Practice Notes

How practices get patients to use their portals

Part 2 in our series on patient portals

I recently sat down with Josh Gray and David Clain, former Advisory Board colleagues who now serve as Vice President and Manager of athenaResearch at athenahealth, to hear their perspective on how to get the most from a patient portal. We’re sharing insights from that conversation in a series of posts. In our first post, we discussed which patients use portals.

In this second post, Josh and David talk about how practices can drive patients to use portals more.

Rivka Friedman: Josh and David, we left off with you explaining that scale neither hinders nor helps portal adoption. If practice size isn’t a driver, what factors drive patients to use portals?

Josh Gray: In our experience working with practices across the athenahealth network, driving portal adoption is largely a matter of managerial resolve. When practices are determined to increase portal adoption, they can do so nearly universally, and in short order. We’ve seen practices achieve top-decile performance in a matter of months, while a practice with less dedication to the goal might register only a small subset of patients over several years.

RF: So if driving portal adoption is truly a matter of will, can any practice “switch the lights on” for their portal at any time?

David Clain: They can, but again, it’s a matter of will. That’s probably why the pattern adoption rates tend to follow is one where the strong get stronger. Top performers continue to improve fairly rapidly over time. Among athenahealth practices, those in the highest adoption tier (the top 150 or so provider groups, with an average portal adoption rate of 75%) improved their adoption by 2.1 percentage points in March of this year alone, while those in the bottom tier actually saw adoption decline by 0.2 percentage points in the same period. In other words, the gap between top performers and others is widening.

High-Adoption Practices Improving Adoption the Fastest

Segment (Portal
Adoption Rate)
Average Tenure  Average
Adoption Rate
Average Change
in Adoption (March 2015)
 0-10%  31 months  5%  -0.2 percentage points
 10-30%  34 months  18%  0.5 percentage points
 30-60%  35 months  43%  1.7 percentage points
 60-100%  36 months  75%  2.1 percentage points

RF: So if I were a practice looking to ramp up adoption in short order, where would I start?

JG: I would point to two best practices. The first is setting a formal portal adoption policy. Many of our top 100 practices have an opt-out policy rather than the far more conventional opt-in policy. In other words, the front office staff and physicians communicate that part of what it means to be a patient in a particular practice is using the portal. A slight shift of attitude can go a long way. It is the difference between asking whether a patient would like to register for the portal versus communicating that portal registration is expected and is integral to the care process.

Second: most patient portals provide several registration methods, ranging from automated emails that patients receive after their visits to hands-on registration support in the physician’s office. Practices using the athenahealth portal have seen the best results from high-touch, in-office registration campaigns. For example, a registrar may invite the patient to use a computer or kiosk to register on the spot.

RF: How successful do these in-office registration efforts tend to be?

JG: More than half of patients who begin the registration process in the office end up creating portal accounts; when patients receive text messages with login information before check-out, the portal conversion rate is about 25%. In contrast, sending automated reminder emails to patients is much less effective: only 4% of patients who receive automated emails register for the portal. Once patients leaves the office, it is much harder to register them.

RF: That’s a big difference.

DC: We think there are two explanations for the disparity. First, when a patient registers in-office, staff can answer their questions and guide them through the process. For patients who are busy or less comfortable with technology, having support from a staff member is invaluable. Even more importantly, though, staff often offer patients the opportunity to register after spending time explaining the benefits of the portal. It’s no surprise patients are more likely to register after hearing why the portal is so valuable.

Patient portal adoption

Are portals really that valuable an asset for physician offices? See our final post about whether portals actually drive patient loyalty.

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Poster: Get patients to use your portal

See simple tips on design and implementation to get patients to use your portal.

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