Despite significant investments in telehealth to engage patients in their care, about two-thirds of insured US adult patients were not using an online patient portal in 2017, according to a new study by the University of Michigan. Nonusers were more likely to be male, have less than a college degree, be on Medicaid, and lack a regular provider. The report reveals these factors, along with race, were also related to whether a patient reported receiving an offer to use a portal.
Patient portals defined as secure online websites that give patients 24-hour access to health information—can enhance patients’ engagement in their own health, said lead author Denise Anthony, professor of health management and policy at U-M’s School of Public Health.
“They ask more questions of doctors, they become more engaged in knowing about and keeping themselves healthy,” she said. “Given these benefits, we wanted to look at who isn’t using a patient portal. To make sure these technologies benefit all people, we first have to find out who is and is not using them.”
Patient Portal Study Background/Overview
For the study, published in the December issue of Health Affairs, researchers Denise L. Anthony, Celeste Campos-Castillo and Paulina Lim of the University of Wisconsin-Milwaukee used data from the nationally representative 2017 Health Information National Trends Survey, limiting the study to those who had insurance and who had seen a doctor in the past 12 months.
Of the roughly 2,300 respondents, 63 percent reported not using a portal the previous year. Nonusers were more likely to not have been offered access to a portal. They also tended to be male, 65 or older, on Medicaid, lack a regular provider and have less than a college education. Of those using a portal, 95 percent had been offered access to one. However, 41 percent of those offered access did not use a portal.
Reasons for Not Utilizing Patient Portals
The study reveals that there are no demographic differences in who was likely to cite a technological barrier, having no internet or having no online medical record, as a reason for not using a patient portal. Medicaid and Medicare beneficiaries were significantly more likely to say they didn’t want to use a portal because they prefer to speak directly to a provider.
Patients older than 40, and some racial and ethnic minority groups were more likely than younger and white patients to report concerns about security and privacy. Hispanics and people older than 50 were less likely to report they had no need to access a portal.
Provider Communication Is Key to Addressing Poor Use of Patient Portals
Provider communication skills may be key to addressing another important reason for not using a portal cited by older patients and some members of racial/ethnic minority groups: concerns about privacy and information security. In addition, privacy concerns can influence health care seeking and sharing of information with providers. Providers who can elicit and allay patient concerns about privacy may not only facilitate patients’ use of online portals but also enhance patient trust in and communication with providers.
Reducing disparities in patient portal use will require that providers, particularly those serving vulnerable populations, communicate with all patients about portal use and have the capacity to discuss these technologies with patients. Providers’ communication with patients—a key tenet of patient-centered care—must include discussions of technologies such as online portals that address patients’ concerns, including fears of eroding relationships with providers.
Policymakers could provide incentives to healthcare providers to better communicate and spend more time with patients, particularly disadvantaged patients, both in person and online, Anthony said. Another policy recommendation is to encourage providers to target disadvantaged patients while changing technological features to improve portals’ usefulness. With such changes, portals could actually diminish existing health disparities, she added.
Careful monitoring of who is and who is not using patient portals, and why, and designing technologies to address patients’ needs, will help ensure that such innovations do not exacerbate disparities, but lead to healthcare transformation for all.