Abstract:

Background:
An electronic patient portal is a protected online website that gives patients 24-hour access to personal health information via the Internet. Portals are an important piece in a physician’s 's tool belt, but little is known as to how they can be used to promote patient engagement. Portal use can improve clinical outcomes in persons with chronic diseases (CD). Many patients report positive attitudes toward e-portal use, such as appreciating having their complete health record in one place, 24-hour access, and being able to track their health progress over time. However, reports of barriers to access, initial adoption, and continued use exist. The purpose of this study was to identify barriers to e-portal use in patients with CD to assist students and early-career physicians in improving patient engagement skills.

Methods:
A systematic review of the current state of the science regarding barriers/facilitators to portal use among persons with CD was conducted. Studies were included when their authors were published in peer-reviewed journals, discussed portal use, and evaluated patients with CD. Studies were excluded if they were not within the last 10 years (2007-2017) or if their study population included children, substance abuse disorders, or HIV. A computerized search of (4) databases (Google Scholar, PubMed, CINAHL, Cochrane Library) was performed using the keyword search term “patient portal” AND “chronic disease” AND “barriers,” and ultimately, 15 articles were chosen for the analysis.

Results:
Of the articles reviewed, five themes emerged: sociodemographic characteristics (SD), technological capacity (TC), healthy literacy (HL), security concerns (SC), and provider encouragement (PE). Regarding SD, the research (5 articles) showed minority men (i.e., Hispanic/Latino, Black, Asian) with lower incomes and less education were less likely to use portals than white women with higher levels of education and higher incomes. Low levels of TC (n=8), were associated with lower levels of portal use. Low HL was associated with limited portal use; patients with low HL took longer to do tasks and made more mistakes while using the portal. Additionally, several studies (n=5) showed that patients were concerned about privacy and security breaches of their personal information, which limited their interest in portals. Lastly, provider encouragement appeared as a key factor for portal use (n=7). Many patients had never been introduced to the portal by their provider and they often did not know it existed. Also, there were concerns about provider reimbursement for time spent communicating through the portal, leading to decreased use.

Conclusions:
Multiple factors discussed above can create barriers for patients affecting portal use, including gender, race/ethnicity, health literacy, comfort with technology, security concerns, and provider encouragement. These findings suggest that there are many opportunities for improvement in training medical students and graduate trainees in portal use engagement before entering clinical practice. While concerns about reimbursement and security may be challenging to address, as technology-enhanced care in medicine becomes more widely accepted, implementation and utilization is likely to increase. Eliminating barriers to portal use in patients with CD while training medical students and graduate trainees in portal use engagement has the potential for better health outcomes and decreased cost.

Keywords:

Electronic patient portal, e-portal, health informatics, medical education, health technology.