Why patients don’t like portals…and what to do about it

Some doctors love them. Most patients don’t.

According to Taya Irizarry, a strategy consultant at Highmark Health who has conducted research on portals, “the only reason that patient portals got a kickoff in the beginning was because they were part of HITECH’s meaningful use criteria.” Portals were seen as a way to support patient engagement, which theoretically might lead to better health outcomes.

Theoretically. As yet, Irizarry said, there’s little concrete evidence that patient portal use leads to better outcomes.

“Just because an organization has a portal does not guarantee patient engagement. Just because you build it, it doesn’t mean that they will come,” she explained. “The real crux of people using patient portals is that they have to see them as being valuable.”

The patient perspective

It doesn’t seem like patients see the value. A new, large-scale study found that, even among patients who had health insurance and who had been to see a doctor in the past year, 63% had not used a portal during that time.

Only about 60% of the study’s 2,300 participants were even offered the option, but a significant number of non-users had other reasons for avoiding their portals. Both in terms of patient preferences and physician communication, “we’ve got some real challenges there,” said Denise Anthony, a professor of health management and policy at the University of Michigan and lead author of the study.

This particular research uncovered three main reasons that patients avoided portal use. Some said that they preferred to speak to their doctor directly. Others cited concerns about privacy and security. Another group felt that accessing the portal was a technological challenge.

While you might expect that last group to be primarily made up of older people, Anthony said that wasn’t the case. No one age, ethnic, or socioeconomic group was particularly likely to cite technological problems as a barrier keeping them away from patient portals.

The problem with portals

People may not actually be that technologically illiterate. The problem may lie with portals themselves.

“They’re big, they’re heavy, they’re full of a bunch of medical jargon, they’re hard to use,” Irizarry said, explaining that patients are often overwhelmed by the sheer amount of medical information available in a traditional portal.

According to Irizarry, that has a lot to do with the way that the HITECH act measures patient engagement with the portal. “There’s no measure of how good the patient portal is, no measure for quality, no measure of utilization rate,” she said. “It’s just ‘have people signed onto the patient portal?’”

So what can healthcare organizations—and everyone else—do?

First of all, Anthony said, doctors have to address patient concerns head-on. Providers can assure their patients that portals have excellent security and privacy measures in place, and make clear that “this is not going to impede their relationship with their provider; it’s expected to enhance that.”

Brochures and other educational materials need to tell not just how to use a portal—in step-by-step, jargon-free language—but why. Explaining that a portal can be used for both communication and health management, and helping patients imagine how they personally might use the tool, is a great beginning.

Both Anthony and Irizarry suggested having a staff member available to walk patients through the portal setup. Especially for “an older population who doesn’t have a college education, that might be really useful,” Anthony said.

Increasing the value

But portals themselves need some work. “The original idea was, ‘the more information, the better,’” Irizarry said. “There’s a long sidebar, with ten different links to things. So you click on laboratory results, and it’s every lab result you’ve ever had. There are test results, with numbers that you may or may not understand.”

Patients still want that information, said Pamela Kallmerten, a clinical associate professor at the University of New Hampshire. “They just don’t want the actual provider’s office notes, with medical jargon and that kind of thing,” she said. “They would rather have an office visit summary. They want embedded links, so they can click on a lab result and find out what [a specific term] means. Information in its pure form is not patient-friendly.

In addition, there’s little support when something goes wrong: patients who lose their passwords or have technical difficulties need some assistance. Education can help there, Kallmerten added: in one study she conducted, a patient even suggested offering a community class on portal use and troubleshooting.

That’s also an area where vendors can help: “Vendors could develop some kind of embedded link with a service, where the patient could enter a live chat room,” she suggested.

Even if there’s a lack of evidence to support specific outcomes, Kallmerten said, portals are still an important way to engage patients in their care. “It’s the opportunity to not only share information but to enhance communication with the provider,” she said. “You have more of a conversation, so you can come up with a shared decision.” ♥

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