- Healthcare providers practicing in low-income rural settings are facing trouble establishing patient portal use, which may be due in part to their attitudes towards the technology and how open their patients are to engaging with the tools.
A study conducted by a research team led by David P Miller Jr., MD, MS, shows that establishing widespread patient portal use among certain populations may be an unrealistic expectation.
The researchers conducted interviews with 20 providers across one large academic medical center, a state university, and a network of 16 health centers in rural North Carolina. They asked participants about the various factors which influence or hinder patient portal adoption amongst low-income adults in the area.
External pressure such as meaningful use and other federal requirements was the most commonly cited factor into why providers encourage their patients to register for their patient portals. Although this served as a huge motivator for patient portal adoption, many of the providers reported this pressure as a negative aspect to their workflows.
“So it’s going to be an issue of ‘How many of your patients are using the patient portal?’ Two. ‘Oh? Two? Well, you failed,’” one of the participants recalled to the researchers.
The providers also reported a considerable number of drawbacks related to using patient portals, most notably an increased workload. Because patient portals give patients a supposed easy-to-access avenue toward communicating with their providers, physicians and nurses were concerned that they would take advantage of this and communicate with their providers too often.
“I’ve heard of other colleagues who have had patients who maybe sort of abuse it, and write a little too many emails back and forth, and are just – you know, it’s one question after the next after the next after the next,” one physician explained.
This kind of “abuse” could lead to disrupted physician workflows. If physicians receive an influx of direct secure messages from their patients, they may be burdened with the need to answer them while trying to deliver care to another patient in the office.
Several other providers expressed concern that this ease of access to one’s provider could cause patients to think they do not need to personally visit the doctor as often. Separate studies show that lower income patients do seek out email or other alternative methods of contacting a physician due to financial restrictions.
“Like right now there’s a problem in medicine that people want all their care over the phone, and this just adds another layer to ‘I want all of my care for free,’” one doctor expressed.
Providers also stated that they are facing challenges with regard to patient buy-in. Because a majority of the patients seen by the surveyed providers are in low-income rural areas, providers found that they have low health IT literacy. This can cause those patients to be more resistant to adopting a new technology, and feel alienated from the practice.
“Two physicians expressed concerns that patients with insurance, higher education, or better access to technology would benefit from the additional services of patient portals while older or vulnerable patients who do not use portals would become further disadvantaged,” the researchers noted. “For patients who fail to use a portal, ‘the barriers are just going to be bigger.’”
That all said, many of the providers stated that they believed patient portal use would increase in the future. Because the technology is still relatively new, it may take time for patterns of full patient adoption to emerge.
This may be because of some of the reported benefits to patient portals. For example, providers stated that patient portals could increase efficiency and information sharing between other healthcare professionals.
Most notably, patient portals have the potential to increase patient access to information.
“Additionally, staff expect portals to help patients better manage their care by providing them with easy access to their lab results, medication lists, and visit summaries,” the researchers explained. “This feature could particularly benefit older adults who may have trouble understanding information during the medical encounter.”
Such benefits could lead to increased patient satisfaction. The surveyed providers mirrored what several other industry experts have said of patient portals: providing an individual with access to her health information makes her feel empowered in her care.
“Clinic personnel observed that early adopters of portals greatly enjoyed the increased access to their health information. As one clinic administrator observed, ‘there’s something about that that gives you power and control. And everybody likes to know that they’re in control,’” the research team maintained.
The research team concluded by explaining that because of the several concerns providers had, as well as the limited patient buy-in, providers were less likely to fully embrace the use of patient portals. As such, the industry should take time to research ways to resolve those issues and to more effectively implement patient portals.
“Future studies should examine ways portals can be implemented efficiently in practices and strategies for increasing portal usage in vulnerable populations, including older adults,” the research team concluded. “For portals to reach their full potential and meaningfully improve care, clinicians and patients will need to view them as a technology that adds value to care.”