- Despite strong incentives and provider attempts to the contrary, few patients are actually using the patient portal, according to new data from researchers at the University of Michigan.
Patient portals, which rose in popularity after their inclusion in the EHR Incentive Programs and later in MACRA regulations, are known as the bedrock of patient engagement technology. These tools allow patients to securely message with providers, view their own health information, request prescription refills, pay bills, and book appointments, among other functions.
But research and anecdotal evidence has suggested that these tools, which appear a one-stop shop for patient engagement needs, have not caught on with patient populations, according to lead author Denise Anthony, professor of health management and policy at U-M’s School of Public Health.
“They ask more questions of doctors, they become more engaged in knowing about and keeping themselves healthy,” Anthony said in a statement. “Given these benefits, we wanted to look at who isn’t using a patient portal. To make sure these technologies benefit all people, we first have to find out who is and is not using them.”
Using data from the 2017 Health Information National Trends Survey, Anthony and the research team looked at insured individuals who had visited the doctor within the previous 12 months. Of the 2,300 patient respondents, 63 percent – or just about two-thirds – of patients had not used the patient portal.
Those who said they had not used the portal were more likely to say that their doctors did not recommend portal adoption. These patients also tended to be non-college educated, older males on Medicaid or otherwise without insurance coverage.
Of those who did use the patient portal, 95 percent said their providers recommended they use it, reinforcing the notion that positive provider testimony can increase the odds a patient uses the technology.
Forty-one percent of those patients offered patient portal access did not use the tool. Additionally, there were no demographic differences between patients who did not use the patient portal because they did not have internet or technology access.
However, other patterns did emerge, Anthony and colleagues reported. For example, Medicare and Medicaid enrollees were more likely to say that they didn’t use the portal because they wanted to speak directly with their providers.
Patients over age 40 and some in ethnic minorities were more likely to say they had security concerns about the patient portal than younger, white patients. Hispanic patients and those over age 50 were more likely to say that they did not have a need to use the patient portal.
These trends suggest that access to technology, internet, and other infrastructure are not the most pressing barriers to patient portal use. Instead, patient understanding of and comfort with the tool keep patients from accessing the portal, according to Anthony.
“It will require education as well as technological designs that enable patients to communicate with providers in acceptable ways,” she said.
Some policy changes could overcome those education challenges, Anthony and her colleagues said. For example, incentive programs could encourage providers to spend more time with their patients educating them about how to use the patient portal. Patient education should also touch on the importance of portal engagement and the security provisions in place to keep patient data safe.
Additionally, policymakers could incentivize patient portal customization that targets low-income or otherwise disadvantaged patients. This could help close care disparities that follow minority patients, Anthony said.
Other research has suggested that patient portal adoption is not necessarily the issue. 2018 data from the Medical Group Management Association (MGMA) showed that patient portal adoption has reached about 90 percent. But stronger patient use leaves much to be desired. While patients are signing up for portal accounts, they do not regularly log in.
This suggests that providers need to emphasize the importance of patient portal use. Additionally, providers should customize their tools with functions that are important to their patient panels.