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Outcomes Research

Patient Portal Usage May Reduce the Economic Burden Of US Healthcare

Houston Methodist researchers publish the largest known review of research on patient portal usage – a critical component in potentially reducing the overall economic disease burden.

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Health care spending in the US increased by 2.7 percent in 2021, reaching $4.3 trillion, according to the Centers for Medicare and Medicaid Services. Increased patient portal usage is one way to reduce this giant economic burden while concomitantly enhancing the quality of health care in the US. Toward this end, Stephen L. Jones, MD, MSHI, John F., Jr. and Carolyn Bookout Distinguished professor in Surgical Quality and Outcomes Science and director of the J.C. Walter Jr. Transplant Center at Houston Methodist in collaboration with Terri Menser, PhD, MBA, previously assistant professor at the Centers of Outcomes Research at Houston Methodist conducted a systematic review to identify and compare methods for quantifying and reporting patient portal usage. Details of this review study were published in the Journal of Medical Internet Research in 2021.
Stephen L. Jones, MD, MSHI
Terri Menser, PhD, MBA
A patient portal is a secure online website that allows patients easy, 24-hour access to their health information and medical records. Referred to as the patient’s electronic health record, these are connected to the health care institution’s electronic health records. Patient portals were originally introduced in the late 1990s to enhance patient engagement. However, it was after 2006 that we saw an extensive adoption of patient portal usage. Studies have suggested a positive correlation between patient portal usage and health outcomes. Specifically, there is a positive correlation between patient engagement and patient portal usage. Increased patient engagement is related to enhanced patient participation in their health care management which in turn leads to decreased office visits, better adherence to treatment regimens, increased disease awareness, and overall increased patient satisfaction. Together, these factors contribute to a marked improvement in health care outcomes, particularly in the case of chronic diseases. Ninety percent of health care organizations offer patients access to patient portals (as of 2018). However, despite the adoption of patient portal usage, there is currently a paucity of systematic measurements of patient portal utilization. The lack of consistency across health care institutions regarding patient portal utilization impedes future research on how to improve patient portal usage. The review study performed at Houston Methodist sheds light on several crucial factors that contribute to the lack of a systematic approach in studying patient portal utilization. Patient portals offer several advantages. They allow patients to securely view and print their medical records including doctor visits, immunizations, laboratory results and discharge summaries. On the other hand, patient portals also allow patients to request prescription refills, schedule doctor visits, make payments and message their healthcare team with any concerns. Notably, patient portals greatly supported the management of the COVID-19 pandemic since many patients were able to take advantage of these platforms to view their test and laboratory results, book appointments and access patient education materials. On the flip side, several disparities exist across health care institutions regarding the usage of patient portals. For instance, some health care institutions mostly use patient portals for appointment scheduling, updating demographic data and conducting patient assessments prior to doctor visits. Others use patient portals mainly for sharing laboratory results and exchanging messages with patients. The lack of consistency in patient portal usage and adoption makes it difficult to create benchmarks and compare metrics.
Our investigation supports the claim that not all health care systems study patient portal utilization systematically; thus, health care system support of different communication modalities is essential. A systematic approach to measurement of portal usage is necessary to draw comparisons more readily across existing and future studies. Investigation of both provider and patient use/adoption will provide insight to generate a platform that is most beneficial for all users. Future investigation should more holistically analyze patient portal components in combination with the utilization of health services to elicit potential relationships currently unseen between portal use and patient health outcomes and to explore use that is truly meaningful.
Stephen L. Jones, MD, MSHI
John F., Jr. and Carolyn Bookout Distinguished professor in Surgical Quality and Outcomes Science and director of the J.C. Walter Jr. Transplant Center at Houston Methodist
Terri Menser
Previously assistant professor at the Centers of Outcomes Research at Houston Methodist
Furthermore, the initiation of portal use is lower in racial and ethnic minorities, individuals of lower socioeconomic status and those without internet access. This has created a “digital divide” – a concept that has garnered considerable attention. Disparities in patient portal usage due to disparities in income may be circumvented to some extent if portals are offered across multiple platforms, including telephones. Investigations of provider portal utilization are also critical. Studies have shown that increased physician use of portals is associated with increased patient portal use. Organizational policies in health care institutions influence physician portal use and non-use and hence this is another key area of study. According to Jones and Menser, “Our investigation supports the claim that not all health care systems study patient portal utilization systematically; thus, health care system support of different communication modalities is essential. A systematic approach to measurement of portal usage is necessary to draw comparisons more readily across existing and future studies. Investigation of both provider and patient use/adoption will provide insight to generate a platform that is most beneficial for all users. Future investigation should more holistically analyze patient portal components in combination with the utilization of health services to elicit potential relationships currently unseen between portal use and patient health outcomes and to explore use that is truly meaningful.” Future investigations can focus on studying the differences in portal functionality across different healthcare institutions as well as portal-specific patient education and training. In the current post-COVID era, this is undoubtedly a critical area of investigation to enhance patient health outcomes, patient satisfaction with healthcare, and health care related cost cutting.
Lauren L Beal, Jacob M Kolman, Stephen L Jones, Aroub Khleif, Terri Menser. Quantifying Patient Portal Use: Systematic Review of Utilization Metrics. J Med Internet Res. 2021 Feb 25;23(2):e23493. doi: 10.2196/23493.
Abanti Chattopadhyay, PhD
May 2023
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