Unintended consequences of patient portals

There seems to be an inverse relationship between the amount of spin one hears about “the next big thing” and reality.  First it was EMRs and virtual e-visits, then social media, and now patient portals seem poised to be next big thing.   The drumbeat of vendors and pundits is unmistakable: physician that don’t adapt will be toast.   It can all sound pretty convincing until you ask to see the evidence.  What do patients think?

Take the physician patient portal.   If you read between the lines, patient portals are frequently being positioned as the new “front door” to physician practices.   By signing on to a secure website patients will have real time access to the electronic health record and will be able to communicate with their physicians by e-mail.   Additional patient features include being able to schedule an appointment with their doctor, reading their test results and refilling prescriptions.  But despite these features, according to John Moore at Chilmark Research, “nationwide use of patient portals remains at a paltry 6%.”

So now we know what vendors and pundits think about patient portals. What about patients – what do they think?

They would love it right?  I mean who at this very moment isn’t at home trying to email their doctor?  Yeah, right.

If a qualitative study of primary care patients in Journal of Internal Medicine is any indication, those most interested in using a patient portal were patients who were:

  • Dissatisfied with their physician
  • Dissatisfied with their physicians communications ability
  • Dissatisfied with their ability to get medical information from their physician

Those patients least likely interested in using a patient portal offered by their physician are patients who are:

  • Satisfied with their physician
  • Satisfied with their physician’s communication abilities
  • Difficulty in using the portal

Of significant note, patients who reported good relationships with their doctors were afraid that the patient portal would potentially undermine that strength of that relationship.    In other words, patients were afraid that e-visits would replace face to face visits.  Researchers were surprised that not one patient in the study identified encrypted email communication with their doctor as an advantage of patient portals.

While the findings from this study are not generalizable, the study does highlight a potentially significant unintended consequence of encouraging patients to use a new patient portal.   Patients may interpret the move as a signal from their physician that they will have less face-to-face time with their doctor, which in their mind is not a good thing.

To be sure, there are notable exceptions to the cautionary tale described here.  MyGroupHealth, the patient portal developed by patients and providers at Group Health Cooperative in Seattle, is perhaps the best example.


  1. Patient portals are not going to go away.  Having a patient portal is expected to be a requirement in the final  Stage 2 Meaningful Use (MU) Requirements (June 2012) and is listed as a condition for advanced Patient Centered Medical Home (PCMH) accreditation by NCQA.
  2. Ask patients what they think about a patient portal – what services should it offer, would they use it, how should it be promoted and so on.  After all, it is supposed to be patient-centered.
  3. The real value of the patient portal lies in physicians providing  patient-centered, clinical support to patients rather than promoting products and services.
  4. Integrate the patient portal into the primary care physician’s work flow and practice.  If you collect patient data on the portal then make use the physician actually uses the information during the patient visit.

Steve Wilkins is a former hospital executive and consumer health behavior researcher who blogs at Mind The Gap.

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  • http://twitter.com/hellohealthceo Nathanial Findlay

    Patient portals are an enabling technology which create an additional
    means for physicians and patients to collaborate on their care
    together. Like any technology, its value is in how it is applied.
    Establishing its place in the physician’s workflow, setting the
    expectations with the patient on when it is appropriate and treating
    the interactions with the same respect and focus as an in-person visit
    are key.

    Those seeking a better relationship with their physician will of
    course be among the first to seek new ways to address what they
    perceive as existing communication challenges. But for the majority of
    patients who are satisfied with their physician and physician
    communication, it is for the physician to present a vision for how
    this technology will fit into their care model and provide new
    benefits for their patients.

    Health care is following a long list of marketplaces in which their
    patients have already adopted online communications to interact with
    providers as well as consume their goods and services. In the face of
    chronic under-reimbursement and limited and rushed physician-patient
    interactions, patient portals not only provide real convenience to the
    patient consumer, but can be a platform for a richer physician-patient
    relationship as well as a new source of income for practices from
    patients willing to pay for the convenience.

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