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What Are the Top Barriers to Patient Portal Adoption, Use?

Despite strong clinician support, patient portal adoption still hovers at 90 percent because patients face some barriers to meaningfully using the tool.

As a fundamental patient engagement technology with numerous reimbursement payments tied to its adoption, providers have long searched for the secret sauce to facilitate high patient portal use. Medical professionals not only aim to meet meaningful use and MACRA requirements, but also want to foster better patient activation in care through the use of a patient-facing medical record.

Patient portal benefits are numerous – they provide patients access to their health data, allow patients to securely message their providers, and in many cases allow patients to complete administrative tasks such as scheduling appointments and paying bills. Providers have recognized those benefits and nearly universally offer access to the technology.

However, patient portal uptake is still limited, despite provider enthusiasm and the tool’s potential benefits.

A 2017 Government Accountability Office (GAO) report noted that while nearly 90 percent of providers offer access to the patient portal, less than one-third of patients have integrated the tool into their daily lives. Among the limited number of patients who enrolled on the software, even fewer use it regularly.

Providers must understand the barriers that keep their patients from adopting and using patient portals. After they identify those barriers, providers can create strategies to address them and facilitate better patient uptake of the tool. Ideally, this will lead to better patient activation in care and create better patient engagement.

Patients see limited use for patient portal

Notably, very few patients actually think they need the patient portal, the GAO report noted. Patients who are mostly healthy and who are not managing a chronic illness may not think they need regular access to their medical records and therefore write off the patient portal.

“For an individual with chronic disease who sees a physician often or touches a medical care facility often, the portal seems to have pretty obvious utility,” said Thomas Selva, MD, a pediatrician CMIO at the University of Missouri Health Care. “I can message my doctor, I can look at my labs, etc. But if you ask an otherwise healthy individual, ‘Why would you use the portal?’ they would just look at you with a blank stare and say, ‘There's nothing there.’”

In these cases, experts say providers should emphasize the tools that are useful over the patient portal. While a younger patient may not need to become familiar with lab results, they could benefit from digital appointment scheduling tools, Selva pointed out in a previous interview with

Providers need to look at the various features that could bring their specific populations to the portal. For Selva, that meant elements that could reduce the friction between patient and healthcare access. Online appointment scheduling made it easier and more convenient for patients to access care.

For other organizations, it meant offering the tool over a mobile interface. Patients have access to smartphones at an increasing rate, and these tools allow patients to take their health records on the go.

Health IT professionals see promise in mobile patient portals, especially following the announcement of Apple Health Records, the fruit’s new venture in the personal health records (PHRs).

The interface is not usable

Patients are also unlikely to use a product that is not simple and easy to use, Selva noted.

“We had rolled out an early version of the patient portal, which was originally called IQHealth, quite some time ago,” he recalled. “But it had very minimal patient adoption, and part of the reason was that it was clunky. It was really hard to set up accounts because you had to go through this whole kind of circuitous path of getting the patient's account set up so that you knew it was attached to the right person.”

Organizations with better health data interoperability and mobile-optimized tools will see more patients engaging with the usable technology.

Healthcare organizations should ensure the patient portal also displays data that is useful to the patient in a way that is useful to the patient. Burying lab results or not offering access to clinician notes will likely keep patients from seeing the utility of the portal. Even if providers offer this health data, making it difficult for patients to navigate to it will reduce the utility in the technology.

Patients have low health literacy

Patient health literacy is an integral key to improving patient portal adoption. Just as patients want to see the features they value in way that is navigable, they also want to understand that information. If a patient has low health literacy, they are unlikely to find patient portal data useful.

Some health IT developers have begun to leverage natural language processing (NLP) to make patient portal information more accessible for patients with lower health literacy. On average, most patients have poor health literacy. NLP helps to translate certain clinical terms in the patient portal to make them more understandable for patients.

Providers must also do their jobs to improve patient health literacy. This means using patient health literacy tests and offering patient education where applicable.

Providers do not promote patient portals

Making the patient portal more attractive for patient adoption is only half the battle, Selva from MU Health asserted.

“You've got to remember you've got to bring the provider to the portal as well,” he explained. “Again, we had to demonstrate to providers that if patients have access to their own information, they're much more engaged in their care. Patients are probably going to follow your plan of care much more closely and much more reliably, and there's clear data on that.”

Research suggests that patients are more likely to adopt the patient portal if they hear provider testimony of for the tool. Providers to truly believe in the patient portal and integrate it as the bedrock of the patient-provider interactions tend to see higher adoption rates.

Some providers have begun to tell patients that the portal is the primary way in which they will communicate – if the patient does not adopt the tool, they may fall by the wayside. Critics of that approach state that providers could lose those patients forever should they not communicate in a way that is convenient for the patient.

Providers can also promote patient adoption by enrolling patients in the clinic, explaining the key functions that can benefit patients in their healthcare management, and explaining how the tool will improve their patient-provider relationships.

Consistent exposure and provider testimony about the patient portal will eventually have a positive impact on patient adoption rates. However, when medical experts combine those strategies with a usable tool that displays information that is useful for patients, they will see even more success.

Going forward, health IT developers must truly assess what will be important for patients using the patient portal. Until they do so, it will be difficult to promote the tool to patients.

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