The State of Evidence in Patient Portals: Umbrella Review

Abstract

Background Patient portals have emerged as a recognized digital health strategy. To date, research on patient portals has grown rapidly. However, there has been limited evaluation of the growing body of evidence on portal availability, use, clinical or health behavior and outcomes, and portal adoption over time. Objective This paper aims to comprehensively consolidate the current state of evidence on patient portals using the umbrella review methodology, introduce our approach for evaluating evidence for quantitative and qualitative findings presented in included systematic reviews, and present a knowledge translation tool that can be used to inform all stages of patient portal adoption. Methods For this study, a modified version of the Joanna Briggs Institute umbrella review method was used. Multiple databases were searched for systematic reviews focused on patient portals, and the final sample included 14 reviews. We conducted a meta-level synthesis of findings from quantitative, qualitative, and mixed methods primary studies reported in systematic reviews. We organized the umbrella review findings according to the Clinical Adoption Meta-Model (CAMM). Vote-counting, GRADE (Grading of Recommendations, Assessment, Development, and Evaluations), and CERQual (Confidence in the Evidence from Review of Qualitative Research) were used to assess the umbrella review evidence. Results Our knowledge translation tool summarizes the findings in the form of an evidence map. Organized by the CAMM categories, the map describes the following factors that influence portal adoption and effects over time: patient contexts, patient's interest and satisfaction, portal design, facilitators and barriers, providers' attitudes, service utilization, behavioral effects, clinical outcomes, and patient-reported outcomes. The map lists the theories and mechanisms recognized in the included portal research while identifying the need for business models and organizational theories that can inform all stages of portal adoption. Our GRADE and CERQual umbrella review evaluation resulted in the majority of evidence being rated as moderate to low, which reflects methodological issues in portal research, insufficient number of studies, or mixed results in specific focus areas. The 2 findings with a high rating of evidence were patients' interest in using portals for communication and the importance of a simple display of information in the portals. Over 40 portal features were identified in the umbrella review, with communication through secure messaging and appointment booking mentioned in all systematic reviews. Conclusions Our umbrella review provides a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews. Unsystematic and variable reporting of portal features undermines the ability to evaluate and compare portal effects and overlooks the specific context of portal use. Research designs sensitive to the social, organizational, policy, and temporal dimensions are needed to better understand the underlying mechanisms and context that leverage the identified factors to improve portal use and effects.

Oncology Patients’ Experiences With Novel Electronic Patient Portals to Support Care and Treatment: Qualitative Study With Early Users and Nonusers of Portals in Alberta, Canada

“…The evidence on the implementation and uptake of patient portals is unequivocal about the facilitating factors, such as creating awareness about the portal, easy sign-up process, intuitive navigation, explanation of medical terms, and the use of lay language [ 18 ]. Yet, all these facilitators were lacking at the time of the study.…”

“…When reporting research on patient portals, it is important to clearly outline characteristics and functions of specific portals and describe sociopolitical and organizational contexts of portal implementation and utilization [ 18 ]. Below we describe the complicated context of portal implementation in Alberta, Canada, where this study was performed.…”

Patient portal engagement and diabetes management among new portal users in the Veterans Health Administration

“…11 Despite these studies, the association of portal use and clinical outcomes is still not well understood. 20 Complicating relationships between portal use and outcomes are underlying sociodemographic, health status, and health literacy differences between portal and nonportal users. 21,22 Among patients that use portals, few studies have examined portal use over an extended period of time (eg >12 months) and whether consistent use of patient portals is associated with health outcomes.…”

Factors Enhancing Trust in Electronic Communication Among Patients from an Internal Medicine Clinic: Qualitative Results of the RECEPT Study

“…Important policy and ethical challenges pertain to the widespread adoption of EHRs to not further widen healthcare disparities for patients less technologically literate or unable or reluctant to communicate via electronic devices 22 . While clinic demographics did not support this study to assess disparities explicitly, our data defines a range of individual and organizational factors that can inform future research on how and to what extent patients’ trust and decisions to utilize care electronically vary among broader demographic groups.…”