Characteristics of Patients Using Different Patient Portal Functions and the Impact on Primary Care Service Utilization and Appointment Adherence: Retrospective Observational Study

Background Patient portals are now widely available and increasingly adopted by patients and providers. Despite the growing research interest in patient portal adoption, there is a lack of follow-up studies describing the following: whether patients use portals actively; how frequently they use distinct portal functions; and, consequently, what the effects of using them are, the understanding of which is paramount to maximizing the potential of patient portals to enhance care delivery. Objective To investigate the characteristics of primary care patients using different patient portal functions and the impact of various portal usage behaviors on patients’ primary care service utilization and appointment adherence. Methods A retrospective, observational study using a large dataset of 46,544 primary care patients from University of Florida Health was conducted. Patient portal users were defined as patients who adopted a portal, and adoption was defined as the status that a portal account was opened and kept activated during the study period. Then, users were further classified into different user subgroups based on their portal usage of messaging, laboratory, appointment, and medication functions. The intervention outcomes were the rates of primary care office visits categorized as arrived, telephone encounters, cancellations, and no-shows per quarter as the measures of primary care service utilization and appointment adherence. Generalized linear models with a panel difference-in-differences study design were then developed to estimate the rate ratios between the users and the matched nonusers of the four measurements with an observational window of up to 10 quarters after portal adoption. Results Interestingly, a high propensity to adopt patient portals does not necessarily imply more frequent use of portals. In particular, the number of active health problems one had was significantly negatively associated with portal adoption (odds ratios [ORs] 0.57-0.86, 95% CIs 0.51-0.94, all P<.001) but was positively associated with portal usage (ORs 1.37-1.76, 95% CIs 1.11-2.22, all P≤.01). The same was true for being enrolled in Medicare for portal adoption (OR 0.47, 95% CI 0.41-0.54, P<.001) and message usage (OR 1.44, 95% CI 1.03-2.03, P=.04). On the impact of portal usage, the effects were time-dependent and specific to the user subgroup. The most salient change was the improvement in appointment adherence, and patients who used messaging and laboratory functions more often exhibited a larger reduction in no-shows compared to other user subgroups. Conclusions Patients differ in their portal adoption and usage behaviors, and the portal usage effects are heterogeneous and dynamic. However, there exists a lack of match in the patient portal market where patients who benefit the most from patient portals are not active portal adopters. Our findings suggest that health care delivery planners and administrators should remove the barriers of adoption for the portal beneficiaries; in addition, they should incorporate the impact of portal usage into care coordination and workflow design, ultimately aligning patients’ and providers’ needs and functionalities to effectively deliver patient-centric care.

[1]  A. Chan,et al.  Technology-Enabled Consumer Engagement: Promising Practices At Four Health Care Delivery Organizations. , 2019, Health affairs.

[2]  Denise L Anthony,et al.  Who Isn't Using Patient Portals And Why? Evidence And Implications From A National Sample Of US Adults. , 2018, Health affairs.

[3]  Muxuan Liang,et al.  On the effect of electronic patient portal on primary care utilization and appointment adherence , 2018, BMC Medical Informatics and Decision Making.

[4]  Janneke M de Man-van Ginkel,et al.  Use and the Users of a Patient Portal: Cross-Sectional Study , 2018, Journal of medical Internet research.

[5]  David C. Kaelber,et al.  Patient portals and broadband internet inequality , 2017, J. Am. Medical Informatics Assoc..

[6]  Dylan S. Small,et al.  The Trend-in-trend Research Design for Causal Inference , 2017, Epidemiology.

[7]  T. Miller,et al.  International projections of age specific healthcare consumption: 2015–2060 , 2017, The Journal of the Economics of Ageing.

[8]  A. Mendel,et al.  Impact of health portal enrolment with email reminders at an academic rheumatology clinic , 2017, BMJ quality improvement reports.

[9]  Amy Allen,et al.  Patient Portal as a Tool for Enhancing Patient Experience and Improving Quality of Care in Primary Care Practices , 2017, EGEMS.

[10]  Michael J. Lopez,et al.  Estimation of causal effects with multiple treatments: a review and new ideas , 2017, 1701.05132.

[11]  Hong Li,et al.  Text Message Reminders Increase Appointment Adherence in a Pediatric Clinic: A Randomized Controlled Trial , 2016, International journal of pediatrics.

[12]  Y. A. Hong,et al.  Has the Digital Health Divide Widened? Trends of Health-Related Internet Use Among Older Adults From 2003 to 2011 , 2016, The journals of gerontology. Series B, Psychological sciences and social sciences.

[13]  Ilana Graetz,et al.  The Digital Divide and Patient Portals: Internet Access Explained Differences in Patient Portal Use for Secure Messaging by Age, Race, and Income , 2016, Medical care.

[14]  N. Gordon,et al.  Older adults’ readiness to engage with eHealth patient education and self-care resources: a cross-sectional survey , 2016, BMC Health Services Research.

[15]  Thomas N Friemel,et al.  The digital divide has grown old: Determinants of a digital divide among seniors , 2016, New Media Soc..

[16]  C. Latulipe,et al.  Primary Care Providers’ Views of Patient Portals: Interview Study of Perceived Benefits and Consequences , 2016, Journal of medical Internet research.

[17]  Joann G Elmore,et al.  Do Patients Who Access Clinical Information on Patient Internet Portals Have More Primary Care Visits? , 2016, Medical care.

[18]  Urmimala Sarkar,et al.  Barriers and Facilitators to Online Portal Use Among Patients and Caregivers in a Safety Net Health Care System: A Qualitative Study , 2015, Journal of medical Internet research.

[19]  Terhilda Garrido,et al.  Association between secure patient–clinician email and clinical services utilisation in a US integrated health system: a retrospective cohort study , 2015, BMJ Open.

[20]  D. Anthony,et al.  Negotiating stigma in health care: disclosure and the role of electronic health records , 2015 .

[21]  Hui Li,et al.  Personal health record use for children and health care utilization: propensity score-matched cohort analysis , 2015, J. Am. Medical Informatics Assoc..

[22]  Taya Irizarry,et al.  Patient Portals and Patient Engagement: A State of the Science Review , 2015, Journal of medical Internet research.

[23]  Denise L. Anthony,et al.  The double-edged sword of electronic health records: implications for patient disclosure , 2015, J. Am. Medical Informatics Assoc..

[24]  Theodoros N. Arvanitis,et al.  Patients' online access to their electronic health records and linked online services: a systematic review in primary care. , 2015, The British journal of general practice : the journal of the Royal College of General Practitioners.

[25]  Kenneth M. Langa,et al.  Health Literacy and the Digital Divide Among Older Americans , 2015, Journal of General Internal Medicine.

[26]  Clemens Scott Kruse,et al.  Patient and Provider Attitudes Toward the Use of Patient Portals for the Management of Chronic Disease: A Systematic Review , 2015, Journal of medical Internet research.

[27]  Joris van de Klundert,et al.  How outcomes are achieved through patient portals: a realist review , 2014, J. Am. Medical Informatics Assoc..

[28]  Robert J. Stroebel,et al.  Impact of patient portal secure messages and electronic visits on adult primary care office visits. , 2014, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[29]  Lorin M. Hitt,et al.  The Impact of E-Visits on Visit Frequencies and Patient Health: Evidence from Primary Care , 2013, Manag. Sci..

[30]  Susan S Woods,et al.  Patient Experiences With Full Electronic Access to Health Records and Clinical Notes Through the My HealtheVet Personal Health Record Pilot: Qualitative Study , 2013, Journal of medical Internet research.

[31]  Elske Ammenwerth,et al.  The Impact of Electronic Patient Portals on Patient Care: A Systematic Review of Controlled Trials , 2012, Journal of medical Internet research.

[32]  T. Palen,et al.  Association of online patient access to clinicians and medical records with use of clinical services. , 2012, JAMA.

[33]  Kurt Hornik,et al.  Spherical k-Means Clustering , 2012 .

[34]  Farzad Mostashari,et al.  Achieving meaningful use of health information technology: a guide for physicians to the EHR incentive programs. , 2012, Archives of internal medicine.

[35]  Monica M. Horvath,et al.  Impact of Health Portal Enrollment With Email Reminders on Adherence to Clinic Appointments: A Pilot Study , 2011, Journal of medical Internet research.

[36]  Jens Hainmueller,et al.  Synthetic Control Methods for Comparative Case Studies: Estimating the Effect of California’s Tobacco Control Program , 2010 .

[37]  Terhilda Garrido,et al.  Patient access to an electronic health record with secure messaging: impact on primary care utilization. , 2007, The American journal of managed care.

[38]  Per Egil Kummervold,et al.  Electronic patient-provider communication: Will it offset office visits and telephone consultations in primary care? , 2005, Int. J. Medical Informatics.

[39]  Lucy W. Kivuti-Bitok.  Computerization readiness. Online Journal of Nursing Informatics(OJNI) , 2001 .

[40]  C. Brown.  Coding for evaluation and management services. , 1991, Bulletin of the American College of Surgeons.