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Why Won’t Patients Embrace Portals?

by Paul Nardone | January 07, 2020

doctor and patient emerging from separate computer screens to shake handsA recent study tracked patients in 12 health systems across the country for 9 months (March – December 2018) and found that just 0.7% of patient portal users also downloaded their health record data using their phones (accounting for 0.1% of all health system patients, assuming standard adoption rates of the patient portals within those health systems).

Healthcare organizations (HCOs) and their vendors may be missing an opportunity to better engage patients if they ignore their portals and obsess over app downloads and adoption. If vendors make patient portals more palatable to patients, more enthusiastic app adoption could follow. Ensuring patients can easily access and utilize patient portals makes those patients more likely to use patient portal-adjacent offerings. However, patients continue to find portals hard to navigate and difficult to learn. This blog post will offer solutions for addressing each issue, hopefully allowing patients to benefit from the portals that provider organizations are working so hard to build.

User Experience

Because smartphone users tracked by the study were all previous users of a patient portal, a less than stellar experience with the patient portal may have dissuaded patients from exploring other online offerings from the same provider. Standards for patient-facing health-IT tools are rising as health apps improve their functionality and user experience. For instance, Apple Health presents users with easily navigable, well-presented health data. Conversely, most portals greet patients with inadequate functionality, confusing formatting, and hard to understand health data. Patients often lose interest in these portals, unsure of how to take advantage of any of their promised offerings.

To address these issues, designers of patient portals need to follow principles of interaction design. Patient portals should present a streamlined, intuitive user interface that enables patients to quickly and easily find and manage their data. Information should be readable and actionable; instead of simply indicating “high LDL” when presenting numeric blood work results, which many patients would not know how to interpret or use, portals should explain how a patient’s high cholesterol is impacting their health and link resources to healthy lifestyle adaptations right there in the app. Smartphone applications on small screens can easily become cluttered, but the same interaction design principles apply. User testing can determine if attempts to meet these criteria were successful, as well as identify additional areas of potential improvement.

Learning How and Why to Use the Portal

Patients also need more help navigating portals. A previous study revealed that many patients received no help beyond being informed of the existence of the patient portal website (if they had been made aware of its existence at all). When asked, patients described learning to use the portal as a “trial and error” process or stated that they “played around with it” until they figured it out. No patient reported having someone explain how to use the portal or what the benefits of using the portal might be.

Adding simple automated tutorials to the patient portal after an initial login, providing a phone number to call for guidance, or offering in-person assistance at a provider’s office for those struggling to use the portal could help patients take advantage of what the portal offers.

Visibility

Unenthusiastic providers may not even tell patients that a portal exists, with one provider stating, “there was an incentive to get so many people signed up so we were trying to talk to everybody initially but not any more so I kind of leave it up to them if they’re interested in that.” Without outside marketing, most people would be unlikely to use or learn about a patient portal until a care episode, if at all.

Many other healthcare stakeholders already provide strategies for marketing patient portals (the ONC even has a patient engagement playbook that covers the topic), but most boil down to improving outreach and having office staff commit to patient portal enrollment. Encouragement by all members of the office staff (doctors, nurses, management staff, etc.), advertisements in the office, and regular e-mail outreach to patients that are not signed up for the patient portal are all examples of these strategies.

Conclusions

The study I linked to above about portals should not be surprising. It is unlikely that patients who had already struggled to figure out how to use a patient portal would take extra steps to learn and use an associated smartphone app. However, the importance of addressing these issues cannot be understated. Providing and utilizing patient portals has been proven to improve patients’ health status. Interest in expanding the use of smartphones to connect patients and providers has been growing for many years. So, healthcare stakeholders should push for these issues to be addressed, allowing patients, providers, and payers to reap the benefits that patient portals could enable.

5 responses to “Why Won’t Patients Embrace Portals?”

  1. Bill Grana says:

    Great post thank you. Consider also the importance of strong customer and technical support in gaining increased adoption and use of patient portals. Many hospital systems have failed to consider this aspect or otherwise don’t devote the appropriate resources to patient portal support.

    • Paul Nardone says:

      Glad you found the post helpful! You raise a great point – surveys and studies have shown that patients rarely feel supported in their efforts to learn about the portals, whether that be from a technical standpoint (ex: “How do I access my digital health record?”) or a benefits standpoint (ex: “Why would I log into the portal in the first place?”). Customer/Technical support provides a huge opportunity to help patients benefit from the offerings that providers and vendors have already implemented.

  2. e-Patient Dave deBronkart says:

    Paul, thank you for shedding light on some of the reasons these portals suck.

    Some of us in the patient community are incensed that normally smart people in the medical community are so BLIND to the behavioral reality that if a portal contains very little info, consumers will have little reason to use it! And what’s really “incensing” about it is that ten years ago when this all started, those same forces (basically establishment medicine) insisted that portals be LIMITED to displaying very little information.

    This is a close parallel to the recent wars on social media about physicians hating EMR usability, and therefore hating the governments that mandated them (“This is all Obama’s fault”). I was present in DC in 2010 when some EMR industry lobbyists were forcefully OBJECTING to the people in the Obama administration who wanted usability to be a criterion for an acceptable system.

    For healthcare to achieve its potential, information needs to move around so it can be at the point of need, for both patients and HCPs!

    • Paul Nardone says:

      Dave,
      I agree with all of what you’ve said, and thank you for providing some much-needed insight as to why all of our woes surrounding portals came into being in the first place! I focused more on what is wrong with the portals in my piece above, but it’s equally important to know why all of those issues came into being (as you explain in the article you linked below). You’ve said it well by saying that information needs to move around so it can be at the point of need for patients and HCPs, and addressing the issues we identified in our respective articles (interoperability, usability, visibility, security, etc.) should help to make more mobile information a reality.

  3. e-Patient Dave deBronkart says:

    Christine Bechtel, Lygeia Ricciardi, Casey Quinlan, Donna Cryer and I just had a retort on this published today on the Health Affairs blog.

    Why Aren’t More Patients Electronically Accessing Their Medical Records? (Yet!)

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