What might be hindering patient portal usage?

Personally, I find patient portals to be convenient. It’s an easy way to send healthcare-related questions to my provider such as, “does this medication have any side effects?” or, “can you please refill my prescription?”  I perceive the primary benefit as not having to schedule an appointment or wait on hold for 15 minutes to get an answer.  Quick, easy, and a great method of communicating with your healthcare provider given our constantly on-the-go society.  However, 64% of American adults within the U.S. don’t use their online patient portal.  With portals being such an easy way for patients to get answers for their healthcare questions, what’s hindering their use?

For this post, I wanted to elaborate on patient portal barriers discussed in Patient-Initiated Electronic Messages and Quality of Care for Patients with Diabetes and Hypertension in a Large Fee-for-Service Medical Group: Results from a Natural Experiment by McClellan and colleagues, based on my experience using patient portals as a healthcare worker.  To provide some background, the article focuses on patients diagnosed with hypertension or diabetes within a large, multispecialty, fee-for-service practice.  The occurrence of e-messaging was measured by patient-initiated threads to their providers.  Ultimately, the authors did not find a consistent association between e-messaging and improved clinical outcomes.

One reason provided to describe patients’ non-improving clinical outcomes is that clinicians primarily used e-messages to address simple questions rather than to provide complex clinical advice.  As a nurse, I can corroborate that straightforward questions, such as communicating to patients their normal lab values, were the simplest to address using e-messages and most frequent.  Complex clinical advice typically required multiple exchanges through the portal, and the majority of patients found it easiest to call the office or schedule an appointment when they had several concerns to address with their provider.

The studied practice setting was fee-for-service. Clinicians were compensated $3 to $5 per message.  Since this was significantly less than the provider compensation for an office visit, the authors proposed that clinicians might have encouraged office visits for patients with issues not able to be addressed through limited e-messaging.  In comparison, the practice I worked for did not provide compensation to clinicians for e-messaging.  However, regardless of the length or detail of a patient’s portal communication, it’s difficult to get a full picture of their current condition without an in-person assessment.  Many of the clinicians I worked with requested office visits in lieu of e-messaging because to change a patient’s medication or order additional diagnostic testing without an in-person assessment was simply unsafe.

Beyond the limitations to e-messaging discussed in the prior article, authors Ronda, Dijkhorst-Oei, & Rutten also discuss the barriers to patient portals in Reasons and Barriers for Using a Patient Portal: Survey among Patients with Diabetes.  The article surveyed Netherlands-based diabetic patients at 1 outpatient hospital clinic and 62 primary care practices.  Of those patients surveyed, the main barrier to patient portal enrollment was unawareness.  Despite the study occurring in the Netherlands, the results are comparable to patients within the U.S.  Of the 2,017 US adults surveyed for the Annual Xerox EHR Survey (2014) 35% were unaware of the patient portal’s availability and 31% stated their provider had never discussed the patient portal with them .

With the expansion of Meaningful Use, patient portals are becoming an increasingly important feature in many patient’s healthcare experience.  As the popularity of portals continues to rise, it’s the responsibility of each provider and patient to find the blurry line separating e-message vs. office visit.