Patient Portal Adoption Rates: A Systematic Literature Review and Meta-Analysis

Despite the increasing availability of online patient portals that provide access to electronic health records, little is known about their adoption by patients. We systematically reviewed the literature to investigate adoption of patient portals across studies. We searched MEDLINE and Scopus to identify relevant papers. We included 40 studies: 24 were controlled experiments, with prospective data collection in an actively recruited population; 16 were real-world experiments, with adoption being evaluated retrospectively after system deployment in clinical practice. Our meta-analysis showed an overall mean adoption rate of 52% (95% Confidence Interval [CI], 42 to 62%). Rates differed markedly between study types: controlled experiments yielded a mean adoption rate of 71% (95% CI 64 to 79%), compared to 23% (95% CI, 13 to 33%) in real-world experiments. This difference was confirmed in a meta-regression analysis of the influence of study characteristics on adoption rates. Our findings suggest that adoption rates reported in controlled studies do not reflect those in everyday clinical practice. Until we understand how to effectively increase adoption, patient portals are unlikely to consistently lead to improvements in care processes and health outcomes.

[1]  Hardeep Singh,et al.  Patient access to medical records and healthcare outcomes: a systematic review , 2014, J. Am. Medical Informatics Assoc..

[2]  Jens H. Weber,et al.  Conditions potentially sensitive to a Personal Health Record (PHR) intervention, a systematic review , 2015, BMC Medical Informatics and Decision Making.

[3]  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.

[4]  Julia Adler-Milstein,et al.  A comparison of how four countries use health IT to support care for people with chronic conditions. , 2014, Health affairs.

[5]  Keith Simpson,et al.  Patient access to complex chronic disease records on the Internet , 2012, BMC Medical Informatics and Decision Making.

[6]  Michael S. Wolf,et al.  Disparities in registration and use of an online patient portal among older adults: findings from the LitCog cohort , 2015, J. Am. Medical Informatics Assoc..

[7]  Theodoros N. Arvanitis,et al.  Patients’ online access to their electronic health records and linked online services: a systematic interpretative review , 2014, BMJ Open.

[8]  A. Zweben,et al.  Effective Strategies for Maintaining Research Participation in Clinical Trials , 2009, Drug information journal.

[9]  D. Bates,et al.  The digital divide in adoption and use of a personal health record. , 2011, Archives of internal medicine.

[10]  Kasper Hornbæk,et al.  Current practice in measuring usability: Challenges to usability studies and research , 2006, Int. J. Hum. Comput. Stud..

[11]  Evangelos Kontopantelis,et al.  Analysing indicators of performance, satisfaction, or safety using empirical logit transformation , 2016, British Medical Journal.

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

[13]  C. Kruse,et al.  The Effect of Patient Portals on Quality Outcomes and Its Implications to Meaningful Use: A Systematic Review , 2015, Journal of medical Internet research.

[14]  K. Simpson,et al.  Patients’ Continuing Use of an Online Health Record: A Quantitative Evaluation of 14,000 Patient Years of Access Data , 2014, Journal of medical Internet research.

[15]  Kasper Hornbæk,et al.  Old wine in new bottles or novel challenges: a critical analysis of empirical studies of user experience , 2011, CHI.

[16]  J. Ioannidis,et al.  The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. , 2009, Journal of clinical epidemiology.

[17]  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.

[18]  David Wiljer,et al.  The anxious wait: assessing the impact of patient accessible EHRs for breast cancer patients , 2010, BMC Medical Informatics Decis. Mak..

[19]  Claudia Pagliari,et al.  Embedding online patient record access in UK primary care: a survey of stakeholder experiences , 2012, JRSM short reports.

[20]  Wolfgang Viechtbauer,et al.  Conducting Meta-Analyses in R with the metafor Package , 2010 .

[21]  Neil M. Paige,et al.  Electronic Patient Portals: Evidence on Health Outcomes, Satisfaction, Efficiency, and Attitudes , 2013, Annals of Internal Medicine.

[22]  Shelagh A Mulvaney,et al.  Patient Web Portals to Improve Diabetes Outcomes: A Systematic Review , 2010, Current diabetes reports.

[23]  Vimla L. Patel,et al.  Cognitive and usability engineering methods for the evaluation of clinical information systems , 2004, J. Biomed. Informatics.

[24]  N. Adler,et al.  Using Electronic Health Records for Population Health Research: A Review of Methods and Applications. , 2016, Annual review of public health.

[25]  Successful practices in the use of secure e-mail. , 2014, The Permanente journal.

[26]  Suzanne Bakken,et al.  Review of health information technology usability study methodologies , 2011, J. Am. Medical Informatics Assoc..

[27]  Brian Fisher,et al.  Patients' access to their electronic record: offer patients access as soon as you can. , 2013, The British journal of general practice : the journal of the Royal College of General Practitioners.

[28]  Christopher Pearce,et al.  A personally controlled electronic health record for Australia , 2014, J. Am. Medical Informatics Assoc..

[29]  Howard Pai,et al.  Is Canada ready for patient accessible electronic health records? A national scan , 2008, BMC Medical Informatics Decis. Mak..