Patient Portal Perceptions in an Urban Community Health Center Setting: Insights for Telehealth

Abstract

Introduction
 Patient portals are the “front door” to telehealth - online scheduling, video visit links, and digital after visit summaries are often conveyed via the patient portal. Patient portal tools often require similar patient skills and attitudes as telehealth adoption. Analyzing patients’ perceptions and beliefs around this digital patient engagement tool may lead to insights regarding telehealth, particularly in historically underrepresented patient populations.
 
 Methods
 Participants from a Federally Qualified Health Center (FQHC) in Chicago, IL were surveyed on general technology use, healthcare-specific technology use, and barriers and facilitators to patient portal use.
 
 Results
 The 149 respondents (81% response rate) represented a unique population base with 96% African American, 74% with educational attainment of some college or less, and 48% with at least one chronic medical condition. Technology access and use were high with 78% computer ownership, 98% mobile phone ownership (with 75% smartphone ownership). In terms of patient portal perception, 75% rated Perceived Usefulness (U) as high. Perceived Ease of Use (E) domains similarly had 70% or higher agreement from patients, and potential barriers and facilitators in the Attitudes Toward Use (A) section included a preference to calling their doctor, and minority of patients viewing the portal as unsafe way to communication, too complicated to use, or taking too much time. Additional stratification analysis by demographic variables (age, gender, educational attainment, and number of chronic conditions) revealed differences in portal perception across the Usefulness, Ease of Use, and Attitudes domains.
 
 Discussion
 Insights from barriers, attitudes, and capacity to use patient portal tools deliver important insight into overall adoption of other digital health modalities, including telehealth. In an urban historically underserved patient population, technology access and use is quite high, and mobile phones access was nearly ubiquitous with a large majority using the internet function on their mobile device. Different age groups, genders, levels of educational attainment, or degree of multi-morbidity have different values and needs. Therefore, each subpopulation needs targeted messaging of different portal benefits.
 
 Conclusion
 Our research provides initial insights into patient-level factors influencing patient portal attitudes, with implications toward telehealth adoption. Demographic differences have a significant impact on attitudes toward technology adoption. Equitable uptake of portal and telehealth services will require tailored messaging, training, and multiple modes of communication, including web-based and mobile.