I recently sat down with Josh Gray and David Clain, former Advisory Board colleagues who now serve as Vice President and Manager of athenaResearch, to hear their perspective on how to get the most from a patient portal. athenaResearch is a department within athenahealth, a leading provider of cloud-based services and mobile applications for medical groups and health systems.
This is the first in a series of posts where we’ll share insights from that conversation.
Rivka Friedman: Let me start with the most basic question: Why portals?
Josh Gray: Provider groups around the country are all looking to engage more deeply with patients, and work together to improve health outcomes. Digital engagement is central to this ambition. Portals offer patients ready access to their health records, allow them to schedule appointments and pay bills, and allow patients to securely message their providers about health concerns, prescriptions, and care plans. It gives providers a way to stay in contact with patients between visits.
But simply offering patients a portal does not mean they will use it. Here at athenahealth, we’ve recently launched the Peak Performance Initiative, aimed at helping providers improve their practice operations. The initiative combines athenahealth’s big-data analytics with best-practice research and consultations with leading providers. In our most recent work, we analyzed more than 1,100 provider groups using our software to determine what distinguishes physician groups with very high portal adoption rates from average programs.
RF: So basically, portal adoption does not obey the "Field of Dreams" rule: if you build it, they still may not come.
JG: Exactly. And it can be difficult to identify what sets great portals apart from average ones. But since all athenahealth clients use the same version of the same software, we can rigorously benchmark provider performance, and learn exactly how patients and providers use portals, and what sets apart the cream of the crop.
RF: When we talk to our members about portal adoption, one of the first comments we hear is that “portals are really only popular among young people.” Is this true?
David Clain: That was one of the first myths that our analysis debunked. Providers with low portal adoption rates often think that their patient mix is to blame. But in our experience, all age groups use patient portals. Most adults—regardless of age—are receptive to creating portal accounts, as long as the benefits are explained clearly and a portal is integrated into the care process.
Portal adoption rates are highest for 30-39 year olds, but even patients into their 60s have a reasonable propensity to use portals. By the way, portal adoption reflects the percentage of a practice’s patients that already use the portal when they visit or register for the portal within 30 days—so it’s a measure of uptake. Adoption rates begin to trail off once patients reach their 70s, although even then, 70-somethings are only about 25% less likely than patients in their 50s and 60s to use portals. Older patients who do register tend to use portals more frequently.
RF: The other thing we hear frequently is, “we’re not big enough to invest in a portal.” Is there a threshold where portal adoption suddenly becomes easier?
DC: Surprisingly, scale neither hinders nor helps portal adoption. Across the athenahealth cohort, portal adoption rates do not rise or fall with practice size.
We see similar adoption rates for practices ranging from single-provider offices to large health systems with hundreds of providers (see graph below). Pretty much every size cohort hovers around the 25% mark.
We speculate that small practices and large health systems each have distinct advantages for boosting portal adoption. Providers in small groups may be more likely to have ongoing relationships with their patients, while larger practices may bring greater resources to bear in launching portal adoption campaigns.
Don't miss part two to learn how practices get good—very good—at driving patients to use their portals. In our third installment, experts tackle the question every provider is asking: do portals actually cultivate patient loyalty?