Do Patient Portals Improve Care?

Meaningful use refers to not just having electronic health records (EHR), but using them in a useful way for patients. And while getting the various EHRs to talk to one another seems not to have been considered meaningful, EHRs have implemented patient portals – a means for patients to e-communicate with their physicians and see their health records. A new paper describes some of the savings associated with the use of patient portals.

The study focused on patients with diabetes who were members of Kaiser Permanente of Northern California, about 160,000 patients; 77% had additional medical problems and about a quarter made use of the patient portal. [1]

• Patients with access to the portal increased their office visits by 21%. This was true for both patients with multiple problems as well as diabetes by itself.
• Portal use was associated with an 8% decrease in ED visits and an 11% decrease in hospitalization, statistically significant for those with multiple problems and trending in that direction for patients with diabetes alone.

Portals, at least in this study, enhanced access to physician communication. In speaking with patients, some had questions answered within the portal resulting in not needing an appointment, while others found results or concerned that warranted face-to-face discussion and an additional appointment. Similarly, the portal’s ability to address requests for prescription refills off-hours reduced ED visits. Portals acted as buffers between a patient’s desire for 24-hour access and physicians’ desires for a work-life balance. And while ED visits and hospitalizations are one measure of wellness, it is not clear whether portals improve patient health; to the extent that the foster improved communication, they provide a benefit.

Portals are not free of problems. Only about 30% of Medicare beneficiaries use them despite nearly 90% of their physicians providing them. As with many healthcare disparities, age, income, and in this instance broadband access, limit portal use. And like other new technology, there is a schism between the designers’ intentions and what users found beneficial. For example, physicians have been slow to incorporate appointment scheduling in the system; and patients find having laboratory and imaging results, without the explanatory framework that a physician provides, may induce more anxiety than assurance.  

If you read the hype of marketing that passes for news, patient portals will be transformative, empowering, providing a wealth of services to allow the patient to “navigate their health journey.” As one article has written 

“Patient portals are —intended to provide that improved engagement and outcomes—have yet to deliver on the promise. But that’s expected to change within the coming decade as portals become more patient-centered.” [2]

You have to ask if these patient portals were not designed to be patient-centered, to begin with, what was there purpose? That answer lies in the requirements and financial incentives associated with "meaningful use" that spurred their development and Silicon Valley’s belief that it is better to ship a product than not to ship at all. 

[1] The study period covered the two years after Kaiser initiated the portal in 2005. Patient engagement with portals increased to around 50% by 2018.

[2] The future of patient portals Medical Economics

Source:  Patients with complex chronic conditions: Health care use and clinical events associated with access to a patient portal PLOS One DOI:10.1371/journal.pone.0217636