Patient Portals

Patient Portals



A Federal priority for health information technology in the U.S. is patient engagement. The aim is to involve patients more directly in their medical care, especially for those with chronic diseases, to improve outcomes and reduce costs. One of the key principles is to provide information to patients in a more transparent, easy to use format so that information can be used for improved medical management and to support behavior modification when it is needed. Patient portals offer EHR owners a method to meet some of the Meaningful Use stage 1 requirements. Portals vary in functionality so one-size-fits-all certainly does not apply.


One of the primary functions of a patient portal is to provide access to a patient's medical record. This can open up the entire chart, certain predetermined sections, or a summary document such as a CCD or CCR. Options include the ability only to view data or the possibility of uploading information to a home device or personal health record. Some portals allow patients to make contributions to the record such as correction of errors, annotations and other patient-generated types of data. Other functions have also been enabled by some portal designers. Popular features include the ability of patients to request medication refills online, patient mediated appointment scheduling, and secure email interchange with a clinician or office staff. Other portals offer bill payment options, ways to complete medical history questionnaires, patient education materials, and even social media site links.


One idea is to give patients more control over their medical information. As many know, consent for release of information has been a challenging policy and technical barrier to more robust information exchange. There are those who think that the patient should be solely in control of information flow by uploading all their health information to a personal health record. Then the patient could decide to whom to release information, which information, for what purposes of use, and for how long. This clearly represents an optimistic view of the health care community's ability to engage patients. Experience to date with large patient portal implementations has shown that only a minority of patients make use portals. Consumer adoption of PHRs has likewise been disappointing.


The Direct Project specification, as it is rolled out and implemented by major EHR vendors, may be a game-changer for both use of portals and adoption of PHRs. Direct should make it easier to direct the push of information from EHRs to PHRs so that the workflow becomes more automated and "easy" to perform.


There have been some concerns about privacy issues. Patients accessing portals often are authenticated by a single factor through use of user names and passwords. This is a relatively weak method for user identification. Furthermore, EHR owners are concerned that use of patient portals could expose them to data breaches and malicious attacks. These issues will have to be addressed through policy and technology development as we move through the more advanced stages of Meaningful Use.