Patient Portals Still Struggling To Engage Users


CMS published statistics on patient portal engagement across rural and secondary hospitals and while at first glance the numbers seemed to suggest the roll out of portals was a success, closer inspection reveals that the results were abysmal.

Meaningful Use Stage 1 mandated that all hospitals and practices provide patients with the ability to view, download, and transmit a patient-friendly copy of their electronic medical record, within four days of being treated. The results were promising on the surface, but the catch is that any hospital that had zero patients attempt to access their portal was excluded from the performance metric. In total, this exclusion applied to 2,472 hospitals, representing 66 percent of all US hospitals. 66 percent of US hospitals had zero patients attempt to access their portal.

ONC mandated patient portals with the hope that access to health information would drive patient engagement in the overall healthcare process. The requirement ignited a buying frenzy in the patient portal market, which prior to Meaningful Use had been known more for unprecedented failures like Google Health, than for any positive improvements in outcomes, care coordination, or overall cost of care. At the time, there were no requirements that patients actually use the hospital’s portal, and with all of the other more daunting changes required within MU1, most hospitals simply implemented their EHR vendor’s portal rather than testing the market for a platform that might deliver real value to patients. As a result, demonstrated by CMS’s new report, most hospital’s measured no traffic to their portal during their attestation period.

In MU2, the requirement changed from mandating that patients have access to their records, to mandating that hospitals would be responsible for compelling patients to use the portals. The initial metric was set at 10 percent, meaning that 1o percent of all discharged patients would have to go home, log into their hospital’s patient portal, and view their medical record. Hospitals, who generally have small, if any, marketing departments were unprepared to launch a public marketing campaign to drive traffic to their portals, and so the reaction from industry groups was largely negative. In the final rule of MU2, the metric was dropped to 5 percent, but the spirit of the requirement stood. While data is not yet available on patient portal engagement rates among hospitals attesting for MU2, what is clear is that the same portals that failed to attract patients during MU1 are likely still deployed in these health systems.

As a result, CMS recently announced that it would scrap the 5 percent threshold for MU2, and instead simply require that every hospital get just a single patient to access the portal during attestation to meet the redefined patient portal objective. The future of patient portals at this point is unclear. At the same time that CMS is scaling back MU2 portal requirements, ONC published its draft rules for MU3 which pushes portal requirements much further, requiring that 25 percent of patients access their records online, that 35 percent engage in secure messaging with their clinical team, and that 15 percent contribute patient-generated health data to the portal.

The reality of patient portal usage in the US seems to starkly contrast the ONC’s ambitious plans for them, and while MU3 might still levy nearly unachievable patient engagement requirements on hospitals, CMS is at least thus far taking action to address the fallout.

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