Table 1.

Key questions and decisions for planning and implementation of an inpatient portal

Key questionsOur decisions
What hardware, security and infection control measures are needed?A tablet was purchased for every hospital bed. A device management software secures tablets and their contents, and allows for updating. The tablets have a protective cover and are stored in a charging dock at the nursing station on each unit when not allocated to a patient. A nurse collects the tablet upon discharge. The unit secretary wipes each tablet with a disinfectant wipe and clears the tablet's data.
Which patients should be offered a tablet and how will proxy access be managed?For children <12 years old, the tablet is offered to the legal guardian. For adolescents and adults, the tablet is offered to the patient. Patients with altered mental status, eating disorders or with concerns of abuse or neglect are excluded.
Who is responsible for providing and orienting the patient or caregiver to the inpatient portal application?Unit secretaries scan and link a tablet to the patient's EHR on admission. Nurses then offer the tablet to the patient or caregiver, log it in with them, and review the portal and response time expectations. A self-guided orientation and frequently asked questions tab are also included.
Is staff information going to be shared?Photos are included of the staff that are taking care of the patient. Staff can have their full name or just first name and last initial displayed.
What test results will be released and at what frequency?Inpatient laboratory results are released every 30 minutes from 7am–11pm. Links to reference ranges and education are provided. Pregnancy, sexually transmitted infection, culture, pathology, tumour marker and radiology results are not released.
Will patients be allowed to send messages or requests? If so, what are response expectations?The unit secretary triages all requests and messages. Response times are 15–30 minutes for requests and 60 minutes for messages. Messages are typically addressed during the nursing bedside hourly rounding.
What will be included in the patients' schedule?Approximate times for medication administration, laboratory collection, therapies, radiology and procedures are included.
What educational materials will be available and where will they come from?We include basic admission and safety education for all patients. Links are also available for more information on diagnoses, laboratory results and medication information.
Will patients be allowed to audio- or video-record staff?As per hospital policy, patients or caregivers are allowed to audio- or video-record staff with their permission. Videos and notes are sent to the patient's ambulatory patient portal upon discharge.
What other apps be included on the tablet?A few apps that are free of charge, do not collect identifying information and are appropriate for all ages are included.
How will staff be trained?An online, didactic learning module and in-person, hands-on training was required for nurses and unit secretaries. Training included a description of the inpatient portal, rationale for using it (including feedback from patients and staff on the pilot unit), staff expectations, and time to practise using it, ask questions and give feedback. Standardised job description instructions were also developed. Brief, informational sessions were given to inform physicians and other staff.
  • EHR = electronic health record.