A recent study tracked patients in 12 health systems across
the country for 9 months (March – December 2018) and found that just 0.7% of
patient portal users also downloaded their health record data using their
phones (accounting for 0.1% of all health system patients, assuming standard adoption rates of the patient portals within
those health systems).
Healthcare
organizations (HCOs) and their vendors may be missing an opportunity to better
engage patients if they ignore their portals and obsess over app
downloads and adoption. If vendors make patient portals more
palatable to patients, more enthusiastic app adoption could follow. Ensuring
patients can easily access and utilize patient portals makes those patients
more likely to use patient portal-adjacent offerings. However, patients
continue to find portals hard to navigate and difficult to learn. This blog
post will offer solutions for addressing each issue, hopefully allowing
patients to benefit from the portals that provider organizations are working so
hard to build.
User Experience
Because
smartphone users tracked by the study were all previous users of a patient
portal, a less than stellar experience with the patient portal may have
dissuaded patients from exploring other online offerings from the same
provider. Standards for patient-facing health-IT tools are rising as
health apps improve their functionality and user experience. For instance,
Apple Health presents users with easily navigable, well-presented health data.
Conversely, most portals greet patients with inadequate functionality, confusing formatting, and hard to understand health data. Patients
often lose interest in these portals, unsure of how to take advantage of any of
their promised offerings.
To
address these issues, designers of patient portals need to follow principles of
interaction design. Patient portals should present a streamlined,
intuitive user interface that enables patients to quickly and easily find and
manage their data. Information should be readable and
actionable; instead of simply indicating “high LDL” when presenting
numeric blood work results, which many patients would not know how to interpret
or use, portals should explain how a patient’s high cholesterol is impacting
their health and link resources to healthy lifestyle adaptations right
there in the app. Smartphone applications on small screens can easily
become cluttered, but the same interaction design principles apply. User
testing can determine if attempts to meet these criteria were successful, as
well as identify additional areas of potential improvement.
Learning How and Why to Use the Portal
Patients
also need more help navigating portals. A previous study revealed that many patients received no
help beyond being informed of the existence of the patient portal website (if
they had been made aware of its existence at all). When asked, patients
described learning to use the portal as a “trial and error” process or stated
that they “played around with it” until they figured it out. No patient
reported having someone explain how to use the portal or what the benefits of
using the portal might be.
Adding
simple automated tutorials to the patient portal after an initial login,
providing a phone number to call for guidance, or offering in-person assistance
at a provider’s office for those struggling to use the portal could help
patients take advantage of what the portal offers.
Visibility
Unenthusiastic
providers may not even tell patients that a portal exists, with one
provider stating, “there was an incentive to get so many people signed
up so we were trying to talk to everybody initially but not any more so I kind
of leave it up to them if they’re interested in that.” Without outside
marketing, most people would be unlikely to use or learn about a patient portal
until a care episode, if at all.
Many
other healthcare stakeholders already provide strategies for marketing patient portals (the ONC
even has a patient
engagement playbook that covers the topic), but most boil down
to improving outreach and having office staff commit to patient portal
enrollment. Encouragement by all members of the office staff (doctors, nurses,
management staff, etc.), advertisements in the office, and regular e-mail
outreach to patients that are not signed up for the patient portal are all
examples of these strategies.
Conclusions
The
study I linked to above about portals should not be surprising. It is unlikely
that patients who had already struggled to figure out how to use a patient
portal would take extra steps to learn and use an associated smartphone app.
However, the importance of addressing these issues cannot be understated.
Providing and utilizing patient portals has been proven to improve patients’ health status. Interest in expanding
the use of smartphones to connect patients and providers has been growing
for many years. So, healthcare stakeholders should push for
these issues to be addressed, allowing patients, providers, and payers to reap
the benefits that patient portals could enable.
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