Have patient portals lived up to their potential?

Patient portal technology is far from enjoying universal use, despite promises that the technology can improve the doctor-patient experience.

The reasons for the technology’s lackluster performance are complex. 

Consider the experiences of Michael L. Munger, MD. He has one-third of his patients signed up to use the patient portal he implemented nearly two years ago, but only a portion of those patients actually use it. They log in to the portal to schedule appointments, pay bills, request prescription refills and view medical information such as test results-all of which saves his staff time.

Munger wants to add more functions to the portal and convince more patients to use it, although he’s not optimistic about getting everyone onboard.

“I’d love to see 100% of the patients use it. I don’t think we will, but I think we’ll get more [to sign up],” says Munger, who practices primary care at St. Luke’s Medical Group in Overland Park, Kansas.

Patient portals are part of the drive to bring more technology to the front lines of healthcare. Advocates of the technology say it helps physicians run their practices more efficiently by shifting some patient communication to online resources and off themselves and their staff. But health IT experts and physicians say the healthcare industry has been slower in adopting such digital tools than have consumers and some other industries.

As a result, physicians are seeing only some of the benefits promised by patient portals. And more importantly, if they want to maximize the advantages that this technology offers, they’ll have to do a better job promoting and using it.

“Simply turning on the portal and not using any of its tools makes you a physician that patients aren’t going to want to go to. Physicians need to rethink how they want to engage patients if they want to effectively utilize this resource,” says Michael McCoy, MD, chief executive officer of the consulting firm Physician Technology Services Inc. 

McCoy gives the healthcare sector’s use of patient portals a grade of “D,” saying too many physicians either don’t use them or fail to optimize their portal’s features to streamline services, increase efficiencies and better engage patients. 

Most physicians who use portal technology have enabled only several rudimentary functions. Generally, they’re using them to provide information on common medical problems and conditions; facilitate some prescription refills; allow access to medical records; and share test results. At some practices, patients also can use portals to make appointments and communicate with practice staff.

A November 2015 survey by the Council of Accountable Physician Practices and the Bipartisan Policy Center quantifies this limited use. Only 28% of the 5,000 adults surveyed have doctors who offer patient portals they can use to view medical information; another 34% indicated they want such
access. 

Amelia Coleman, M.Ed., director of the practice management consulting group at MBA HealthGroup, says she sees physicians and patients using very few of the capabilities offered by portal technology.

“Right now, in general, the use of portals is passive,” she says. “Most of the patients I’ve talked to who are using portals are using them to get information after visits. They’re viewing bills or lab results or information sent by their doctor after the visit. I see less examples of patients using it to schedule visits or to send messages.” 

For example, Coleman notes that many practices still have patients fill out questionnaires on paper rather than doing so electronically via the portal, even when that  capability is available. She gives the use of portal technology a 4 overall  on a 10-point scale.

Stumbling blocks

Experts cite multiple reasons for the slow uptake of portal technology. First among them is the technology’s relative newness.

“Most physicians in the United States haven’t been using an electronic health record (EHR) system all that long, so it’s not surprising that many haven’t turned on these [portal] features from their vendors,” says internist Thomas Payne, MD, FACP, medical director of IT services at University of Washington School of Medicine and board chairman of the American Medical Informatics Association.

As a result, he says, many physicians are still learning how to incorporate the various portal functions into their practices’ workflow or patient interactions. He adds that some doctors are wary about sharing their notes with patients for fear that patients may be confused by them or take up valuable appointment time asking about notations or medical jargon rather than  discussing the actual conditions they describe.

The blame for poor portal  adoption rates isn’t all on the physician side, experts say. They note that concerns over data privacy and protection-both of which are much more heavily regulated in healthcare than in virtually any other industry-also have slowed the development and adoption of patient portal technology. 

Many patients resist using them as well. They report they don’t like having to visit different portals for each doctor they see, and that the portals can be difficult to navigate, particularly when compared to other consumer websites, such as travel and online retailers. 

“Many portals are just so vastly different than what patients use in their personal lives. What would take you 10 clicks to send a message through the patient portal would take two clicks and 10 seconds on some [consumer] site,” Coleman says.

Moreover, not all patients have access to computers and the Internet, which leaves them without the ability to use the portal technology in any meaningful way.

Payers’ policies have slowed adoption and more robust use of portals, says
Joseph E. Scherger, MD, MPH, a primary care physician with Eisenhower Medical Center in Rancho Mirage, California, and member of the Medical Economics editorial advisory board.

Scherger has used email and other online platforms to communicate with his patients for two decades. He and many other physicians have been advocating since the late 1990s for greater online communication between patients and doctors and their staff, but payers don’t generally reimburse for online communication. As a result, he says, doctors who have a fee-for-visit practice see portals as extra, uncompensated work.

Potential value

Despite limits on reimbursement, portal technology does provide value to doctors and patients, some medical leaders say. Payne notes that portals often foster better communication and engagement between doctors and patients-which studies have shown to improve health outcomes.

“A lot of the issues we have in medicine can be traced back to communication problems-a gap in understanding, a misunderstanding, forgetting something that was said during a visit,” he says. “I don’t want to oversell the portal as a panacea or a miracle, because it’s not, but it does help address communication by increasing it and making it more convenient for people. And in that way I think it will help people do better in managing their own care.”

Research backs this up-to some degree. A 2015 systematic review of study published in the Journal of Medical Internet Research on how patient portals affect outcomes found that 37% of the 26 studies and one review screened reported improvements in seven key areas, including medication adherence, disease awareness and self-management of disease. 

The researchers noted that although the results “show an increase in quality in terms of patient satisfaction and customer retention … there are weak results on medical outcomes.” 

Jessica S. Ancker, MPH, Ph.D, associate professor of healthcare policy and research at Weill Cornell Medicine College, says her research has found that patients who use portals  most frequently-younger patients who are better educated and more motivated around health-are those who already tend to have better health outcomes.

But those who don’t fit that description are generally the ones who could benefit the most, she says, as “poverty is a very strong predictor of poor health.” She suggests that if access and use of patient portals could encompass more demographic groups, the technology might produce even better results. 

Future improvements

Payne says he expects physicians will increase their use of portals as they grow more comfortable with EHRs and other healthcare technologies and thus become more tech-savvy generally.

Similarly Munger, who serves as president-elect of the American Academy of Family Physicians, thinks the use of portal technologies will increase as physicians and patients become more accustomed to this new way of interacting and as the technology itself improves. 

“As with any aspect of the EHR, it’s going to require time to make that portal personalized and what you want it to be,” he adds. 

Meanwhile, health IT experts say new portal functions will spur further use of them in areas where there are currently limitations. As an example, Ancker points to the limits of portals and the complementary technology infrastructure (i.e. the networks connecting different medical offices and institutions) that make it nearly impossible for many patients to use the portal to share their medical records electronically.

Ideally, Ancker says, patients could log into a portal, select the information they want to send to other doctors, and then simply hit a button to electronically share those records. 

Ancker says the lack of IT connections between medical institutions hinder patients’ ability to do that, although the healthcare industry and software vendors are working on improving interoperability and portal functions so as to enable such record-sharing in the future.

She also points to the fact that most patients still can’t upload healthcare data from their personal health devices to their doctors via portals, and thus must do so  manually. Again, she and others see emerging analytics technology that will help with this.

The expectation, they say, is that analytics tools will sort through patient data to present the information in ways that help doctors, rather than bury them in unnecessary details.

This technology, for example, could analyze patient-reported weights to flag a patient with congestive heart failure with sudden weight gain, thus alerting someone at the practice to contact the patient.

“There are a lot of improvements in portal technology; vendors are investing a lot of resources in their development,” Coleman says. “And we’ll see other technologies complementing portals to enhance doctor workflow.”