Welcome to the final post in our series on patient portals – an attempt to imagine the future. Part 1 of this series summarized the latest data on who is using portals. Part 2 explained some of the barriers to use as well as what factors increase use.
Evidence of Increased Patient Engagement and Other Benefits of Patient Portals
Several studies suggest that patient portals can improve patient engagement, satisfaction, care experiences, and health-related outcomes. A systematic review of the impact of patient portals or portal features on quality outcomes found improved medication adherence, disease awareness, and disease self-management. Office visits decreased, but preventive care, extended office visits, and patient satisfaction all increased.
Patients interviewed for a GAO study described using their patient portals to share information with other providers. Patients described the convenience of printing out their medical information such as lab results from their portals. They reported bringing that information to medical appointments.
Reed et al found that 31% of patients with chronic conditions reported that using the portal improved their overall health. A systematic review of studies of patient and provider attitudes about portals and the management of chronic disease was conducted. The review concluded that patient portals significantly improve the self-management of chronic disease and improve the quality of care.
How can patient portal use and patient engagement improve?
See Part I of this series for a framework for health IT and patient engagement.
Research on patient portal use can be guided by frameworks and models. Examples are the Theory of Acceptance and Use of Technology, the patient engagement framework, and the socio-technical model. The resulting literature offers suggestions for ways to facilitate and influence portal adoption. They also offer a vision for the future of patient portals. Recommendations based on this research address portal conceptualization, design, or redesign, and supporting patient acceptance and use of portals. Following these recommendations can help increase patient engagement.
Conceptualization and Design/Redesign
- Develop portals that are compatible with health care customers’ lifestyle, such as mobile versions allowing access to their data anywhere.
- Design features based on consideration of needs and practices of older adults. This will facilitate appeal and maximize usability. A standard patient portal design providing patients with the resources to understand and manage their chronic conditions may promote portal adoption.
- Adopt high-yield features and functions of healthcare applications that have been found to lead to engagement success with patients. To improve user experience with future portals, developers could look towards mobile health (mHealth) applications in design, function, and user interface.
- Provide patients with more transparent, real-time, and user-friendly access to their medical records. This will help them track their medical progress and be more prepared for visits with their providers. Reviewing test results before their provider interactions prepares patients for and augments important discussions. Improved access to this information can also help patients better understand and plan for the hospital or other care discharge process. And it may even help patients identify errors in their medical records.
- Address the significant limitations of today’s portals. These include:
- Little to no portability of the information: information isn’t easy to download in portable format or upload into a medical or health app;
- No single place to see a complete picture of their health history for patients who receive care from multiple providers; and
- Critical information from x-rays, pathology reports, and clinician notes is generally not available.
Support for Use
- Measuring the health literacy of a patient population may help identify patients who need the most support in using health technologies.
- Performance expectancy is a significant adoption driver of portals. When promoting portals, it is important to emphasize the advantages they provide to the patients in managing their health-related activities more efficiently. It is also important that the advantages be easy to spot, because this affects perceptions of how easy a technology is to use.
- Habit is the degree to which individuals tend to execute behaviors automatically due to learning. Habit operates as a stored intention path to influence behavior. Developing habit to use portals requires more communication effort, such as through customer support service. The intent is to reinforce both the stored intention and the portal’s link to behavior.
- Educating users in technology could alleviate some usability issues. Further research is needed to identify optimal approaches to support older adult populations. Many older patients receive little-to-no information about how to use patient portals. Developing and implementing more older adult-friendly portals and providing appropriate training to this population is recommended.
- Patient-centered focus and themes: According to an interdisciplinary group of stakeholders, three patient-centered themes are central to designing a better portal:
- Enhancing cognitive support;
- Promoting respect while maintaining boundaries; and
- Facilitating patient and family empowerment.
Important Knowledge Gaps
Future research should help identify specific populations that would benefit most from a greater degree of engagement through a patient portal. Adoption by patients and endorsement by providers will increase when patient portal features align with patients’ and providers’ information needs and functionality.
We also need more research on how to effectively engage patients and family members. The research can help identify the level of information that improves patient satisfaction and outcomes. It can also shed light on those patient engagement technologies that are most effective in various settings.
Informatics and human factors researchers suggest that portals be developed in coordination with mHealth vendors, health care organizations, and their data. This coordination will help understand how patients are using portals and how to make them most useful. This type of evidence can help ensure that portals create value for patients, clinicians, and health care organizations. These researcher strongly recommend rigorous evaluation to ensure that portals meet their potential in improving patient outcomes.
According to a systematic methodological review by Fraccaro and colleagues, patients’ interactions with patient portals have been extensively studied. However, the influence of patient portals on users’ decisionmaking is less well studied. They recommend that methodological approaches to evaluating usage and usability of portals be improved so that more robust research can illuminate the complex process of how portals lead to improved health and care.
The Future of Patient Portals
For now, adoption and use are increasing and portals are becoming more user-friendly. Portals are the primary way for patients to access their medical record information electronically. But do the portals help patients meet the highest levels of patient engagement and partnership? Probably not yet. At the same time, the rapid pace of technology advancement is transforming health care and the ways that patients will access and use their medical record data.
More sophisticated enabling technology
Building in enabling technology to portals, such as voice-commanded digital assistants, artificial intelligence, and natural language processing, could help portals cater to a wider range of audiences. Future enhancements could include links to medical education and disease-specific design.
Blockchain
New technologies such as blockchain may change how patients’ medical record data is accessed and shared. A recent two-part series on blockchain was published on this blog (Taking Stock of Blockchain: Part 1 and Part 2 by Justin Kirschner). The blogs explained how blockchain can allow sharing patient medical information with more stakeholders, for more purposes, while ensuring patient privacy and data security. Using blockchain in EHRs avoids adding a third party between the patient and the records. By serving as a decentralized control mechanism, blockchain facilitates patient privacy and autonomy, data security, and ease of distribution. A new architecture for medical records using blockchain may have implications for the future of patient portals. Will portals continue to serve as the primary means by which patients access and share their medical record information?
A suite of patient engagement applications
Allscripts, a company that makes electronic health record (EHR) software, recently announced that they are developing a diverse set of patient engagement tools on one platform. The platform aims to reach more patients and drive more meaningful patient portal adoption by integrating a whole health system’s patient engagement technology suite. The suite will include the patient portal, as well as other patient engagement applications that providers may prescribe.
Wearable device data integrated with EHRs
The integration of device data into patient portals is an exciting new development. Devices and technologies streamline data movement from patients to providers through patient portals. This can help patients, particularly those with chronic conditions, manage their care and health. Several start-up organizations have or are developing technology to enhance wearable health technology and integrate into the EHR. Some insurance companies, including United Healthcare and Humana, encourage the growth and uptake of wearables through health tracking and incentive programs.
Health IT standards to support new applications
Recent policy efforts have prioritized patient access to EHR data through application programming interfaces (APIs). APIs use standards to connect third-party software, including mobile applications, to EHRs for easy transmission of data. They allow patients to download their data from the EHR and choose which applications can access that data. APIs are part of an infrastructure where developers can leverage EHR data to bring innovative patient-centered products to patients. So far, the uptake of APIs by health systems and patients and by hospitals has been modest.
A proposed new rule sets data standards for health information technologies to communicate and interact with each other, defining a universal interface. This rule and another Centers for Medicare and Medicaid Services rule (CMS-9115-P) are focused on allowing consumers free and easy access to their health data. Under the proposed rule, patients will be able to opt to share their data with whomever they choose.
These new standards can foster innovation and allow applications (apps) to connect with any patient medical record system. According to one HIT expert, these changes
…could spark an apps-based health information economy that gives patients and providers choices in the functionality they want and need to use, and creates a large market for innovators’ inventions.
These policy initiatives can impact how patients will access and interact with their medical record information. The implications of these initiatives are reflected in the excitement of nationally recognized health IT and privacy experts. Time will tell whether portals will someday live up to their potential. And, looking further into the future of portals, if new, innovative applications and tools can move beyond the limited functionality and usability of many of today’s portals. If so, portals and other health IT tools and apps that access medical records will help patients reach greater levels of engagement in their health care.
Colene Byrne