Clinics Wary of Portals Despite Health Data Sharing Benefits

January 29, 2016 - A qualitative study of provider views on patient portals finds recognition of the technology’s potential to improve patient communication and health information exchange; however, at clinics serving low-income patients, personnel have concerns about portals’ unintended consequences.

The study, led by researchers at the Wake Forest School of Medicine, was published earlier this month in the Journal of Medical Internet Research. The objective was “to determine how administrators, clinic staff and healthcare providers at practices serving a lower income adult population viewed patient portals in terms of their potential benefit, areas of concern and hopes for the future,” according to the study report.

The study team conducted in-depth interviews between October 2013 and June 2014 with 20 clinic personnel from health centers in four North Carolina counties.

Interviewees acknowledged portals’ potential to improve communication and enhance information sharing, but raised concerns that portals may generate additional work, confuse patients, alienate non-users and increase health disparities. They expected few older and disadvantaged patients to use the technology.

Participants cited EHR meaningful use requirements at the main motivator for implementing portals. They described potential benefits in the following areas:

• Office efficiency — decreasing phone calls; handling messages more quickly; and eliminating the need to inform patients of normal test results.
• Patient and caregiver access to information — increasing patients’ ability to manage their own health; increasing caregiver ability to assist with medical affairs; and increasing patient satisfaction.
• Information sharing with other health professionals — decreasing duplicate tests and reducing medical errors (typically caused by patients’ lack of knowledge of their medications, duplicate prescriptions or incorrect therapies).

“Despite these potential benefits, staff expressed many more concerns about the negative impacts of portals on their practices,” the study report states.

Perceived threats to the practice included the potential for a high volume of messages through the portal; time pressure on staff to incorporate new portal procedures; decrease in office visits; and liability concerns about information conveyed via portal.

Interviewees also raised the potential for portals to cause patient confusion or anxiety (in the absence of direct physician or staff interaction); the possibility of alienating older patients unfamiliar with the technology; and the threat of widening health disparities among income classes and education levels.

Additionally, clinic staff and physicians worried about inaccurate data entry in portals, system or communication failures, and privacy concerns related to unauthorized access to portal information.

“In general, staff saw patient portals as a mandated product that will rarely be used by older adults,” the report states. “This, in turn, discouraged providers from embracing this new technology.”

Educating patients about portal capabilities and functions could help improve patient uptake, according to the study team. However, the challenge will be identifying who can provide this training because clinicians and medical staff lack the time to take on extra tasks.

The study authors recommend further research focusing on strategies for increasing portal adoption in vulnerable populations.

“In general, clinics that have used a planned, systematic implementation strategy have seen higher rates of portal uptake than clinics that rely on clinicians to inform and enroll patients. However, the importance of having clinician and provider buy-in before implementation has also been highlighted,” the report states.

The co-authors conclude, “For portals to reach their full potential and meaningfully improve care, clinicians and patients will need to view them as a technology that adds value to care.”