In Part 1 of this series, I summarized the latest data on who is accessing patient portals and for what purposes. In this post, I discuss the facilitators and barriers to patient portal use.
General barriers to patient portal use
Let’s start by discussing barriers to portal use. Patient portals have generally not been created to optimize user functionality. In fact, patients report them to be difficult to navigate and not user-friendly. A 2017 Government Accountability Office (GAO) report [pdf] found that while users of patient portals reported being able to view their health information electronically, many patients reported frustrations and difficulties with the portals and their usability. For example, they expressed frustration with the time and effort it took to set up electronic access through their providers, manage multiple passwords for different portals, and understand each portal’s user interface.
Patients were also often unclear about whether the information they accessed could be electronically downloaded or transmitted (a goal [pdf] established by the Office of the National Coordinator for Health Information Technology, or ONC). Further, many patients reported that the information was often not presented in helpful ways, or was incomplete or even incorrect. Some reported that there was no simple way to correct or flag incorrect information in the portal. Another limitation was that their health information could not be aggregated across time into a single comprehensive health record.
According to an ONC Data Brief released this year, among those patients who accessed their online medical record within the past year, around 80% considered it both easy to understand and useful.
Three-quarters of surveyed individuals cited their preference to speak with their health care provider directly as a reason for not using their online medical record within the past year, and around a quarter cited concerns related to privacy and security of online medical records. About one-fifth of individuals lacked the basic technology to access the portal.
Barriers for older adults
These general findings were also corroborated in a systematic review of patient portal use and experience among older adults. But among older adults, the two main barriers to portal use were concerns about privacy and security, and access and ability to use technology and the Internet. Unwanted information disclosure to caregivers with access to their patient portal was another particular deterrent for older adults.
In a 2018 national survey, older adults (50-80 years) commonly cited the following reasons for not setting up a patient portal:
- Did not like communicating about their health by computer (40%)
- Did not have a need for a portal (38%)
- Did not know they needed to set something up (33%)
- Had not gotten around to setting up a portal (29%)
- Did not feel comfortable with technology (26%)
Of note, older adults 65–80 identified technology barriers and lack of comfort as key reasons for not setting up a portal (47% compared to 30% of younger adults). Adults 50–64, in comparison, reported few specific barriers but had not taken the time to set up a portal.
Facilitators of patient portal use
Recent research has helped to better understand factors that facilitate portal use. Patient portals often are designed in concert with other health care system functions such as scheduling appointments and communicating securely with providers. According to Walker, Sieck, Menser and colleagues, offering a variety of functions is a central component of patient engagement, particularly for patients attempting to self-manage chronic conditions.
These functions can allow patients to input and track health information. They can facilitate communication between patients and providers, and also offer patients access to consumer-friendly information about diseases. Patients using portals described facilitators in the GAO report [pdf] such as access to “convenience features” such as appointment reminders, medication refill requests, messaging their providers, and appointment scheduling.
Provider endorsement and encouragement of using portals is also an important facilitator. The ONC reported survey findings that patients who were encouraged by their health care provider to use their online medical records were nearly twice as likely to access their online medical record [pdf] compared to those who were not encouraged.
Facilitators for older adults
Based on a systematic review of patient portal use and experience among older adults, the two main facilitators were receiving technical assistance and encouragement from family and providers to use the portal. Older patients who viewed a short instructional step-by-step instructional video prior to using a patient portal were found to experience fewer difficulties.
Common uses of portals reported by older adults such as viewing test results, scheduling an appointment or requesting prescription refills confirm that they are benefiting from portal technology. Portals were found, in the 2018 national survey, to offer an efficient mechanism for older adults to conduct “business tasks” and obtain medical information and advice, without spending time on hold or waiting for a call-back from the doctor’s office.
Summary of facilitators of and barriers to patient portal use, 2015-2019 studies
| Population | Facilitators | Barriers |
| Adults from sampled households | -design features in concert with other functions
-convenience factors, such as scheduling appointments |
-preference to speak to health care provider directly
-no need to use portal perceived -privacy/security concerns |
| Older adults | -technical assistance and training
-individual focused interventions -advice to use patient portals from family and providers -older adult friendly & theory-based portal e-learning program -usefulness of portal -start by promoting use of popular, easy-to-use features -positive attitude and belief towards patient portals in general |
-higher expectations of portal based on ideas of what functionalities portal should provide
-unresponsiveness of physicians to secure messages sent by patients -usability problems (e.g., small font) |
| Patients with chronic disease or condition | -provides patient-provider communication
-convenience of using portal -useful information -integrated well with health care |
-security concerns
-lack of user-friendliness -preferring in-person health care -internet access barriers |
| Systematic and targeted review of literature, includes various types of patients and parents, settings (e.g., outpatient and inpatient) | -provider endorsement/encouragement
-access/control over health information -enhanced communication -improved efficiency (e.g., less paperwork) -access to patient’s information -usability and utility -personalization -collaborative communication with providers |
-lack of awareness/training
-privacy and security concerns -difficulty with portal access -unavailable features -preference for personal interaction with providers -aspects of health literacy (e.g., not familiar with medical terminology) |
Table Sources: Irizarry et al., 2015; Reed et al., 2019; Patel and Johnson, 2019; Sakaguchi-Tang et al., 2017; Nahm et al., 2018; Kruse et al, 2015. Powell, 2017; Powell and Myers, 2018; Wildenbos et al., 2018; Grossman et al., 2019; Portz et al., 2019; Dendere et al., 2019
In Part 3 of this series, let’s explore the future of patient portals and how emerging technology may address these facilitators and barriers!
Colene Byrne