‘Every Patient, Every Time’: Boosting Techquity in Patient Portal Use

November 27, 2023 - For many healthcare organizations, the patient portal has become the place where patients access the healthcare system and keep coming back. It’s a wraparound digital experience that meets the moment on healthcare consumerism, but if organizations don’t prioritize digital health equity, it can also perpetuate health disparities.

“Patient portals really transformed how we can actually engage with our patients, and more so in how new patients view and access our services over the course of time,” Ravi Patel, the vice president of digital health at Lurie Children’s Hospital in Chicago, said to PatientEngagementHIT in an interview.

Patient portal functions run the gamut of online appointment scheduling, patient data access, patient-provider communication, patient intake, prescription refills, and numerous other functions. When patients leave the care encounter, they might get pinged to pick up a prescription or to schedule a referral, leaving the patient portal like the guide helping the patient—or in a pediatric setting like Lurie, the guardian—navigate the care journey.

It wouldn’t be impossible, but it’d certainly be difficult to navigate through the hospital system and patient care without accessing the portal, Patel said. But that’s okay because, for the most part, that’s what consumers want.

People don’t want to take 15 minutes out of their day to schedule an appointment, and that’s especially true for the native internet users of the Gen Z and Millennial generations who are now the parents of kids getting care at Lurie. They don’t want to call for a prescription refill, or to ask their doctor a question, or to update their insurance information.

All of this is possible because this isn’t the patient portal of the meaningful use days. The federal stimulus program, which gave organizations money for adopting EHRs and patient portals and for hitting key usage benchmarks, certainly propelled patient portal offerings, but healthcare’s now moved far past that.

“It is a bidirectional mode of communication now with a patient portal,” Patel explained. “When we first came up, especially if you go all the way back to meaningful use, it was just like we created access to their medical records, and as a result, we expected patients to go do something.”

It became apparent pretty quickly that the “if you build it, they will come” adage wouldn’t work, at least for the patient portal.

While the number of organizations offering patient portal access reached near ubiquity a few years after meaningful use, the number of patients actually logging into the tool was low. In April 2019, the Office of the National Coordinator for Health IT (ONC) reported that patient portal offerings were reaching nearly 90 percent, but patient registration lagged to around 25 percent.

Those numbers have been flipped upside-down. In October 2023, ONC released stats showing that 57 percent of patients were offered and accessed their medical records via the patient portal in the previous year, showing a sharp uptick in patient engagement.

Patel said that user interest is driven in large part by more sophisticated patient portals and trends of healthcare consumerism.

“Now, we can prompt patients to go do something,” he said. “It's very different when I have access to an app and that app is telling me I need to schedule this follow-up appointment, versus, ‘oh, you should go read through your medical records, and you may read through your after-visit summary that no one reads through, and at the end of it tells you, oh, you should schedule an appointment with neurology.’”

The patient portal isn’t just a data source; rather, it’s a GPS system helping the patient move about the healthcare journey.

Those capabilities pair well with trends toward healthcare consumerism, Patel added. Those trends were emerging well before COVID-19 struck, but the pandemic helped patients become accustomed to digital healthcare interactions and introduced them to online capabilities they may not have known about previously.

“And now you get not only people who are activated on it, but high utilizers of it because they see all of the functionality,” Patel explained. “And because we're giving everyone that opportunity and enforcing that first interaction with the platform, the first interaction then creates this positive reinforcement cycle that further propagates more and more engagement.”

Next, it’ll be an eye for digital health equity—or techquity, a buzzword slated to take over healthcare in the coming year—that will be the next frontier, Patel said. As it stands, patient portal access and use aren’t equal across demographics. ONC reported in January 2023 that Black and Hispanic patients are less likely to be offered patient portal access compared to their White counterparts.

That used to be the case a Lurie Children’s, where patient portal adoption has soared in recent years due to health equity efforts.

Like many other healthcare providers, patient portal adoption and use lagged at Lurie pre-COVID, lingering at around a quarter of patients. Only about a third of those who’d adopted the technology actively logged int within 30 days of an encounter, Patel noted.

Today, patient portal adoption is at 87 percent, and while that’s in part due to the added functionality within the tool, Patel asserted it’s also because of the organization’s commitment to digital health equity.

Overall, Lurie’s digital health team wanted to make it easier for patients to get onto the portal. That started with a broad effort to make the tool look more attractive to users, like updating the email that encourages adoption and fixing some internal issues with patient enrollment, data capture, and call center assistance.

“That may have gotten us the first 10 or 15 percent increase, but really, I think the second part of it is more important, which is this concept of every patient, every time,” Patel stated.

“There was a lot of implicit bias that was present when we were offering MyChart,” he added, referencing the Epic Systems patient portal Lurie uses. “As we're offering the patient portal to patients, we were making a judgment call. We thought they didn't have access to a device. We thought they didn't have access to high-speed internet. We thought this was something that they weren't going to use. We didn't think that they had digital health literacy.”

“Well, that was all pure judgment. We had no idea. We don't record that data anywhere. We don't look for that data anywhere. So, we are purely making that assumption based on interacting with that patient.”

Clinicians with a long-term relationship with their patients may be right about those assumptions, Patel conceded, but he maintained that it’s still best to offer the patient portal to every single patient. That allows patients to decide whether they want to use the technology or express why they are unable to.

In some cases, barriers to patient portal use will be personal preference. A provider may not respond to direct messages as quickly as a patient would like, making the call center a better fit for that patient.

“The beauty is when we've made all of these digital tools available, we've decanted from all of those other things,” Patel said, noting that call center wait times are significantly shorter now that the portal has broader patient use.

There very well could be other logistical issues, like low digital health literacy or lack of device or poor access to high-speed internet, keeping patients from using the patient portal. Because Lurie offers the technology to every patient, Patel said the organization can much better pinpoint use barriers and advocate for more resources.

“Now I've got 12 percent not on the portal where I've got real challenges,” he noted. “How do I address that? And that doesn't go away. We still need to work with the governor's office, at least in the state of Illinois, on improving our broadband access, improving device accessibility.”

The important part is that Patel has a much better handle on how widespread those problems are, helping him and his team make the case to public agencies for more resources.

As Lurie continues its work toward digital health equity, it’s also looking at the processes it can improve internally to improve patient access to health IT.

Right now, the organization is assessing a 4,000-patient survey looking into why patient portal users like the tool and why non-users haven’t yet adopted it. While Patel and his team may not be able to force the patient portal into a tool that works for every patient—some people simply prefer the phone and other access modalities—this will help the organization continue to shape its digital and analog front doors.