Patient Portal Use and Experience Among Older Adults: Systematic Review

Abstract

BackgroundThe older adult population (65 years or older) in the United States is growing, and it is important for communities to consider ways to support the aging population. Patient portals and electronic personal health records (ePHRs) are technologies that could better serve populations with the highest health care needs, such as older adults.ObjectiveThe aim of this study was to assess the existing research landscape related to patient portal and ePHR use and experience among older adults and to understand the benefits and barriers to older adults’ use and adoption of patient portals and ePHRs.MethodsWe searched six pertinent bibliographic databases for papers, published from 2006 to 2016 and written in English, that focused on adults 60 years or older and their use of or experience with patient portals or ePHRs. We adapted preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to review papers based on exclusion and inclusion criteria. We then applied thematic analysis to identify key themes around use, experience, and adoption.ResultsWe retrieved 199 papers after an initial screening and removal of duplicate papers. Then we applied an inclusion and exclusion criteria, resulting in a final set of 17 papers that focused on 15 separate projects. The majority of papers described studies involving qualitative research, including interviews and focus groups. They looked at the experience and use of ePHRs and patient portals. Overall, we found 2 main barriers to use: (1) privacy and security and (2) access to and ability to use technology and the Internet. We found 2 facilitators: (1) technical assistance and (2) family and provider advice. We also reported on older adults’ experience, including satisfaction with the system and improvement of the quality of their health care. Several studies captured features that older adults wanted from these systems such as further assistance managing health-related tasks and contextual health advice and tips.ConclusionsMore research is needed to better understand the patient portal experience among older adults from initial use to adoption. There are also opportunities to explore the role of design in addressing barriers and supporting facilitators to patient portal and ePHR use. Finally, the future use of these systems by older adults should be anticipated and considered in the design process.

Use of an Ambulatory Patient Portal for Advance Care Planning Engagement

“…14,16 Despite the high read rate, the relatively lower use of the portal for ACP compared with article-based AD completion and in-person ACP discussions highlights the need for further evaluation of how and why older adults choose to engage in ACP, including through the patient portal. 20 Our early work described perspectives of early adopters of the ACP tools. 21 More than one-third of interviewees were age 60 years and older and had varying perspectives on usability of portal-based tools compared with article ADs, however that analysis was not after an outreach process to raise awareness about the ACP tools.…”

Usability Evaluation of a Mobile Phone–Based System for Remote Monitoring and Management of Chemotherapy-Related Side Effects in Cancer Patients: Mixed-Methods Study

“…For example, older adults may experience difficulties when using technologies such as mobile devices or smartphones [39]. However, there has been a growing interest in the design of technologies, including innovative health technology design for older adults, who often manage complex health conditions and multiple chronic illnesses, to provide better and more sufficient supportive care services [40]. Our study findings demonstrated that older participants (>65) were interested and had a positive attitude toward using the ASyMS device, although a few of them mentioned that they prefer to use the ASyMS on a larger device with larger font size.…”

Factors that affect the use of electronic personal health records among patients: A systematic review

“…Of nine reviews assessing factors that affect patients' adoption of ePHRs and patient portals [i.e. 10,19,25,130,[131][132][133][134], the current review is the only one that differentiated between factors affecting the intention to use, subjectively-measured use, and objectively-measured use.…”