An objective comparison of the best EHR patient portals

A patient portal provides a secure way for patients to interact with their healthcare provider via the internet. Generally, part of the healthcare provider’s EHR, the patient portal allows patients to view their medical record, communicate with their provider, schedule and manage appointments, access health education material, check prescription refills, update their medical history and fill out intake forms, among other features.

When selecting an EHR based on its patient portal it is important to make a selection that is user friendly, secure and offers features that will facilitate patient engagement.

Patient portal usage statistics

Providers generally adopt patient portals at a rate slightly below the EHR adoption rate. According to a report from the Government Accountability Office (GAO),  9 out of 10 health care providers that participated in HHS's Medicare Electronic Health Record Incentive Program offered their patients an EHR patient portal. However, the same report notes that only one-third of patients actually use the patient portal. In a 2017 survey conducted by the Medical Group Management Association, which examined how patients used patient portals, the results indicate 29% use patient portals to access test results, with 28% using the feature for bill payment, communicating with providers and medical staff, downloading or transmitting medical records, and scheduling appointments.

The issues that appear to be preventing greater adoption of patient portals by users vary. In a 2017 article published in the journal Healthcare, the authors examine this issue, their findings indicate barriers to patient portal use include design and interface limitations, health literacy issues, and many people find the portal difficult to use. Research indicates that that older adults with less access to and experience with technology, less education, and who demonstrate low health literacy and numeracy skills experience greater difficulty using patient portals.

Benefits of patient portals

Patient portals can foster patient engagement which, in turn, improves health outcomes and reduces healthcare costs by facilitating the process of communicating and sharing information between patients and providers. With better communication, patient engagement is enhanced as patients become more involved in their care and providers can also monitor patients more effectively and provide vital information to them when needed.

With high adoption rates of mobile technology, patient portals will likely become an even more powerful tool for patient engagement as accessibility to patient portals is made easier with the introduction of mobile phone apps that can access and share data with a provider’s patient portal.

Patient engagement

Patient portals can increase patient engagement, however, evidence of a positive correlation between patient portal use and patient engagement is contingent on which functions are available to patients and which patients are using these functions.  The general consensus is that patient portals enhance patient satisfaction, may improve self-care, and increase adherence to treatments.

With increases in patient engagement facilitated by patient portal use, research shows increases in patient engagement have been linked improved patient outcomes across a number of metrics and have been shown to reduce the rate of preventable readmissions.

Streamlining communication

Patient portals can potentially streamline and enhance communication between patients and providers. For example,  according to the Office of the National Coordinator for Health Information Technology, who conducted a case study of patient portals in a medical group, the results indicate that patients and providers found that the use of a patient portal reduced the amount of time they spent on transferring information to patients and prevented miscommunications.

Mobile technologies

Mobile technology offers promise with regard to helping patients become more connected to more personalized interactions, it has been suggested that these apps need to be connected to personal health records to be effective and improve patient outcomes. As noted in the Healthcare article referenced above, mobile apps are more intuitive than more ‘traditional’ patient portals, with features such as easy log-in access, simplified data display, and real-time tracking making apps easier to use. If problems related to keeping users engaged over the long term with mobile technology could be overcome, “patient portals could adopt some high-yield features and functions of apps that lead to engagement success with patients.”

An example of a recent effort to integrate mobile technology with patient portals can be found in the Apple Health Records beta program. On July 2, Apple announced the participation of healthcare organizations in the program which would enable patients to access health records on iPhone, directly in the phone’s Health app. To date, the Cleveland Clinic and 27 other hospitals have announced participation in the program which could provide one of the initial pushes to wider adoption of mobile technology use with patient portals.  

Challenges of patient portals

The most frequently noted problems with patient portals center on potential security weaknesses and usability across care settings.

Security

The security of data transmitted to a patient portal presents a major concern given that transmitted sensitive data to a patient who is accessing their records off-site can open up new avenues for hackers to breach patient privacy. Further, patient side security is also a significant concern as patients who fail to secure their login credentials may fall victim to unauthorized access to their personal health information. Lastly, as mobile access to patient portals increases, legal concerns have been raised as to whether mobile apps linked to a patient portal fall under HIPAA or a developer's own privacy policy, creating potential compliance traps for healthcare organizations.

Use across care settings

Patients often encounter difficulties accessing and harmonizing data when they have received treatment between multiple practices for different things. In this case, a patient receiving care across multiple settings would need multiple logins to access each provider’s patient portal. For users who have shown to be reticent to engage patient portals due to a lack of technological literacy, adding on more complexity to engage portals may discourage their use.

Feature comparison of EHR patient portals

Research firm, KLAS, ranked the top patient portal in its 2018 "Best in KLAS: Software and Services" report, consolidating the report based on customer feedback from nearly 2,500 interviews with EHR users.

The following three EHR patient portals featured here were ranked as the top products in the annual report.

Epic’s MyChart

The MyChart patient portal solution provides a standard array of patient portal features such as allowing patients to access their medical records, message their doctors, access patient education materials, attend e-visits, request medication renewals, complete questionnaires, and schedule appointments. The portal can also be used in an inpatient setting whereby a patient in the hospital can access MyChart to stay in touch with their care team, review their schedule, access personalized patient education materials, and request help. Lastly, the portal can be accessed through the health features loaded on Apple devices, MyChart’s mobile capabilities enable patients to use patient portal features from their mobile device.

The patient portal is available as an add-on to the EHR package with users reporting a cost of approximately $2 per patient per year.

eClinicalWorks’ Patient Portal and Healow App

The eClinicalWorks’ Patient Portal holds capabilities similar to its closest competitor Epic. However, unlike its competitors, this system allows users to utilise health tracking features to manage their health, engage preventative health goals, and most importantly access multiple patient portal accounts from a single one location. Through the use of a mobile application named Healow, the patient portal can be accessed from a mobile device and provide users with enhanced interoperability. Healow can also integrate with the patent portal’s health tracking feature by synchronizing with wearable devices to monitor a patient’s health data and activity goals.

The patient portal is included in the base EHR cost of $445 per month per provider.

athenahealth's athenaCommunicator

Athenahealth’s patient portal features are similar to the eClinicalworks and Epic patient portal products when examining its base features including the availability of mobile access. The athenahealth patient portal offers two interesting features including an online payment function that can be used as a payment collection tool by sending automated “soft” collections messages to patients in arrears. Further, this patient portal focuses heavily on meeting MIPS measures by allowing seamless communication between patient and provider on routine matters and on issues related to  preventive health reminders.

Cost information was not available regarding athenahealth’s patient portal.

 

The benefits offered by a patient portal far outweigh its cost, however one cannot simply select a patient portal blindly and assume that it will bear results in gains in patient engagement. Rather the selection process must consider the overall EHR product and the features offered in the patient portal. At a minimum an organization should consider user friendliness as the most important attribute, then assess other factors as needed.

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Jeff Green

About the author…

Jeff Green, MPH, JD works as a freelance writer and consultant in the Healthcare information Technology Space.

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Jeff Green

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