Providers’ portal usage rates have been high for some time. While many patients have access to a portal, routine use is less common. In this three-part series, we will explore several questions:
- Who is using portals?
- What are the factors that prevent or facilitate the optimal use of portals to engage patients in their care?
- How can the portal experience be improved, and what are some of the important areas for further study?
The health care industry is seeking new and innovative ways to increase patient engagement in their healthcare through the adoption of health information technologies. These technologies include patient portals, which provide access to online medical records. Patient engagement, or activation, helps patients better advocate for themselves and become more active participants in their care. It increases satisfaction with their care, improves outcomes, and can lower costs of care. This is particularly true for patients with chronic diseases. According to Walker and colleagues’ adaptation of the patient engagement framework, patient portals can support the highest levels of patient engagement and partnerships in their care, from informing, engaging, and empowering, to partnering and supporting community.
Patient portals have received great attention and monitoring by the U.S. government spurred by unparalleled resources to support the adoption of electronic health records (EHRs) through incentive payments [pdf]. Nearly all hospitals [pdf] and healthcare providers now provide patients with portals to electronically view and download their health information.
In recent years, many researchers have published studies about patient portals. This body of research has been systematically reviewed with studies of portal adoption and use, including among older adults, vulnerable populations, and their facilitators and barriers of use. Other systematic reviews have examined portals’ impact on healthcare delivery, patient empowerment, health-related outcomes, quality outcomes, and attitudes toward the management of chronic disease.
Adoption and use of portals – then and now
Early adoption and use of portals was relatively low. Providers participating in the Medicare EHR Program in 2015 reported in a GAO study [pdf] that 15% of hospital patients and 30% of physician patients logged into a patient portal and viewed, downloaded, or transmitted their health information. A much smaller percent were regular users of their portal.
A subsequent Office of the National Coordinator for Health Information Technology (ONC) data brief, based on the HINTS survey, reported that as of 2018, 52% of patients had patient portal access. Only around 28% had accessed the portal within the last year. Among individuals who accessed their online medical record within the past year, most accessed their data only once or twice. Only 10% reported using their portal six or more times. The use of the portals did not change much from 2017.
The most common uses were viewing test results (84%), performing health-related tasks online such as making appointments, requesting prescription refills or filling out paperwork (~60%), and communicating with their health care providers using secure messaging (48%). Less than half downloaded their medical records and only a small percent ever electronically sent any health care data.
A 2017 systematic review and meta-analysis also found a 52% average patient portal adoption rate (as did the ONC data brief), but that the adoption rate varied by type of study in their review. The researchers concluded that little is known about the adoption of portals and how to increase adoption.
Older adults’ patient portal use is growing
Patient portals can be important tools to help older adults, particularly those with chronic conditions, manage their health care. However, barriers to their adoption of technology [pdf] have been well-documented. The majority of studies on older adults’ patient portal use have focused on their perceptions and barriers to using them. Although older adults are generally receptive to using patient portals, multiple barriers — such as lack of training, usability problems, limited health literacy, and privacy and security concerns — limit their use of patient portals. Even today, almost half of Medicare Advantage patients aren’t sure if their health plan offers a portal.
Despite these barriers, around half of adults aged 50 and older surveyed in 2018 reported they have set up a patient portal. Among these, the most common use of the portal was to see test results (84%). Other common uses were requesting a prescription refill (43%), scheduling an appointment (37%), requesting reminders about upcoming appointments (34%), getting advice about a health problem (26%), updating insurance or contact information (22%), and getting a referral (13%). Among the oldest adult portal users, 43% had authorized another person to see their portal information, most commonly their spouse or partner.
It appears that older adults now use patient portals more than younger adults. This is likely because as age increases, the need for health care services also increases. Also, older adults may be successfully overcoming barriers to portal use. Once older adults are engaged in technology, they tend to be high utilizers.
Patients with chronic diseases and conditions benefit from portals
Patients with chronic disease and conditions are of special interest. The Director of the Agency for Healthcare Research and Quality (AHRQ) identified improvements in care for Americans living with multiple chronic conditions as one of the key challenges front and center in the minds of healthcare experts. These challenges require new strategies to augment their primary care. Patient portals may be one of the main strategies to augment their care.
A 2019 study in Medical Care by Reed et al reported findings from interviews with patients with a chronic condition in an integrated delivery system on how portal tools affect their health care experiences and barriers among patients who use a portal. Around half of the respondents reported that they preferred in-person health care over communicating via a portal. Internet access was another barrier, reported by 41% of respondents. Facilitators included portal convenience, the usefulness of information, and the integration of the portal with their health care. All of these can be pathways to improving health.
In Part 2 of this series, we will explore the barriers and facilitators to portal use.
Colene Byrne