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DCLS Application is OPEN!

A Doctorate of Clinical Laboratory Science (DCLS) from the University of Cincinnati Online is built for professionals at the baccalaureate and graduate levels seeking to expand their knowledge and skills to high-complexity laboratory positions. These can include faculty positions in education programs, governmental, or clinical laboratory settings.

Our doctorate program seeks to improve the quality, efficiency, and safety of laboratories across the nation and improve the overall quality of healthcare. Laboratory science professionals relay crucial test results to physicians and require High Complexity Laboratory Directors (HCLDs) to manage and educate those seeking to advance. This program teaches the skills needed to assume these roles and beyond. It can be considered the next step from existing online laboratory science degrees also offered online at the University of Cincinnati: Bachelor of Science in Medical Laboratory Science and Master of Science in Medical Laboratory Science Leadership .

University of Cincinnati’s Doctorate of Clinical Laboratory Science Program

The Doctorate of Clinical Laboratory Science is designed to increase diagnostic efficiency among professionals in laboratories. Whether students are clinical laboratory scientists (CLSs) or medical technologists (MTs) who have at least a bachelor’s degree, they can qualify for this program which will help them accomplish even more.

The Goal of UC’s DCLS Program

The Doctorate of Clinical Laboratory Science program’s goal is to provide students at the baccalaureate and graduate levels with additional knowledge, skills, and attributes that help medical laboratory science professionals succeed. These include attributes in leadership , education , research , and advanced practice that will allow these professionals to meet their professional goals and to maintain and improve the quality of health care nationwide. The DCLS program coursework is built to emphasize the competencies that help medical laboratory professionals serve as leaders, clinical practitioners, and educators according to the American Society for Clinical Laboratory Science (ASCLS) and the American Society for Clinical Pathology (ASCP) .

Doctorate of Clinical Laboratory Science Program Outcomes

Students who complete the DCLS program will be able to:

• Provide customized, patient-centered consultation services to help with clinical decision-making among healthcare teams for their patients.
• Monitor laboratory data, and perform tests and diagnostic procedures for patients using informatics and analytics to improve accuracy and reduce costs and errors.
• Conduct research and apply evidence to demonstrate clinical laboratory tests and algorithms to improve the quality, efficiency, and safety of testing processes.
• Educate healthcare providers and the public, including patients and their families, about the indications, evidence, preparation, and interpretation of lab testing, including at-home self-testing.
• Direct laboratory operations to comply with all state and federal laws and regulations, including guidelines determined by professional licensure boards and certification/accreditation agencies.
• Participate in public and private health policy decision-making at all organization and government levels using evidence.

Is a Doctorate in Clinical Laboratory Science the Right Choice for Me?

Are you a working laboratory professional concerned about pursuing more education due to your existing commitments at work and home? If so, this program is built just for you! The demand for laboratory professionals with the qualifications to lead and educate future professionals is only going to rise in the years to come. With a Doctorate in Clinical Laboratory Science, you can be the difference that the industry needs to ensure that quality health care is provided all across the nation!

Our program is only available during the fall cohort each year, which means it’s best to complete your application early to ensure all the admission requirements are met. Please complete and submit the form at the top of this page to get the process started!

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This program is currently applying for accreditation by the National Accrediting Agency for Clinical Laboratory Science (NAACLS) , 5600 N. River Rd, Suite 720 Rosemont IL 60018-5119.

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Students can be accepted into the Doctorate of Clinical Laboratory Science program from both the Bachelor’s and Master’s levels. Visit the DCLS program’s admission requirements page for the full requirements for both levels.

The University of Cincinnati does not require students in the online Doctorate of Clinical Laboratory Science program to travel for their required residency. The residency is designed to be completed over three semesters and can be partially completed at home and local affiliated sites depending on your location within the U.S.

Visit the DCLS curriculum page for more details on the program classes!

Professionals from ANY laboratory background can qualify for the Master’s in Medical Laboratory Science Leadership program.

Applicants must have at least ONE of the following:

• Medical Laboratory Science/Medical Laboratory Technology certification (ASCP, AMT, AABB or equivalent)
• At least 2-5 years of professional practice as a laboratory science professional or related experience.

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• Best Online Health Science Ph.D. And D.H.S. Programs

Best Online Health Science Ph.D. And D.H.S. Programs Of 2024

Published: Mar 13, 2024, 11:37am

The U.S. healthcare system can be difficult to navigate, often requiring patients to advocate for themselves in times of need. Health science is a healthcare discipline in which professionals seek to improve clinical care, education and administration, prioritizing quality care and making it easier for everyone to navigate our complicated systems.

If you’re interested in a flexible health science degree at the doctoral level, you can earn an online health science Ph.D. or an online Doctor of Health Science (D.H.Sc.). These terminal degrees prepare graduates to work in high-level administrative, managerial and research roles in the healthcare industry.

Read on to learn everything you need to know about health science doctoral degrees, including tuition, accreditation and our ranking of the 10 best doctoral programs in the field.

Why You Can Trust Forbes Advisor Education

Forbes Advisor’s education editors are committed to producing unbiased rankings and informative articles covering online colleges, tech bootcamps and career paths. Our ranking methodologies use data from the National Center for Education Statistics , education providers, and reputable educational and professional organizations. An advisory board of educators and other subject matter experts reviews and verifies our content to bring you trustworthy, up-to-date information. Advertisers do not influence our rankings or editorial content.

• 6,290 accredited, nonprofit colleges and universities analyzed nationwide
• 52 reputable tech bootcamp providers evaluated for our rankings
• All content is fact-checked and updated on an annual basis
• Rankings undergo five rounds of fact-checking
• Only 7.12% of all colleges, universities and bootcamp providers we consider are awarded

Our Methodology

We ranked 11 accredited, nonprofit colleges offering health science Ph.D. and D.H.S. programs online in the U.S. using 15 data points in the categories of credibility, affordability, student outcomes and student experience. We pulled data for these categories from reliable resources such as the Integrated Postsecondary Education Data System ; private, third-party data sources; and individual school and program websites.

Data is accurate as of June 2023. Note that because online doctorates are relatively uncommon, fewer schools meet our ranking standards at the doctoral level.

We scored schools based on the following metrics:

Student Outcomes:

• Overall graduation rate
• Median earnings 10 years after graduation

Affordability:

• In-state graduate student tuition
• In-state graduate student fees
• Alternative tuition plans offered
• Median federal student loan debt
• Percentage of students in federal student loan deferment

Student Experience:

• Student-to-faculty ratio
• Socioeconomic diversity
• Availability of online coursework
• Total number of graduate assistants
• More than 50% of graduate students enrolled in at least some distance education

Credibility:

• Fully accredited
• Programmatic accreditation status
• Nonprofit status

We chose the 10 best schools to display based on those receiving a curved final score of 61% or higher.

Find our full list of methodologies here .

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Degree Finder

Best d.h.sc. and ph.d. in health science online degrees, should you enroll in an online health science doctoral program, accreditation for online health science ph.d. and d.h.sc. programs, how to find the right online doctorate in health science for you, frequently asked questions (faqs) about online health science ph.d. and d.h.sc. programs, mcphs university, touro university worldwide, pacific university, rush university, liberty university, university of the pacific, university of south dakota, faulkner university, university of bridgeport, purdue university global, featured online schools.

Learn about start dates, transferring credits, availability of financial credit and much more by clicking 'Visit Site'

Graduate Tuition

$1,110/credit

Percentage of Grad Students Enrolled in Distance Education

Overall Graduation Rate

MCPHS University , headquartered in Boston, Massachusetts, features an online Doctor of Health Sciences with concentrations in health systems administration, educational leadership and global health. This 54-credit degree prepares students for professional roles in education and leadership.

After completing core coursework in innovative healthcare technology, patient-centered care and population health, students engage with a three-part capstone experience spanning nine credits. Each online learner pays a $525 tech fee in their first semester.

• Our Flexibility Rating: Learn on your schedule
• School Type: Private
• Application Fee: N/A
• Degree Credit Requirements: 54 credits
• Program Enrollment Options: Part-time
• Notable Major-Specific Courses: Healthcare research methods, innovative healthcare technology
• Concentrations Available: Health systems administration, educational leadership, global health
• In-Person Requirements: No

$700/credit

At Los Alamitos, California-based Touro University Worldwide (TUW), students can pursue an online Doctor of Health Science with a tech-centric curriculum. The 48-credit program uses asynchronous delivery for maximum flexibility, along with accelerated courses, allowing learners to graduate more quickly.

TUW’s D.H.Sc. program suits professionals looking to pursue leadership roles in health-related contexts. Graduates go on to become health administrators, nutritionists, physical therapists and mental health specialists. This program does not provide certification or licensure, however; it instead develops the managerial skills for administrative positions in health settings.

• Application Fee: $25
• Degree Credit Requirements: 48 credits
• Program Enrollment Options: Accelerated, full-time
• Notable Major-Specific Courses: Epidemiology, health informatics
• Concentrations Available: N/A

$7,731/semester

The Doctor of Healthcare Science at Pacific University , based in Forest Grove, Oregon, serves advanced healthcare workers looking to take the next step in their professional journey. Most coursework is delivered asynchronously, with some set class times for certain real-time lectures.

Though there is no dissertation requirement, each student completes a scholarly project and presents their findings virtually. To qualify for the D.H.Sc. program, each candidate must work in a healthcare position in education, community health or direct patient care.

• Our Flexibility Rating: Learn around your 9-to-5
• Application Fee: Free
• Degree Credit Requirements: 36 credits
• Program Enrollment Options: Part-time, full-time
• Notable Major-Specific Courses: Healthcare operations management, human resource management in healthcare

$1,046/credit

RUSH University , located in Chicago, Illinois, offers an online Ph.D. in health sciences that delivers an interdisciplinary approach through classroom learning, professional development opportunities and research experience. Graduates can qualify for positions improving the quality of care for various healthcare providers.

Throughout the program, students receive mentorship from health sciences professionals. Along with an optional independent study course worth up to 12 credits, each student completes a dissertation research class and a comprehensive exam to conclude the program.

• Application Fee: $50
• Notable Major-Specific Courses: Leadership theory, composition for effective professional writing

$650/credit

Based in Lynchburg, Virginia, Liberty University features an online Ph.D. in health sciences that takes just three years to complete. Learners can choose from concentrations in exercise and sport science and trauma-informed care, or they can design an individualized pathway.

Liberty delivers coursework asynchronously, allowing students to complete assignments on their own schedules. The program culminates in a dissertation course in which each student researches an original topic of their choosing.

• Degree Credit Requirements: 60 credits
• Notable Major-Specific Courses: Healthcare delivery systems, risk management in health sciences
• Concentrations Available: General, exercise and sport science, trauma-informed care

$1,000/credit

The online Doctor of Health Science from the University of the Pacific in Stockton, California, features asynchronous coursework, which is ideal for working professionals and learners with busy schedules. This program suits healthcare professionals currently working in academic and clinical environments who are looking to advance to administrative positions.

Students can choose from healthcare leadership and educational leadership pathways. Though this program does not include a dissertation or thesis, each learner completes nine credits across three doctoral project courses, which may be submitted for presentation or publication.

• Degree Credit Requirements: 27 to 36 credits
• Notable Major-Specific Courses: Foundations of behavioral science, healthcare leadership
• Concentrations Available: Clinical leadership, educational leadership

$470/credit

The University of South Dakota (USD), located in Vermillion, features a 75-credit online Ph.D. in health sciences with a teaching focus. The teaching core includes nine to 15 credits of prescribed and elective courses, including a three-credit practicum where students apply their knowledge under supervision in real-world settings.

The remainder of the curriculum focuses on research, leadership and health services delivery. Though USD delivers coursework remotely for this program, students must attend in-person residencies, an orientation and a dissertation bootcamp, in addition to completing their practicum.

• School Type: Public
• Application Fee: $35
• Degree Credit Requirements: 75 credits
• Notable Major-Specific Courses: Leadership in healthcare, managing health services resources
• In-Person Requirements: Yes, for field experiences

$780/credit

At Montgomery, Alabama’s Faulkner University , students can pursue an accelerated online Ph.D. in health sciences and graduate in just 18 months. The program uses five-week courses and rolling admissions to meet this timeline. After completing 30 credits in one year, students complete a 15-credit dissertation process over a six-month period.

Coursework explores topics such as clinical statistics, instructional methods for health professionals, health promotion and quantitative research methods. Each online student pays a $75 distance learning fee per semester.

• Application Fee: $75
• Degree Credit Requirements: 30 credits
• Notable Major-Specific Courses: Evidence-based practice, qualitative research methods

The online Doctor of Health Sciences from the University of Bridgeport (UB), headquartered in Connecticut, takes a big-picture view of public health concerns in underserved communities. Learners can choose from clinician, nutrition and education concentrations to align their studies with their prospective professional roles.

The program culminates with a dissertation project. After receiving topic approval, each student works with an advisor to approach their dissertation as a systemic review, a meta-analysis, a literature review or original research.

• Degree Credit Requirements: 57 credits
• Notable Major-Specific Courses: Global health issues, healthcare informatics
• Concentrations Available: Clinician, nutrition, education

Headquartered in Indiana, Purdue University Global delivers an online Doctor of Health Science that allows students to earn “microcredentials” throughout the curriculum. These microcredentials cluster similar classes to develop familiarity and expertise in specific topics, such as health science, health informatics and global health.

After completing the program’s required coursework, each learner engages in an applied project in which they identify a real-world issue in administration, healthcare delivery or higher education and research potential solutions. Purdue Global charges all online learners a flat, per-credit tuition rate, regardless of their state residency status.

• Application Fee: $60
• Degree Credit Requirements: 88 credits
• Notable Major-Specific Courses: Advanced health policy, advanced health leadership
• Concentrations available: N/A

Online college can provide several benefits over in-person learning, such as increased flexibility and affordability.

However, since online programs tend to involve less structure than their in-person counterparts, learners must be organized and carefully manage their time. Synchronous coursework mirrors the in-person learning experience with set class times, while asynchronous delivery allows students to watch recorded lectures and complete assignments on their own time.

Online doctoral degrees may still have on-campus requirements, such as intensives, orientations or dissertation defenses. Ensure you can commit to visiting campus as needed.

College accreditation indicates that an institution or a degree program has received approval from a third-party accrediting organization. These accreditors evaluate schools and programs for factors such as curricular offerings, student outcomes and faculty expertise. Accreditation occurs at the institutional and programmatic levels.

The U.S. Department of Education and the Council for Higher Education Accreditation (CHEA) recognize the following organizations to provide institutional accreditation:

• Higher Learning Commission
• WASC Senior College and University Commission
• Northwest Commission on Colleges and Universities
• Southern Association of Colleges and Schools Commission on Colleges
• Middle States Commission on Higher Education
• New England Commission of Higher Education

Attending an accredited school is required if you want to pursue federal student aid or qualify for certain professional certifications. To check on the accreditation status of any prospective school, use CHEA’s directory tool.

Programmatic accreditation does not exist for health science programs at the doctoral level.

Here’s how to narrow down your options as you consider online health science doctoral programs:

Consider Your Future Goals

Your professional goals should help determine your program choice and whether you earn a Ph.D. or a D.H.Sc.

For example, some health science graduates aim to work in positions that require extensive research experience, such as college-level educator roles. Ph.D. programs are more research-oriented, so if you plan to teach after earning your doctorate in health science, consider prioritizing Ph.D.s in health science.

On the other hand, if you want to apply your doctorate in a public health role , the more practice-based D.H.Sc. might be more suitable.

Understand Your Expenses and Financing Options

Higher education requires a significant financial investment. Among the schools on this list, total tuition ranges from about $23,000 on the low end to more than $61,000, averaging roughly $41,160 for a full doctorate in health science.

To help fund your doctoral studies, submit the FAFSA ® to ensure your eligibility for federal student aid. You can also look for private loans, scholarships from third-party organizations, and fellowships or assistantships from your prospective institution.

Scholarships are provided by schools and independent organizations based on factors such as identity, merit and need. These forms of aid do not require repayment. In assistantships and fellowships, students work professionally with their schools to offset tuition costs.

Can you get a Ph.D. in science online?

American schools generally do not offer Ph.D. programs in science on campus or online. There are other science-related doctoral programs, however, which may feature online delivery.

Are online Ph.D. programs legitimate?

As long as they come from accredited institutions, online Ph.D. programs hold the same level of prestige and legitimacy as their on-campus counterparts.

How long does it take to get a Ph.D. in health sciences?

A health science Ph.D. typically takes four to seven years to complete.

Can I finish a Ph.D. in two years?

Most Ph.D. programs take longer than two years. Some schools, like Faulkner University, use accelerated delivery for students to complete their Ph.D.s in around 18 months. Other doctoral programs, like Doctor of Health Science degrees, generally take less time than Ph.D. programs.

Matt Whittle has experience writing and editing accessible education-related content in health, technology, nursing and business subjects. His work has been featured on Sleep.org, Psychology.org and NurseJournal.org.

Viewing Laboratory Test Results Online

Patients' actions and reactions.

Kate Christensen; Valerie M. Sue

J Participat Med. 2013;5 

• Abstract and Introduction

Background and Objective: This study sought to extend the existing research regarding patients' reactions to viewing laboratory test results online by: (a) investigating patients' emotional responses to viewing test results online, (b) determining what, if any, followup actions patients engaged in after viewing their test results online, and (c) examining the impact of preparatory conversations between physicians and patients on patients' emotional and behavioral responses.

Methods: An email survey of Kaiser Permanente members was conducted. Study participants were patients who had viewed at least one test result online within the past year.

Results: A total of 1,546 patients responded to the survey; response rate was 43%, completion rate was 39%. Survey participants reported high levels of satisfaction, appreciation, calm, happiness, and relief. Few experienced worry, confusion, fear, upset, or anger. The most common followup activities to viewing lab test result online were speaking with family or friends about the results, looking up information on websites, and making a graph of the pattern of test results over time. Patients whose doctors spoke with them about what to expect from their test results experienced significantly more relief, appreciation, satisfaction, happiness, calm; and, less confusion than those who did not speak with their doctors prior to viewing their results. Patients whose expectations were set by their doctors were also less likely to engage in a host of followup activities, including emailing and telephoning doctors and scheduling additional appointments.

Conclusion: This study demonstrates that patients who view their lab test results online overwhelmingly react with positive rather than negative emotions. The results also illustrate the influence of physician-patient prior communication on patients' reactions and their followup actions.

Introduction

Patient access to laboratory test results via online patient portals is growing across the United States and other countries. [ 1 ] This increasing access is being accompanied by widespread concern about patients receiving results without the intermediation of physicians. Traditionally, physicians have been responsible for explaining test results to patients and putting the results into the context of the patient's entire health picture. The concerns are that: (1) patients seeing abnormal test results will react negatively with anxiety or other harmful emotional reactions; (2) patients will not understand the results, whether normal or abnormal, and will need extra time from the physician to explain what they mean. [ 2–4 ] A corollary concern is that patients will be unnecessarily worried about the clinically insignificant results that fall outside of the reference range, or about expected results that fall out of this range, such as an International Normalized Ratio (INR) for a patient on an anticoagulant. [ 5 ]

Research evidence indicates that these concerns may be unfounded. Studies have shown that for the most part patients do not react negatively to the idea of viewing their test results online, and report that they are not concerned about the privacy of those records. [ 2 6 ] In a study focused on electronic access to medical records Pyper et al [ 7 ] discovered that although some medical terms and abbreviations did require explanation, the majority of patients in their study found the content of their medical records generally useful and easy to understand. Moreover, numerous studies have demonstrated that patient satisfaction increases as patients gain greater and faster access to their medical records. [ 8 9 ] None of these studies asked specifically about patients' emotional reactions and followup actions after seeing online test results.

Concerns that providing patients access to their electronic medical records will increase physician workload are unsubstantiated in the literature. Ross et al [ 3 ] noted that merely giving patients access to their medical records did not appreciably increase workload, and in some cases increased efficiency because patient-held records were more likely to be available at the time of appointments than hospital-held records. Similarly, Rodriguez et al [ 10 ] showed that contrary to expectations, 6 months following the implementation of an expanded offering of laboratory results on a patient portal, physicians and nurses said their workload actually decreased or stayed the same.

Although the existing literature does not support the notion that releasing laboratory test results to patients online will result in negative consequences for patients and physicians, there is still some ambiguity surrounding the potential impact of a-priori patient-physician conversations about test results. This study seeks to extend the existing evidence by: (a) investigating patients' emotional responses to viewing test results online, (b) determining what, if any, followup actions patients engaged in after viewing their test results online, and (c) examining the impact of preparatory conversations between physicians and patients on patients' emotional and behavioral responses.

J Participat Med. 2013;5 © 2013  Society for Participatory Medicine

Published here under license by The Journal of Participatory Medicine. Copyright for this article is retained by the authors, with first publication rights granted to the Journal of Participatory Medicine. All journal content, except where otherwise noted, is licensed under a Creative Commons Attribution 3.0 License. By virtue of their appearance in this open-access journal, articles are free to use, with proper attribution, in educational and other non-commercial settings.

Authors and Disclosures

Kate Christensen Kate Christensen was the Medical Director for the Kaiser Permanente website at the time of this research. Dr. Christensen is now enjoying retirement and special projects. Valerie M. Sue Valerie Sue, PhD is a Senior Manager in Strategic Market Planning at Kaiser Permanente. She is responsible for a range of projects including research surrounding patients' use of the Kaiser Permanente website. Competing Interests This research received no specific funding from any funding agency in the public, commercial or not-for-profit sectors. This research was approved by the Kaiser Permanente Northern California Institutional Review Board. The authors have no financial or non-financial, professional or personal competing interests to disclose.

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• PhD in Pathology & Laboratory Medicine

For contact information, please visit the Pathology & Laboratory Medicine website .

Pathology, the study of disease, integrates all aspects of biomedical science to further the understanding of disease processes and develop methods for diagnosis, prevention, and treatment of disease. The PhD in Pathology & Laboratory Medicine is for students who want to participate in breakthrough scientific research and contribute to the advancement of biomedical knowledge, learning how diseases work at a mechanistic level. Graduates will be prepared for postdoctoral fellowships, science writing, running a lab as a principal investigator, and shaping science policy at the government level.

Our department focuses particularly on cancer, immunologic, inflammatory, and neurologic disorders. We have a strong and diverse faculty composed of core and joint members who offer multiple research and training opportunities in experimental pathology.

Current foci of research by departmental faculty and students include:

• The development of the brain
• Disorders of brain development and normal aging
• Effects of nutrition on the developing brain
• Disorders of cell cycle and cell signaling in the pathogenesis and progression of cancer
• Normal and abnormal immunological responses to infectious agents and environmental toxins and to other stimuli
• The neuroscience of Alzheimer’s disease
• Traumatic brain injury
• The pathogenesis of asthma
• Development of immunotherapies for cancer and infectious diseases

Prospective applicants to the PhD program in Pathology must enter via the Program in Biomedical Sciences (PiBS). This program emphasizes interdisciplinary training for the first year, after which time students will be free to transition into one of the doctoral programs offered by the Department of Pathology.

Program in Biomedical Sciences (PiBS)

The Department of Pathology & Laboratory Medicine participates in the Program in Biomedical Sciences (PiBS), which offers training toward the PhD degree by integrating the foundations of interdisciplinary biomedical research with focused investigation and preparation for career advancement.

In the first year, PhD students will participate in the Foundations in Biomedical Sciences (FBS) core curriculum as well as have the opportunity to select elective courses focused on area-specific interests. Additionally, trainees will engage in laboratory rotations, journal clubs, and research seminars. Trainees will work closely with a faculty advisor in the development of an individual plan that will be tailored to serve specific research and professional goals. After selection of a laboratory, students will join the program/department with which the mentor is affiliated and continue advanced studies towards candidacy.

For more on how to apply, please visit our website .

Program Overview

The doctoral program is broadly based, offers research training in both basic and clinical investigations of disease, and encourages students to integrate the two areas where appropriate in their doctoral research. The core curriculum provides course, seminar, and laboratory opportunities for students to learn the pathogenesis, morphology, and cell and molecular biology of human diseases and laboratory techniques used to study them.

Laboratories of faculty in the department and other faculty in Graduate Medical Sciences provide opportunities for doctoral dissertation research in many aspects of the pathogenesis, diagnosis, and treatment of disease.

Students are expected to fulfill all course requirements, choose a dissertation laboratory, and begin preparatory dissertation research within four terms. They then take the qualifying examination and, if successful, present a dissertation research proposal to their faculty committee and proceed with their research. Students in the alternative tracks follow a modified curriculum in which certain departmental requirements are substituted by requirements of the respective interdepartmental program.

Our faculty members are committed to facilitating all pathology graduate students’ efficient progress through our graduate programs, in a goal-oriented manner. The student group is enthusiastic and interactive. And our graduates pursue careers in academia, biotechnology settings, government laboratories and, if also medically trained, in clinical specialties.

Specializations

In addition to the pathology curriculum, students may choose from three additional specialized tracks:

• Pathology—Cell and Molecular Biology
• Pathology—Immunology
• Pathology—Neuroscience

Specialized coursework offered through the department includes:

• Basic and Experimental Pathology
• Protein Modification and Molecular Basis of Human Diseases
• The Business of Science

Involvement with the MD/PhD Program

• Pathology regularly participates in evening sessions with the MD/PhD students where research opportunities within pathology are discussed.
• Several faculty members in pathology serve as interviewers for the MD/PhD applicants, providing a critical component since the group struggles to find sufficient MD interviewers.
• Recent MD/PhD graduates who have defended and gone back to graduate medical school are Bryan Belikoff (Remick Lab/Defended Spring 2010), Besam Khidhir (Haber/Harvard Lab/Defended Spring 2010), Chad Mayer (Kurosawa Lab/Defended Spring 2014), David Stepien (Remick Lab/Defended Spring 2013), Louis Vaickus (Remick Lab/Defended Spring 2010), Terry Hsieh (Remick Lab/Defended Spring 2016), Melody Lun (Off-Site-Childrens Hospital/Lehtinen Lab/Defended Spring 2016), Nisma Mujahid (Off-Site-Massachusetts General Hospital/Fisher Lab/Defended Spring 2017), and Daniel Kirsch (McKee Lab/Defended Spring 2024).

Program Structure

Md/phd and phd general requirements.

A course of study and laboratory experience extending over one to two years is followed by a qualifying examination, which is taken within one term after completion of required coursework. The proposal for dissertation research is then developed and presented to the dissertation committee; the proposed research extends over another two to three years and is performed under the guidance of the major advisor with the help and advice of the committee.

The Director of Graduate Studies serves as a curriculum advisor to all students in the first two years of the program and approves the course registration forms. After the required courses are completed, the student’s research advisor provides direction in the choice of additional courses.

Laboratory rotations are performed in the first year of study to:

• Acquaint students with research opportunities in the program
• Teach a variety of approaches to research and teach specific research methods
• Permit choice of a laboratory for dissertation research. The dissertation research advisor should be chosen and preliminary work in the area of research begun early in the second year of study

Sample Curriculum for PhD and MD/PhD

For first-year PiBS students interested in pathology, the following courses are recommended.

First-year fall (10–12 units)

• GMS FC 708 Professional Skills Development (2 units)
• GMS FC 711 Foundations/Protein Structure (3 units)
• GMS FC 712 Foundations/Genome Structure & Function (3 units)
• GMS MS 700 or 750 Elementary Biostatistics (2 units) (or equivalent)
• GMS PA 810/811 Business of Science (recommended) or elective (2 units)

First-year spring (10–12 units)

• GMS FC 713 Foundations/Cell Architecture & Dynamics (3 units)
• GMS FC 714 Foundations/Biomedical Sciences (3 units)
• GMS PA 510 Medical Immunology (2 units)
• GMS PA 900 Pathology Lab Rotations (2 units)

Second-year fall (10–12 units)

• GMS PA 800 Pathology Seminar (2 units)
• GMS PA 901 Pathology Research (2 units/var units)
• GMS PA 932 Histopathology (4 units)
• GMS electives (2 or 4 units)

Second-year spring (12 units)

• GMS PA 700 Basic and Experimental Pathology (4 units)
• GMS PA 801 Special Topics–Spring (2 units)
• GMS PA 901 Pathology Research (4 units/var units)
• GMS PA 910 Human Biospecimens (recommended) (2 units) or GMS elective (2 units)
• Directed Studies (units as needed)

Required to sit for the qualifying exam

• GMS FIBS I–IV

Responsible Conduct of Research (RCR) is presented by Boston University, requires participation in four sessions of two hours each (usually one session per term), and results in an NIH certificate. Summer sessions are also offered.

For second-year PiBS students interested in pathology, the following courses are required/recommended.

• GMS PA 800 Pathology Seminar (required for qualifying exam) (2 units)
• GMS electives (2 units)
• GMS PA 700 Basic and Experimental Pathology (required for qualifying exam) (4 units)
• GMS PA 901 Pathology Research (2 units)
• GMS PA 910 Human Biospecimens for Research (2 units)

For MD/PhD students interested in pathology, the following courses are required/recommended.

• GMS MS 700 or 750 Elementary Biostatistics (or equivalent) (2 units)
• GMS PA 810/811 Business of Science (recommended) (2 units) or GMS elective (2 units)
• GMS PA 801 Special Topics (2 units)

Additional Requirements

Participation and attendance in the Departmental Friday Seminar are required through all terms of study and research. Two course units are given for one term (beginning in second year for Cell Biology Track).

For all students pursuing the combined MD/PhD degree, PA 510 Immunology and PA 700 Pathology requirements are fulfilled by the medical curriculum.

Each student is required to present a seminar in the departmental seminar series in addition to their dissertation defense. This is usually done in the fourth year.

Qualifying Exams

Chobanian & Avedisian SOM Department of Pathology & Laboratory Medicine

Pathology PhD graduate students are eligible to take this compulsory examination after successfully completing the required coursework. This will typically take place at the end of second year for PhD students and at the end of third year for the MD/PhD students.

There is one exam period each year: June–July.

Written (computer-typed) examination—6–8 hours

Morning and afternoon sessions consist of essay questions based on individual coursework, directed readings, critiques of selected publications (with an emphasis on experimental design), and evaluation of pathology seminars. These study instructions are provided by the individual members of the examination committee no more than two months prior to the examination. The students are responsible for contacting the committee members. None of the suggested study material/publications can be brought to the exam. The answers will be submitted anonymously to the examiners for grading. Copies of past exams are available. All candidates will provide a list of their coursework and grades to the examination committee. Upon passing the written exam, students will proceed to the oral examination, which takes place 7–10 days after the written exam.

Oral examination—1 ½–2 hours

Exam evaluation : Pass/Fail/Conditional Pass. In the event of a conditional pass, the examining committee will define the appropriate corrective steps and a time frame for completing these steps.

After passing the qualifying examination, the graduate student will proceed with selection of their thesis committee.

Current members of the committee are: Dr. J. K. Blusztajn, Dr. B. Slack (committee chair), Dr. I. Delalle, Dr. D. Jones, and Dr. T. Mellott. Alternate member: Dr. J. Crott.

PhD Thesis/Doctoral Dissertation Committees

The committee must consist of at least five members, which includes the student’s thesis advisor. At least three members must have primary or secondary appointments in the Department of Pathology & Laboratory Medicine at the time they are asked to join the committee.

For a complete description of requirements for assembly of the committee, please visit the BU Chobanian & Avedisian School of Medicine website .

Admission & Financial Assistance

Criteria for admission.

Students must have received a baccalaureate degree from an accredited university. Additional criteria considered by the admissions committee include:

• A good academic record/GPA
• GRE test results and TOEFL for international students
• Personal statement
• Letters of references
• Interview evaluation (if invited)
• Interest level in pathology research
• All aspects of the applicant, including research experience and publications, are considered in the decision process

Financial Support

All PhD and MD/PhD students who are admitted to the program automatically receive a stipend, tuition, activity fees, and health insurance. For the 2023–2024 academic year, the stipend is $41,200.

Students are also eligible to compete for support from outside agencies, such as the National Institutes of Health, the National Science Foundation, and the Howard Hughes Medical Institute. While in graduate school, students are also eligible to compete with other GMS students for research and travel awards from the department and the Chobanian & Avedisian SOM .

Additional Opportunities

Research opportunities that provide students with the techniques and knowledge necessary to confront scientific problems

Teaching opportunities through the  Chobanian & Avedisian SOM , BU CityLab Academy, BU Metropolitan College, and Chobanian & Avedisian SOM Student Affairs office tutoring program

Departmental seminars provide students with the opportunity to hear and interact with pathologists and basic scientists from a variety of disciplines

Journal Club allows students to lead discussions about current literature, fundamental papers, or new ideas in their fields of study

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Wharton Stories

How to prepare a strong phd application.

Doctoral candidates and departmental coordinators at the Wharton School outline a few tips to help you navigate the PhD application process.

It’s no secret the application process can be intimidating. Where do you start? What exactly are schools looking for on your application? What materials do you need to submit? Doctoral candidates and departmental coordinators at the Wharton School have outlined a few tips to help you navigate the process.

Don’t Delay the Process

A successful PhD applicant starts thinking about their application months or even years before the deadlines. For Alejandro Lopez Lira , a third year student in Finance, the application process began a year before he actually submitted the paperwork. He said, “I spoke to my advisors way before, like one year before, about my letters of recommendation, where to apply, everything involved in the process.”

Each program has different requirements, which can make for a tedious process. Karren Knowlton , a third year in Management, said, “I took a little while to draft a personal statement. I had my mom, who teaches creative writing, and a few other people that I trust just read over it. Then you have to tweak it for different schools because they want slightly different things.”

Taking time to prepare your application is critical. Starting the process sooner rather than later gives you several advantages:

• It allows your letter of recommendation writers enough time in advance to thoughtfully prepare a letter that speaks to who you are as a PhD candidate.
• It gives you more time to review your materials, fix any errors, and proofread, proofread, proofread.
• Finally, it means a lot less stress when the deadline starts rapidly approaching. By planning ahead, you’ll have a much smoother process applying.

Get Letters of Recommendation

Prof. Matthew Bidwell , who previously served as the doctoral coordinator for the Management program , said a common mistake he sees are letters of recommendations from employers. Although he said it is impressive to see work experience, having an employer write a letter is not the best choice.

“We don’t pay very much attention to those because rightly or wrongly, we worry that they’re not looking for the kinds of things that we’re looking for,” he said. “If you have one, it’s not a disaster, but when you see people with two or three — most of their recommendations coming from their work — that kind of heightens our concern. You’re committing to a fairly specialized career, do you really know what that career entails?”

Instead, he suggests getting to know an academic who will be able to write a recommendation attesting to your ability to manage doctoral-level research and work.

Include Research/Work Experience in Your Field

Each program has a unique set of criteria to evaluate applicants, but several doctoral coordinators agree that some research and work experience in your field of interest will strengthen your application overall.

Prof. Fernando Ferreira , doctoral coordinator for the Business Economics and Public Policy and Real Estate programs, thinks work experience can be useful in demonstrating an applicant’s abilities. He said, “Any work experience after undergraduate school is important. If that experience is more related to research it’s even better, but work experience in general is always good.”

Prof. Guy David , doctoral coordinator for the Health Care Management & Economics program , thinks that work experience benefits applicants in terms of giving them a broader view of business. “Work experience creates retrospection about how the world works, how organizations make decisions, and how people function in various situations,” he said.

However, he warns that spending too much time away from an academic setting can have its drawbacks too. “It may lead people to start their PhD later when they are not in the habit of immersing themselves in rigorous studies and have a shorter horizons to develop a name for themselves,” he said.

Although having both research and work experience can strengthen your application, you will not be denied entry because you are lacking either.

Prof. Bidwell said, “I think research experience does give us some confidence that people have some idea about what it is that we do. In terms of work experience, I think we don’t have a strong view. We quite like work experience, but we also take people straight out of undergrad.”

Prepare for the Standardized Tests

Most PhD programs require students to take the Graduate Record Examinations (GRE). Having high test scores is a key part of an application as it tests skills learned over the course of many years in school. Quantitative skills are especially important when applying to doctoral programs in business areas. Much like any other standardized test, the GRE requires preparation.

Karren, who took the GRE twice to ensure her scores were high enough, offered advice to those who may be struggling. “I would absolutely recommend practicing the writing beforehand. Look up examples and have your outline structured,” she said. “So much of it is just getting the right structure and how you formulate your arguments so knowing what they’re looking for is key.”

Test prep can be time-consuming, but like anything else, practice makes perfect. There are multiple text books and online sites to help you prepare for the exam. Karren aimed to improve her math scores the second time she took the GRE and recommended this site to help strengthen math skills.

Taking advantage of resources to help you study can limit the number of times you need to take the GRE while ensuring you score high enough to remain in the applicant pool.

Watch a Webinar with Former Wharton Vice Dean Catherine Schrand

Posted: August 4, 2017

• Admissions and Applying
• Advancement and Transition

Doctoral Programs

Start your doctoral journey.

Whether you’re just starting your research on PhD programs or you’re ready to apply, we’ll walk you through the steps to take to become a successful PhD candidate.

Deciding to get a PhD

You might be surprised to find out what you can do with a PhD in business.

Is an Academic Career for You ? What Makes a Successful PhD Student

Preparing for the Doctoral Path

The skills, relationships, and knowledge you need to prepare yourself for a career in academics.

How the PhD Program Works How to Become a Successful PhD Applicant

Choosing the right program

What’s the difference between PhD programs? Find out how to choose one that fits your goals.

What to Consider When Choosing a Doctoral Program What Differentiates R1 Universities?

Starting an application

Tips for a successful application process.

Application Requirements Preparing Your PhD Application

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• v.4(3); 2020 Mar

Patients’ Attitudes Toward an Online Patient Portal for Communicating Laboratory Test Results: Real-World Study Using the eHealth Impact Questionnaire

Esther talboom-kamp.

1 Saltro Diagnostic Centre, Utrecht, Netherlands

2 Public Health and Primary Care Department, Leiden University Medical Centre, Leiden, Netherlands

3 National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands

Rosian Tossaint-Schoenmakers

Annelijn goedhart, anke versluis, marise kasteleyn.

Communicating laboratory test results online has several advantages for patients, such as improving clinical efficiency and accessibility, thereby helping patients to take an active role in managing their health.

This study aimed to investigate the experiences and self-efficacy of patients using an online patient portal that communicates laboratory test results.

We used the online-administered eHealth Impact Questionnaire to explore patients’ attitudes toward the portal. Patients visiting the portal were asked to complete the questionnaire. The subscale Information and Presentation assessed the usability of the patient portal and the subscale Motivation and Confidence to Act assessed self-efficacy to determine whether patients were motivated to act on the presented information. We used a cutoff score of 65 or greater to determine whether the portal was rated positively.

The questionnaire was completed by 354 of 13,907 patients who viewed their laboratory results in the patient portal, with a response rate of 2.55%. The mean Information and Presentation score was 67.70 (SD 13.12) and the mean Motivation and Confidence to Act score was 63.59 (SD 16.22). We found a positive, significant correlation between the 2 subscales ( r 345 =.77, P <.001).

Conclusions

Patients participating in the study rated the usability of the portal positively. However, the portal only slightly helped patients to take an active role in managing their own health. The low response rate precludes generalization of the results. Future research should examine avenues to further increase patients’ self-efficacy and study whether portal acceptability differs in subgroups. Patient portals conveying laboratory test results in understandable language seem usable and potentially provide a viable way to help patients take a more active role in managing their own health.

Introduction

Patient involvement in decision making and delivery of health care is important to patients, health care providers, and policy makers. When patients are activated to be more engaged in health and disease issues, their behavior changes toward more self-management [ 1 ]. Therefore, patient involvement is stimulated as an essential element of patient-centered care and as a means to improve the quality and efficiency of care [ 2 , 3 ]. With modern digital possibilities, such as electronic patient portals, patients’ activation and information can be organized more easily. The internet is increasingly being used by care consumers to look for answers about health concerns and has the potential to change health care behavior [ 4 , 5 ]. Although personal health records and patient portals are promising tools, evidence of their effects on patient centeredness of care, efficiency of care, and health outcomes is inconsistent [ 6 - 8 ]. Furthermore, adoption rates of electronic health (eHealth) vary greatly and are often less than 50% [ 9 - 13 ].

Several health care organizations in the Netherlands, such as Saltro diagnostic center, have invested in the development of a high-quality patient portal that is blended into usual care. Solutions that are blended into usual care generally have higher adoption rates [ 14 ]. Saltro’s portal provides access to laboratory test results, including explanatory information and visualization, for the individual patient [ 15 ]. The aim is to facilitate patients to play an active role in their diagnostic process and disease management. Patient health engagement is indispensable to improve diagnostic accuracy [ 16 ]. When patients take an active role in this process, for instance by asking questions and voicing their opinions, it improves the diagnostic process [ 17 ]. Consistent with the trend of patients being more proactive and involved in their own health care [ 18 ], becoming a more knowledgeable consumer may reduce the risk of diagnostic error [ 19 ].

The full potential of patient portals will only be reached if patients understand the results that are communicated, in this case, the information that becomes available from laboratory tests. How the content is presented in a portal and how the patient interprets this affects the overall usefulness of the information [ 20 ]. The information in a patient portal can, for example, cause insecurity for the patient—as patients can become emotionally destabilized by the confusion or impact of the test results—which can negatively affect patient health engagement [ 21 ]. This risk is more prominent when patients find the results difficult to interpret [ 22 ]. Problems have previously been reported with the complexity of the provided information, making it mainly useful for patients with high health literacy [ 23 ]. Research has also shown that misinterpreting the risk of blood test outcomes is common, with patients underestimating the severity [ 24 ]. These findings raise concerns for patient safety. How results are communicated through patient portals is thus important and needs to be done in a manner that minimizes the risk of misunderstanding. Therefore, testing how patients perceive online portals and test results is recommended, for example, by using the eHealth Impact Questionnaire (eHIQ) [ 25 ].

Previous research with the Saltro patient portal showed that the presented test results were valuable and important to the majority of the participants (ie, members of a health care consumer panel) [ 15 ]. To further scientific knowledge, research is needed to examine how patients perceive the online portal. Therefore, we set up a questionnaire study to explore patients’ attitudes toward a patient portal that was specifically designed to communicate laboratory test results with explanatory texts and supporting visuals. The first aim of this study was to provide insight into the usability of patient portals (including ease of use, perceived trustworthiness, and appropriateness of information). Examining user experience is important, because perceived trustworthiness has been linked to use and engagement with online health information [ 26 , 27 ]. The second aim of this study was to provide insight into how the Saltro laboratory test results portal affects patients’ motivation and confidence to manage their health. This relates to self-efficacy, defined as a person’s confidence in his or her ability to perform specific behaviors that are considered beneficial [ 28 ]. Self-efficacy is considered important for motivation and intention to act on information [ 29 ]. The third aim of this study was to analyze whether there is a positive association between the perceived usability of the patient portal and self-efficacy, consistent with the literature [ 30 , 31 ]. Overall, this study aimed to assess the experiences and self-efficacy of patients using a patient portal and the association between the 2 constructs.

Design and Participants

We conducted a real-world study between September 2018 and February 2019 to explore patient attitudes toward a patient portal. The participants were patients who received a diagnostic request form from their general practitioner (GP) for a blood test at Saltro, a primary care diagnostic center and laboratory in the Netherlands. Each month approximately 65,000 patients receive a diagnostic request form for a blood test at Saltro. These patients have access to the patient portal, although not all patients use the patient portal. Patients who viewed their test results in the patient portal were approached online to participate in this study by completing an online questionnaire. There were no specific inclusion or exclusion criteria. This study did not require approval from an ethics committee, because no personal information was collected, and the data could therefore not be traced back to the individual.

Patient Portal

In 2015, Saltro launched a test result Web-based portal that gives patients access to their laboratory test results, including understandable explanatory information personalized to the individual patient (based on sex and age). The portal was created together with health care professionals and patients. All medical content was written by a multidisciplinary team consisting of a GP, a communication specialist, and a clinical chemist. The texts were written to be understandable for the majority of people and have been reviewed by patients and adjusted based on their advice. The level of health literacy of the result information has been estimated at communication level 1B on the scales of the Common European Framework of Reference for Languages [ 32 ]. A previous evaluation study showed that over 85% of patients found the accompanying text with the laboratory results comprehensible [ 33 ]. Daily, approximately 300 unique individuals look up their laboratory results in the portal. Patients also have the option to share their results with others.

After having blood drawn, patients can look up the test results by logging in to the GP website with a username and password. The login procedure is in line with Dutch security legislation and guidelines (ie, the Dutch Personal Data Protection Act) and the General Data Protection Regulation guidelines. There are no age restrictions to logging in. After logging in, the patient sees an overview of all new and old laboratory tests ordered by date (see Figure 1 ). This makes it possible to compare new test results with previous results.

Patient portal overview showing the laboratory tests that were ordered, with the result of the most recent test displayed at the top.

After clicking on a specific date, the patient is shown the results of the laboratory test that was performed on that date (see Figure 2 ). For each laboratory test, the patient sees the individual results together with traffic light–colored bullets indicating normal or abnormal results. Clicking on an individual test result shows an explanation of the laboratory test results in a simple and understandable manner. The texts contain an explanation about the test, what was measured, and why a physician might order this test. If a test result is abnormal, then possible diagnoses are mentioned, and patients are advised to discuss the result with the GP. Next, the individual test results are discussed together, and an explanation of what the results could mean for the patient is given.

Display of the results of a specific laboratory test in the patient portal.

In addition to the text, a visual is presented underneath the explanatory text (see Figure 2 ). The visual presents the individual numeric value of the laboratory test result and how it relates to the reference value(s). Colors are added to emphasize this range. The reference values differ per laboratory test, and sometimes also by sex and age. A green dot or line means that the result is normal for the patient, and there is no deviation. An orange dot or line means the laboratory result is divergent or abnormal. As the individual numeric value of the laboratory test is presented above the line, patients can see whether their value is normal or deviates from the reference value. The majority of patients find this information valuable and important [ 15 ]. Patients are referred to their GP if they have questions. If the dot or line is red, it means the laboratory result is severely deviating (compared with the reference value). In that case, Saltro directly contacts the GP to get in contact with the patient for suitable treatment. Textbox 1 shows an example of a patient journey.

Example of a patient journey.

A person develops complaints about his health and goes to the general practitioner (GP). The GP examines the person and requests blood tests. The person goes to the phlebotomist from Saltro, who collects blood, which is analyzed in the laboratory. The same evening the person can look up the results in the portal. He can see which tests are normal and not likely to be the cause of health complaints. He can see what is tested and will know what is functioning accurately in his body, which will be reassuring. He can also see and choose to read the divergent laboratory results first. He can compare the value with reference values to see how deviating the value is. He does not have to search on the internet; he reads quickly what this test means and can contact the GP to discuss worries and questions, and to make decisions together regarding further steps and treatment.

Outcome Measure

The primary outcome of this study was the second part of the validated Dutch version of the eHIQ [ 25 , 34 ]. The eHIQ is a self-reported questionnaire of which Part 2 measures patients’ attitudes toward a specific health-related website, in this case, the patient portal. We chose the eHIQ for the following reasons. First, the eHIQ assesses the patient’s perspective of the website. Second, the questionnaire is translated and validated in Dutch. Third, information from the eHIQ can be used to compare the effects of the websites for benchmarking; with this study we set a first standard. Fourth, the information can be used to improve a website further, in this case, the patient portal. Each of the 26 items is scored on a 5-point Likert scale ranging from “strongly disagree (1)” to “strongly agree (5).” The questionnaire has 3 subscales: (1) Information and Presentation, (2) Motivation and Confidence to Act, and (3) Identification. The Information and Presentation subscale has 13 items and measures whether people find the website easy to use; this includes items on understanding, trustworthiness, and whether images used were appropriate. This subscale relates to usability. The Motivation and Confidence to Act subscale consists of 10 items and assesses whether an individual felt reassured after reading the information on the website and was motivated to manage their health. This subscale relates to self-efficacy. The final subscale, Identification, consists of 3 items and measures whether individuals identify with others who use the website. An example item is “I feel I have a sense of solidarity with other people using the website.” As users of the patient portal do not interact with other users, we considered this subscale to be irrelevant for this study and therefore did not discuss it further. We transformed the total scores for each subscale to a scale of 0 to 100, with higher scores representing a more positive attitude. No official cutoff score is available to determine whether a website or portal is rated as positive or negative. In consultation with the authors who translated and validated the eHIQ in a Dutch population of eHealth users, we determined that a score of 65 or greater is considered positive. The eHIQ has good construct validity, internal consistency, and test-retest reliability [ 25 , 34 ]. Cronbach alpha in this study was considered good (.88 to .90).

Patients who received a laboratory request form for a blood test at Saltro and who used the patient portal in the period between September 2018 and February 2019 were digitally approached to complete the eHIQ-Part 2. After patients viewed their results in the portal, a pop-up window appeared asking them whether they wanted to fill in a questionnaire. Below this question, the questionnaire was shown to patients and patients could complete it in the portal. Individuals who were unwilling to complete the questionnaire (based on the first question) had to click the pop-up away. These individuals, however, were asked to complete the questionnaire again when they logged in at a later point to view other test results. Patients could complete the questionnaire only once.

Completed questionnaires were automatically sent to us by email. The answers to the questionnaire were coupled to the last test result, indicating whether it was normal or deviant, and the number of laboratory requests for that participant. No personal information of the participant, type of blood test, and the interpretation of the laboratory results were visible to us.

Statistical Analyses

To gain insight into the patient’s perceived usability of the patient portal and their self-efficacy of using a patient portal, we performed descriptive statistics. We calculated the mean scores of the 2 eHIQ subscales and used a cutoff score of 65 or greater to determine how the portal was rated. When the mean of the subscale was 65 or higher, we evaluated the subscale positively. Also, we examined the highest- and lowest-scoring items for each subscale to get a better understanding of which aspects of the patient portal were appreciated and which could be improved further. For items with the same mean score, we chose the items with the highest precision. To examine whether the perceived usability of the patient portal (first subscale, Information and Presentation) was positively associated with self-efficacy (second subscale, Motivation and Confidence to Act), we performed a Pearson correlation. Data were normally distributed and we identified no significant outliers. We performed all analyses using IBM SPSS Statistics version 24 (IBM Corporation).

A total of 13,907 patients viewed their laboratory results on the patient portal and were invited to complete the eHIQ. The questionnaire was completed by 354 patients (2.55%). These participants completed all items of the eHIQ. The mean score of the subscale Information and Presentation was 67.70 (13.12) on a scale ranging from 0 to 100. This subscale of eHIQ thus scored above the set cutoff score of 65 and was evaluated positively. The mean score of the subscale Motivation and Confidence to Act was 63.59 (SD 16.22) on a scale of 0 to 100. This score was just below the set cutoff score and was therefore not considered positively evaluated. Table 1 presents the mean scores of the 2 subscales and the individual items.

Mean scores of the 2 subscales of the eHealth Impact Questionnaire (eHIQ)-Part 2 and the individual itemsa.

a Although the Dutch version of the eHIQ was used in this study, for the purpose of this paper the items from the standard English-language version of the eHIQ are shown.

b This item was reverse scored.

We identified the 3 highest- and lowest-scoring items of the 2 subscales. The highest-scoring items on Information and Presentation were trust in the provided information (mean 4.06, SD 0.69), ease of understanding the information (mean 4.06, SD 0.81), and use of understandable language in the portal (mean 4.04, SD 0.80). The lowest-scoring items were about whether the images were distressing (mean 3.44, SD 0.79), tips were useful (mean 3.27, SD 0.94), and website imagery was appropriate (mean 3.27, SD 0.71). The highest-scoring items on Motivation and Confidence to Act were on better understanding personal health by using the website (mean 3.86, SD 0.74), being encouraged to take health-beneficial actions (mean 3.85, SD 0.93), and confidence to take action (mean 3.56, SD 0.84). The lowest-scoring items were on whether the website would be consulted to make a decision about health (mean 3.38, 0.95), gives confidence to discuss health with other people (mean 3.37, SD 0.94), and gives confidence to explain health concerns to others (mean 3.36, SD 0.91).

To examine whether the perceived usability of the patient portal was positively associated with self-efficacy, we calculated a Pearson correlation. There was a large, positive, significant correlation between the subscale Information and Presentation and Motivation and Confidence to Act ( r 345 =.77, P P<.001). This finding was in line with our expectations.

Principal Findings

This study aimed to investigate patients’ attitudes toward a patient portal specifically designed to communicate laboratory test results, thereby helping patients to take an active role in managing their own health. Findings showed that the usability of the patient portal, assessed by the subscale Information and Presentation of the eHIQ, was rated positively. This suggests that study participants found the patient portal easy to use, considered it trustworthy and appropriate, and found the provided information easy to understand. The self-efficacy of patients using the patient portal, indicative of patients’ motivation and confidence to act on the presented information, also received a relatively high score, but this score was just below the set cutoff score that we used to determine whether patients’ attitudes toward the portal were positive. In addition, as expected, we found a positive association between the portal’s usability and patients’ self-efficacy [ 30 , 31 ]. Altogether, the findings show that patients were generally positive toward the portal, but it is important to identify opportunities to further optimize patients’ self-efficacy, as this affects a person’s intention to act on the information.

Comparison With Prior Work

The usability of the patient portal, which includes patient understanding, was rated positively. This is important because, if all patients are to receive their test results automatically online, the portal needs to be easy to use and provide information that is understandable for all. The high score on usability is in line with previous research examining patient portals with laboratory test results [ 35 - 37 ]. The lowest-scoring items on usability were on provided tips and imagery, which we considered less relevant for this patient portal, as the portal does not include tips or imagery. Therefore, the actual usability of this particular patient portal might have been higher than this study found it to be. As no sociodemographic information was available, we could not determine whether the results differed by subgroup (eg, age, sex, level of health literacy). Future studies should examine whether the patient portal with laboratory test results is usable for all.

As mentioned above, the self-efficacy of patients using the portal—measured with the Motivation and Confidence subscale—was slightly lower than the set cutoff score. Considering that this was, to our knowledge, the first study of a patient portal to use the eHIQ, no official cutoff was available, and this limits our ability to compare this study’s self-efficacy score with other studies’ results. Moreover, to the best of our knowledge, no studies have examined patients’ self-efficacy with questionnaires other than the eHIQ after being presented with online laboratory test results. Both usability and self-efficacy affect an individual’s intention to follow up the test result [ 29 , 38 ]. Therefore, it is important that these factors be evaluated and improved where needed. We discuss some potential avenues for improvement below.

One potential area to improve is the use of reference values when communicating laboratory test results. Currently, a visual presents how the numeric value of the laboratory test result relates to a reference value that takes sex and age into account (when relevant). This standard reference value might, however, be less relevant for individuals with a chronic condition (eg, diabetes). Research has now shown that using reference values that are clinically appropriate (ie, personalized) can help to improve patients’ understanding and decrease negative responses to the results [ 39 ]. Replacing standard reference values with clinically relevant values will not be relevant for all laboratory tests (eg, not for sexually transmitted infection tests), but might be useful for other tests (eg, glucose, kidney function), and future studies should investigate this possibility.

A second potential area to improve is the understanding and effective use of laboratory test results by providing additional information [ 40 ]. One study showed that 50% of patients using a portal accessed additional, external information related to the diagnostics test results [ 36 ]. Adding additional information, however, might also increase the complexity of the presented information and this, in turn, might decrease understanding and limit a patient’s ability to extract the relevant information [ 41 ]. This highlights the need to find the right balance between providing enough information and information overload. Adding links to additional information might provide a solution, by making more in-depth information easily available to those interested, while not running the risk of overwhelming patients with large volumes of text.

A third potential area to improve relates to patient portal use being predicted by perceived usefulness and perceived ease of use [ 38 ]. This emphasizes the necessity to involve end users when designing patient portals to ensure that the portal is perceived as useful and easy to use [ 42 ]. The Saltro patient portal was developed in close collaboration with both patients and health care providers, thereby attempting to address the end users’ needs and assure usability. Nevertheless, it is important to continually evaluate these aspects to ensure that they are adequately met and to identify areas for future improvements.

Limitations and Strengths

Even though communicating laboratory test results online can have some advantages, such as improving clinical efficiency and improving accessibility of results, there is a limited number of studies on the use of such systems [ 41 , 43 ]. This study, therefore, adds to the limited existing literature base. Some limitations, however, also need to be discussed. First, the response rate was low and, consequently, there is risk of self-selection bias. A low response rate, however, does not automatically equal low study quality, as a low response rate is only problematic when it affects the sample’s representativeness [ 44 ]. Still, 97.45% (13,553/13,907) of the patients did not complete the study questionnaire. This high rate of noncompletion precludes generalizing whether the patient portal display and explanation of results are acceptable and informative for all patients.

Second, as mentioned above, no sociodemographic information was available from participants. This restricted us from doing subgroup analyses to see whether attitudes regarding the portal were dependent on these characteristics. Limited research is available on whether portal use and acceptance differ between groups. One study did find that portal use was influenced by age, presence of a chronic illness, and eHealth literacy level [ 39 ]. Further research into potential group differences is necessary, and such information can be used to fine-tune the portal to make it acceptable for every user.

Third, in some cases, it is important that patients act on the test results presented in the portal. Even though self-efficacy can be a valuable predictor of action [ 45 ], it is still a proxy of action and it would be interesting to study the effect on actual behavioral activation.

A strength of this study is that patients completed the questionnaire immediately after they accessed the portal and viewed their results, thereby limiting recall bias and giving an accurate picture of patients’ attitudes toward the portal.

Study participants evaluated the usability of Saltro’s online patient portal communicating laboratory test results positively. Nevertheless, it should be noted that the low response rate precludes generalization of the results. Patients’ motivation and confidence to act on the presented information also scored relatively high, but future research should examine ways to further optimize patients’ self-efficacy to increase an individual’s intention to act on the information. In addition, it is important to determine potential group differences in portal use and acceptance. Overall, study participants had a positive attitude toward the patient portal and the portal potentially can help patients take a more active role in managing their own health.

Acknowledgments

We would like to thank the patients who were involved in several phases of the development of the portal and this study. We also thank the professionals and employees of Saltro who contributed to the development of the portal and this study.

Abbreviations

Conflicts of Interest: ETK, RTS, AG, and AV are employees of Saltro, where the portal has been developed and implemented.

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