.healthit.gov\/sites\/default\/files\/briefs\/oncdatabrief26june2015consumerhealthit.pdf. Accessed September 12, 2016."},{"key":"2020110612444682300_ocx015-B4","doi-asserted-by":"crossref","first-page":"e275","DOI":"10.2196\/jmir.4847","article-title":"Barriers and facilitators to online portal use among patients and caregivers in a safety net health care system: a qualitative study","volume":"17","author":"Tieu","year":"2015","journal-title":"J Med Internet Res."},{"key":"2020110612444682300_ocx015-B5","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/1741-7015-9-45","article-title":"Studying technology use as social practice: the untapped potential of ethnography","volume":"9","author":"Greenhalgh","year":"2011","journal-title":"BMC Med."},{"key":"2020110612444682300_ocx015-B6","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1186\/s12913-014-0607-0","article-title":"Ethnographic process evaluation in primary care: explaining the complexity of implementation","volume":"14","author":"Bunce","year":"2014","journal-title":"BMC Health Services Res."},{"key":"2020110612444682300_ocx015-B7","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1186\/1472-6963-10-348","article-title":"Ethnographic study of ICT-supported collaborative work routines in general practice","volume":"10","author":"Swinglehurst","year":"2010","journal-title":"BMC Health Services Res."},{"key":"2020110612444682300_ocx015-B8","first-page":"14","article-title":"Using rapid ethnography to support the design and implementation of health information technologies","volume":"215","author":"Ackerman","year":"2015","journal-title":"Stud Health Technol Inform."},{"key":"2020110612444682300_ocx015-B9","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/S1386-5056(99)00011-8","article-title":"Patient care information systems and health care work: a sociotechnical approach","volume":"55","author":"Berg","year":"1999","journal-title":"Int J Med Inform."},{"key":"2020110612444682300_ocx015-B10","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1001\/jama.293.10.1261","article-title":"Computer technology and clinical work: still waiting for Godot","volume":"293","author":"Wears","year":"2005","journal-title":"JAMA."},{"key":"2020110612444682300_ocx015-B11","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1525\/maq.1996.10.4.02a00100","article-title":"New bottles, old wine: hidden cultural assumptions in a computerized explanation system for migraine sufferers","volume":"10","author":"Forsythe","year":"2007","journal-title":"Med Anthropol Quart."},{"key":"2020110612444682300_ocx015-B12","first-page":"205","article-title":"The description of technical objects","volume-title":"Shaping Technology\/Building Society","author":"Akrich","year":"1992"},{"key":"2020110612444682300_ocx015-B13","doi-asserted-by":"crossref","first-page":"2378","DOI":"10.1016\/j.socscimed.2012.09.013","article-title":"Benefit or burden? A sociotechnical analysis of diagnostic computer kiosks in four California hospital emergency departments","volume":"75","author":"Ackerman","year":"2012","journal-title":"Social Sci Med."},{"key":"2020110612444682300_ocx015-B14","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/1748-5908-6-6","article-title":"Why is it difficult to implement e-health initiatives? A qualitative study","volume":"6","author":"Murray","year":"2011","journal-title":"Implement Sci."},{"key":"2020110612444682300_ocx015-B15","doi-asserted-by":"crossref","first-page":"e1000360","DOI":"10.1371\/journal.pmed.1000360","article-title":"Why do evaluations of ehealth programs fail? an alternative set of guiding principles","volume":"7","author":"Greenhalgh","year":"2010","journal-title":"PLoS Med."},{"key":"2020110612444682300_ocx015-B16","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1016\/S1386-5056(01)00200-3","article-title":"Implementing information systems in health care organizations: myths and challenges","volume":"64","author":"Berg","year":"2001","journal-title":"Int J Med Inform."},{"key":"2020110612444682300_ocx015-B17","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1111\/j.1468-0009.2009.00578.x","article-title":"Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method","volume":"87","author":"Greenhalgh","year":"2009","journal-title":"Milbank Quart."},{"key":"2020110612444682300_ocx015-B18","first-page":"78","article-title":"Undertaking sociotechnical evaluations of health information technologies","volume":"21","author":"Cresswell","year":"2014","journal-title":"Inform Primary Care."},{"key":"2020110612444682300_ocx015-B19","unstructured":"American Medical Association. Health IT Readiness Survey. https:\/\/www.stepsforward.org\/modules\/ehr-software-vendor-selection. Accessed December 2, 2016."},{"key":"2020110612444682300_ocx015-B20","volume-title":"Basics of Qualitative Research","author":"Corbin J, Strauss A","year":"2007"},{"key":"2020110612444682300_ocx015-B21","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1023\/A:1020909529486","article-title":"A purposeful approach to the constant comparative method in the analysis of qualitative interviews","volume":"36","author":"Boeije","year":"2002","journal-title":"Qual Quant."},{"key":"2020110612444682300_ocx015-B22","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1177\/0018720814549238","article-title":"The usability of electronic personal health record systems for an underserved adult population","volume":"57","author":"Czaja","year":"2015","journal-title":"Hum Factors."},{"key":"2020110612444682300_ocx015-B23","first-page":"1","article-title":"Online patient websites for electronic health record access among vulnerable populations: portals to nowhere?","volume":"0","author":"Tieu","year":"2016","journal-title":"J Am Med Inform Assoc."},{"key":"2020110612444682300_ocx015-B24","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1007\/s11606-011-1728-3","article-title":"Disparities in enrollment and use of an electronic patient portal","volume":"26","author":"Goel","year":"2011","journal-title":"JGIM."},{"key":"2020110612444682300_ocx015-B25","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1001\/archinternmed.2011.34","article-title":"The digital divide in adoption and use of a personal health record","volume":"171","author":"Yamin","year":"2011","journal-title":"Arch Intern Med."},{"key":"2020110612444682300_ocx015-B26","doi-asserted-by":"crossref","first-page":"S162","DOI":"10.1016\/j.amepre.2011.01.005","article-title":"Promise of and potential for patient-facing technologies to enable meaningful use","volume":"40","author":"Ahern","year":"2011","journal-title":"Am J Prevent Med."},{"key":"2020110612444682300_ocx015-B27","doi-asserted-by":"crossref","first-page":"e258","DOI":"10.2196\/jmir.3698","article-title":"Characteristics of patient portals developed in the context of health information exchanges: early policy effects of incentives in the meaningful use program in the United States","volume":"16","author":"Otte-Trojel","year":"2014","journal-title":"J Med Internet Res."}],"container-title":["Journal of the American Medical Informatics Association"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/24\/5\/903\/34149257\/ocx015.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jamia\/article-pdf\/24\/5\/903\/34149257\/ocx015.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,11,6]],"date-time":"2020-11-06T18:23:11Z","timestamp":1604686991000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jamia\/article\/24\/5\/903\/3072321"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,3,15]]},"references-count":27,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2017,3,15]]},"published-print":{"date-parts":[[2017,9,1]]}},"URL":"https:\/\/doi.org\/10.1093\/jamia\/ocx015","relation":{},"ISSN":["1067-5027","1527-974X"],"issn-type":[{"value":"1067-5027","type":"print"},{"value":"1527-974X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2017,9]]},"published":{"date-parts":[[2017,3,15]]}}}