The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating

Abstract

Background and Objective Recent external factors—the 21st Century Cures Act and the coronavirus disease 2019 (COVID-19) pandemic—have stimulated major changes in the patient portal landscape. The objective of this state-of-the-art review is to describe recent developments in the patient portal literature and to identify recommendations and future directions for the design, implementation, and evaluation of portals. Methods To focus this review on salient contemporary issues, we elected to center it on four topics: (1) 21st Century Cures Act's impact on patient portals (e.g., Open Notes); (2) COVID-19's pandemic impact on portals; (3) proxy access to portals; and (4) disparities in portal adoption and use. We conducted targeted PubMed searches to identify recent empirical studies addressing these topics, used a two-part screening process to determine relevance, and conducted thematic analyses. Results Our search identified 174 unique papers, 74 were relevant empirical studies and included in this review. Among these papers, we identified 10 themes within our four a priori topics, including preparing for and understanding the consequences of increased patient access to their electronic health information (Cures Act); developing, deploying, and evaluating new virtual care processes (COVID-19); understanding current barriers to formal proxy use (proxy access); and addressing disparities in portal adoption and use (disparities). Conclusion Our results suggest that the recent trends toward understanding the implications of immediate access to most test results, exploring ways to close gaps in portal adoption and use among different sub-populations, and finding ways to leverage portals to improve health and health care are the next steps in the maturation of patient portals and are key areas that require more research. It is important that health care organizations share their innovative portal efforts, so that successful measures can be tested in other contexts, and progress can continue.

Shared Access to Adults' Patient Portals: A Secret Shopper Exercise

“…5 Beyond making the process of granting or receiving shared access easier, health systems, electronic health record vendors, patients and care partners should all engage together in conversations about how patient privacy is affected by shared access, as each have a significant role to play in protecting privacy while also improving access. [20][21][22] Protecting patient data from unauthorized disclosure is a central goal of the Health Insurance Portability and Accountability Act (HIPAA). Administrative processes that were noted as difficult (e.g., paper forms, requiring in person registration) were likely put in place by organizations to comply with HIPAA and ensure that only people specifically authorized by the patient were granted access to their health information.…”

Ensuring Equitable Access to Patient Portals—Closing the “Techquity” Gap

“…Develop and evaluate the ecosystem around patient portals. A recent review of patient portal research identified important areas of focus, including understanding the consequences of increased patient access, evaluating new virtual care practices, understanding barriers to proxy use, and addressing disparities in portal adoption and use . Patient portals have tremendous potential to empower patients and families through carefully designed innovation, policymaking to encourage adoption, and ubiquitous access and use.…”