Abstract
BackgroundHealth care organizations are increasingly offering patients access to their electronic medical record and the ability to communicate with their providers through Web-based patient portals, thus playing a prominent role within the patient-centered medical home (PCMH). However, despite enthusiasm, adoption remains low.ObjectiveWe examined factors in the PCMH context that may affect efforts to improve enrollment in a patient portal.MethodsUsing a sociotechnical approach, we conducted qualitative, semistructured interviews with patients and providers from 3 primary care clinics and with national leaders from across a large integrated health care system.ResultsWe gathered perspectives and analyzed data from 4 patient focus groups and one-on-one interviews with 1 provider from each of 3 primary care clinics and 10 program leaders. We found that leaders were focused on marketing in primary care, whereas patients and providers were often already aware of the portal. In contrast, both patients and providers cited administrative and logistical barriers impeding enrollment. Further, although leadership saw the PCMH as the logical place to focus enrollment efforts, providers and patients were more circumspect and expressed concern about how the patient portal would affect their practice and experience of care. Further, some providers expressed ambivalence about patients using the portal. Despite absence of consensus on how and where to encourage portal adoption, there was wide agreement that promoting enrollment was a worthwhile goal.ConclusionsPatients, clinicians, and national leaders agreed that efforts were needed to increase enrollment in the patient portal. Opinions diverged regarding the suitability of the PCMH and, specifically, the primary care clinic for promoting patient portal enrollment. Policymakers should consider diverse stakeholder perspectives in advance of interventions to increase technology adoption.
Highlights
BackgroundHealth care organizations are increasingly engaging patients in the management and coordination of their own care [1]
We developed a semistructured interview guide to elicit the history of the My HealtheVet patient portal, understand existing efforts to improve enrollment practices in primary care as well as other settings, gain feedback on potential enrollment interventions, and understand the evolution of the portal
We conducted 4 patient focus groups and interviewed 1 primary care provider from each of the 3 clinics, along with 10 program leaders. 5 key themes that cut across the data were identified: 1. Disconnect over the role of marketing in primary care to increase enrollment; 2
Summary
BackgroundHealth care organizations are increasingly engaging patients in the management and coordination of their own care [1]. Information and communications technologies (ICTs) that facilitate the sharing and exchange of information between patients and their clinical teams’ members are a key aspect of patient-centered care One such technology that equips patients with tools to interact with their clinical teams is the Web-based patient portal. Patient portals have evolved from providing patients with a way to view information in their medical record to encompass secure Web-based apps that offer various electronic tools to support health care system transactions, information tracking, and communication [3]. Health care organizations are increasingly offering patients access to their electronic medical record and the ability to communicate with their providers through Web-based patient portals, playing a prominent role within the patient-centered medical home (PCMH). Objective: We examined factors in the PCMH context that may affect efforts to improve enrollment in a patient portal
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