Patient Portal Lessons And Pitfalls

In an effort to improve health outcomes and patient quality of life at lower costs, provider groups around the country are increasingly focused on developing a deeper connection with patients. Expanding digital engagement is central to this effort, with online patient portals at the center of virtual physician-provider relationships.

But, as many providers have discovered, simply offering patients an online portal does not mean they will use it.

Over the past few months, my colleagues and I have focused on portal adoption as part of the athenahealth Peak Performance Initiative, a program combining big-data analytics, consultations with leading providers, and best-practice research to help provider groups improve various aspects of their practices. For the patient portal study, we analyzed more than 1,100 provider groups on the athenahealth network to determine exactly what distinguishes physician groups with very high portal adoption rates from average programs.

Over the course of our research, we uncovered four key insights:

• Providers with low portal adoption rates often think the age of their patient mix is to blame. The assumption is that older patients are less likely to participate, but that’s not true. Although portal adoption rates are highest for 30-39 year-olds, patients in their 60s have a reasonable propensity to use portals – in fact, they do so at nearly the same rate as patients in their 40s. Adoption rates do not trail off significantly until patients reach their 70s.

• Portal adoption rates do not correlate with the size of the practice. We see similar adoption rates for practices ranging from single-provider offices to large health systems with hundreds of providers. Although their adoption rates are similar, small practices and large medical groups may be taking different routes to the same place. Providers in small practices may be more likely to have ongoing, personal relationships with their patients, and so their patients may be more receptive to a tool that deepens those connections. Larger groups, conversely, can drive portal adoption through their greater resources: some health systems have achieved high portal adoption by creating high-quality marketing materials and hiring dedicated portal onboarding staff. 

• In general, top performers in patient portal software adoption continue to improve rapidly over time. Across athenahealth practices, those in the highest adoption tier – roughly 150 provider groups, with an average adoption rate of 75% – improved their adoption by 2.1% in March 2015. Conversely, those in the bottom tier actually saw adoption decline by 0.2% during the same period.When working with practices across the athenahealth network, we find that driving high portal adoption rates is largely a matter of managerial resolve: those practices determined to increase portal adoption can do so. 

• Most patient portals offer several registration methods, from automated emails sent to patients after their visits to hands-on registration support in the physician’s office. Practices using the athenaCommunicator patient portal have consistently achieved significantly higher yield when registering patients at their offices – for example, by having patients register on the spot using computers provided by the practice. More than half of patients who begin the registration process in the provider’s office ultimately create portal accounts. For those patients who receive text messages with portal login information before they leave the practice, the portal conversion rate is about 25%. Finally, those receiving automated reminder emails are far less likely to register for the portal — only 4%.We believe there are two explanations for this disparity: First, in-office registration allows practice staff to answer questions and guide patients through the portal registration process. For busy patients or those less comfortable with technology, support from a receptionist or other staff member is invaluable. 

The use of patient portals is a necessary first step toward greater patient engagement, giving patients easier access to their providers and a deeper understanding of their health histories and care plans.

David Clain manages athenaResearch, a division of AthenaHealth.