- The study acknowledges that despite frequent assertions of the potential benefits of patient portals, the technology still faces low adoption levels, even within the patient-centered medical home (PCMH) model, which calls for strong care coordination and patient engagement.
To better understand the reason behind limited patient portal uptake, the researchers conducted qualitative interviews with key stakeholders within the Veterans Health Administration, where patient portals reached only one in five patients at the time of the study.
After holding interviews with patients, providers, and VHA leadership, the researchers found that each had a different view of patient portal enrollment, and that taking into account multiple stakeholder opinions can lead healthcare organizations to different paths to effectively increasing patient portal uptake.
For example, PCMH leaders were foremost concerned with employing strong marketing tactics to help all patients learn about the patient portal. However, patients and providers both reported being aware of the technology already, and that increased marketing would be redundant.
Additionally, patients, providers, and PCMH leaders identified different barriers to patient portal enrollment. Patients reported several problems completing the enrollment process, specifically noting technological glitches. In a focus group of patients who were not enrolled in the patient portal, seven out of 12 had tried to enroll in the portal but were ultimately unsuccessful.
Providers likewise cited these issues, expressing frustrations that assistance for enrolling in the patient portal was not widely available.
Furthermore, leadership and providers diverged on the best moment to promote the patient portal.
“Leadership assumed primary care was the best and most logical location within the organization for promoting PHR portal enrollment; however, providers and patients preferred to focus on pressing clinical issues,” the researchers found.
According to patient respondents, discussing both patient portals and clinical concerns during appointments created information overload.
“They gave me the My HealthVet paperwork…and just a brief overview, but then at the same time they’re giving me information about cholesterol…I feel overwhelmed…I really kind of didn’t get My HealthVet,” one patient respondent said.
The leaders and providers also disagreed about which providers should be in charge of promoting patient portal enrollment. While PCMH leaders stated that physicians should take an active role in promoting the technology, physicians said the responsibility should fall on other care team members such as nurses or administrative staff.
Providers also reported that they tend to target specific patient populations who display an inclination toward the patient portal, such as younger patients or patients with health and technology literacy.
“I wait for clues that the patient has some interest,” one provider reported. “My approach is to reinforce them, rather than be proactive, and saying, ‘This is on my checklist to make sure [you enroll].’”
Conversely, PCMH leaders stated that providers should be targeting all patients who have access to the internet.
This contrast may be born out of a reported provider ambivalence toward the patient portal, the researchers noted. Providers, patients, and leadership all acknowledged that some providers have reservations about the technology, such as strain on patient-provider relationships, what data patients can see, and whether the system was fully functional and without glitches.
While the study did not glean one sure-fire fix to improve patient portal enrollment levels, the researchers did acknowledge its value.
“Our findings reveal the importance of seeking a multistakeholder perspective to identify and understand challenges to enrollment in patient portals,” the research team said. “More broadly, our findings may have implications for adoption of new patient facing technologies in general.”
For example, the conflicting views about patient portal marketing revealed one of the primary barriers to patients accessing the technology.
“Although primary care may have intuitively seemed like an ideal setting to improve enrollment, providers and patients offered some cogent reasons that refute this intuitive choice,” the researchers explained. “It was only through our discussions with patients and providers that we learned of their familiarity and existing ambivalence about VHA’s [patient portal].”
Ultimately, these conflicting views suggest that all stakeholders, including practice leadership, providers, and patients, need to be accounted for when introducing a technology. By gathering various viewpoints, the researchers said, healthcare organizations can establish creative and individualized enrollment tactics.