Unlocking the value of patient portals: 3 thoughts from athenahealth

Patient portals are meant to conveniently connect patients and providers, but adoption of these tools lags despite a mounting demand from patients for this very capability.

athenahealth recently examined the state of patient portal adoption across the United States and found just 37 percent of patients have access to a patient portal. Josh Gray, vice president of athenaResearch at athenahealth, discusses why patient portals have not yet become a universal tool in healthcare and what lies ahead for patient access.

Please note responses have been lightly edited for clarity and concision.

Question: Why do you think providers are lagging in patient portal adoption?

Josh Gray: I think there are three major factors at play here. The first is patient readiness. A few years ago that might have been a limiting factor in portal adoption, and for a very small minority of patients it might still be, but patients of all ages are now comfortable using smartphones and interacting with their health data and their providers online.

The second is technology: getting to the point where portals are easy to use, mobile-accessible and provide true value to patients through features like secure messaging with providers, online scheduling, lab results and prescription refills. I think in some cases, the portals providers offer do not yet offer a compelling user experience. We've done a lot of work on that front — we still have more to do. But if we want patients to be eager portal users, we need to offer them a product that's on par with other apps they use.

The third factor that's limiting portal adoption — and in most cases I think the biggest — is provider commitment. At athenahealth we have about 150 practices with more than 60 percent of their patients on the portal, and quite a few with 90 percent adoption. That's because their doctors expect patients to have portal accounts, just as they expect patients to fill prescriptions and show up for follow-up appointments. If clinicians make a commitment to use the portal, and they communicate the same expectation to patients, we think very high levels of adoption are possible, but without that commitment I'm not sure they are.

Q: Do you think portal adoption will dramatically increase over the next few years?

JG: Meaningful use has been the animating force behind portal adoption in the past few years; to receive meaningful use incentive payments, providers need at least 5 percent of their patients to have portal accounts. In the next five years, I think we'll see a significant increase in portal adoption driven by market pressure and by clinical need. Patients are increasingly demanding electronic health data and online access to their care teams, and in many markets providers will need to offer those services to remain competitive.  

At the same time, providers will be increasingly on the hook for keeping patients healthy and out of the hospital. We know that patient engagement is key to health outcomes, especially for patients with chronic conditions, and we know that portals are a necessary component of an effective patient engagement strategy. As providers become increasingly accountable for cost and quality, more and more will encourage patient portal adoption to help them achieve those goals. So yes, I expect more adoption of patient portals in the next few years — and for the right reasons.

Q: How would patients benefit from increased access to portals?

JG: As portals become more sophisticated and providers learn to use them effectively, there are some clear convenience benefits to patients — scheduling an appointment online, sending a doctor a message with a clinical question rather than scheduling an appointment, requesting refills online instead of calling the office and so on. For a primary care doctor in a competitive market, those features are going to be table stakes in the future, and the patient experience will be better for it.  

But the real value of portals, which I expect we'll unlock in the next few years, is in promoting wellness and managing chronic disease. At athenahealth, we don't sell our patient portal as a standalone product — instead it's part of our broader patient engagement platform. I think if we want to measurably improve patient health, simply offering a portal isn't enough. We need to make sure our providers are holding up their end of the bargain — offering online scheduling, responding promptly to secure messages, pushing lab results to the portal, etc.  

We should educate patients about their health — we have educational resources built into our portal for that reason. We're enabling patients and doctors to communicate virtually, so patients don't come into the office unnecessarily but can ask a doctor online about a nagging concern before it becomes an acute problem. We proactively inform patients about wellness services and follow up if they miss appointments or don't fill prescriptions. We ought to provide patients data about their own health so they can take ownership of their care plans. If providers do all of those things, I'm confident patients will be healthier for it. Portals can enable this sort of communication and data sharing, but they really need to be part of a broader patient engagement strategy.

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