Studies still lacking on patient portal usage, efficacy

By Jonah Comstock
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Geisinger Health System's patient portal. Geisinger Health System's patient portal.

Research conducted on patient portals in the last three years shows they provide some measurable benefits, but studies are spotty and don't include a single randomized control trial, according to a new systematic review in the Journal of Medical Internet Research.

"Very few studies associated use of the patient portal, or its features, to improved outcomes," study authors from Texas State University wrote in the study abstract. "Thirty-seven percent (10/27) of papers reported improvements in medication adherence, disease awareness, self-management of disease, a decrease of office visits, an increase in preventative medicine, or an increase in extended office visits, at the patient’s request for additional information. The results also show an increase in quality in terms of patient satisfaction and customer retention, but there are weak results on medical outcomes."

The study was looking to see whether hospitals that were meeting Meaningful Use guidelines with their patient portals were actually seeing adoption of those portals or improved medical outcomes as a result. Because of the lack of experimental study designs and RCTs, however, the answer to those questions are still inconclusive.

Following up on a previous systematic review published in 2011, researchers looked for new research published between 2011 and 2014 for this one. They winnowed a list of 5,000 initial search results to 19 data-driven studies.

In general, use of the patient portal decreased no-shows, improved patient loyalty, increased patient-doctor communication, but also slightly increased workload. Researchers said results varied on whether portals actually improved outcomes.

Taken together, the studies showed that generally patients who use patient portals are satisfied with them. But many patients don't use portals, because of health illiteracy or because of socio-economic disparity. The average portal user, the study found, was a white, well-educated female under 60 with an affinity for electronic communication.

"To improve the association of use of the patient portal with Meaningful Use, hospital administrators should focus heavily on the incorporation of training in proper portal use for patients," the study says. "Portal developers should conduct ease-of-use studies on their products. If the portal is not easy to navigate, it will not be used. Policy makers should consider the extension of Meaningful Use incentives in the area that affects patient portals. The market has been slow to adapt, and as a result, the maturity of the portal is not where it needs to be in order to improve quality of care and more deeply involve the patient in the medical decision."

Ultimately, the authors urged future researchers to apply more rigor in investigating patient portals.

"Future research should focus on use of the patient portal and empirically measured quality indicators such as medical outcomes, medication adherence, and patient satisfaction," they write. "Preferably, the study designs should be RCTs, or at a minimum, an experimental design. ... The patient portal has great potential to meet both intents of Meaningful Use, but there is not sufficient evidence to declare its efficacy."

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