Adopting Patient Portals in Hospitals: Qualitative Study

Abstract

Background Theoretical models help to explain or predict the adoption of electronic health (eHealth) technology and illustrate the complexity of the adoption process. These models provide insights into general factors that influence the use of eHealth technology. However, they do not give hospitals much actionable knowledge on how to facilitate the adoption process. Objective Our study aims to provide insights into patient portal adoption processes among patients and hospital staff, including health care professionals (HCPs), managers, and administrative clerks. Studying the experiences and views of stakeholders answers the following question: How can hospitals encourage patients and HCPs to adopt a patient portal? Methods We conducted 22 semistructured individual and group interviews (n=69) in 12 hospitals and four focus groups with members of national and seminational organizations and patient portal suppliers (n=53). Results The effort hospitals put into adopting patient portals can be split into three themes. First, inform patients and HCPs about the portal. This communication strategy has four objectives: users should (1) know about the portal, (2) know how the portal works, (3) know that action on the portal is required, and (4) know where to find help with the portal. Second, embed the patient portal in the daily routine of HCPs and management. This involves three forms of support: (1) hospital policy, (2) management by monitoring the numbers, and (3) a structured implementation strategy that includes all staff of one department. Third, try to adjust the portal to meet patients’ needs to optimize user-friendliness in two ways: (1) use patients’ feedback and (2) focus on optimizing for patients with special needs (eg, low literacy and low digital skills). Conclusions Asking stakeholders what they have learned from their efforts to stimulate patient portal use in hospitals elicited rich insights into the adoption process. These insights are missing in the theoretical models. Therefore, our findings help to translate the relatively abstract factors one finds in theoretical models to the everyday pragmatics of eHealth projects in hospitals.

Quantifying Patient Portal Use: Systematic Review of Utilization Metrics

“…Margolius et al [ 103 ] found that having a wealthier or larger patient population and working more days per week resulted in primary care physicians receiving more messages from patients, which the authors stratified into message types. Provider use has been shown to lead to patient use [ 20 ], but while patients can be led toward engagement with a system required by their physicians, they can also be led away from a system not utilized by their providers [ 104 ] (eg, if patients message their providers but don’t receive a response). As mentioned previously, patient portal utilization has been employed as a proxy for patient engagement, with increased portal usage associated with better patient outcomes [ 105 ].…”

“…Lacking standardized definitions, variable consistency in the application of MU terminology appears throughout the published literature [ 2 , 32 , 43 , 106 ]. At the most fundamental level, the lack of distinction between the patient health record (PHR), whose ownership and management lies with the patient, and the patient portal, whose ownership and management lies with the health care organization, was evident in publications that investigated patient portals but included information on PHRs in the statistical analysis [ 13 , 104 , 107 ]. Further, Devkota and colleagues [ 51 ] highlighted that mixed outcomes regarding the relationship between frequency of portal utilization and health outcomes are rooted in how studies analyze portal interaction; while some studies focused on message counts [ 31 , 41 , 70 ], others focused on interaction intensity with providers through portal messaging, stratifying by no use, read-only, and read-and-write [ 18 , 43 ].…”

eHealth Patient Portal – Becoming an Indispensable Public Health Tool in the Time of Covid-19

“…In spite of the increasing interest in patient portals, the volume of compelling studies in the field, sustained by the facts and figures, remains fairly limited [8]. Available studies typically address: technological development, adoption, and use of patient portals [9,10], electronic health records and other health documents available through patient portals [11,12], patient engagement and communication [13,14], eHealth literacy [15,16], as well as different medical conditions that can be managed through patient portals [17,18]. However, these studies touch upon one or more features of patient portals under normal circumstances, so their findings are only partially applicable in the present pandemic situation.…”

Participants’ views and experiences from setting up a shared patient portal for primary and specialist health services- a qualitative study

“…The majority of studies on patient portals are from the US, which means that there is less knowledge on patient portals in a European context [ 12 – 14 ]. Most studies are conducted within one healthcare domain [ 15 , 16 ] or on patient portals for specific conditions [ 17 , 18 ]. Although eHealth tools have been put forward as central for improving integrated care [ 19 , 20 ] few studies have focused on the processes of establishing a patient portal across healthcare domains [ 21 ].…”