Systematic Review Examines the Evidence on Electronic Patient Portals and their Effect on Health Outcomes

BACKGROUND:
Healthcare systems are increasingly offering patients electronic methods to communicate with providers and learn about their health problems. Patient portals tied to existing electronic health record (EHR) systems, such as VA's My HealtheVet (MHV), are designed to give patients secure access to various kinds of health information. Portals also can allow secure methods of communication and information sharing. Investigators conducted a systematic review of the relevant literature from January 1990 through January 2013, evaluating peer-reviewed articles on patient portals tied to existing electronic medical record systems, specifically looking at whether or not these systems improve health outcomes, patient satisfaction, healthcare utilization and efficiency, and adherence. Additionally, investigators evaluated the evidence about patient attitudes and characteristics – and barriers and facilitators to portal use. In total, 46 articles, including 14 randomized controlled trials, were identified as relevant to this review.

FINDINGS:

• The evidence is insufficient as to the effects of patient portals on health outcomes. A limited number of studies and variations in study design, portal functionalities, and implementation processes make it difficult to draw strong conclusions or generalizations about this relatively new technology.
• Examples were identified in which portal use was associated with improved outcomes for patients with chronic diseases (i.e., diabetes, hypertension, depression), but these were generally studies that used the portal in conjunction with case management.
• Evidence was mixed about the effect of portals on healthcare utilization and efficiency.
• Some findings included more acceptance of portals by patients who were younger and had more computer literacy or trust in the Internet, and more enthusiasm for portals among patients than physicians. Administrative and human factors in the interface were cited as barriers to use.

LIMITATIONS:

• The quantity and quality of the original studies in this review was inadequate to fully evaluate most of the outcomes, and there was little information on implementation processes.
• Studies did not examine the benefits of being able to use portals to download information from health record to share with other providers (i.e., the Blue Button function in MHV).

IMPLICATIONS:

• The jury is still out on whether patient portals such as MHV improve health outcomes or increase healthcare efficiency, although patients seem to value the ability to access their own medical records. While patients' attitudes on portals are generally positive, more widespread use may require efforts to overcome racial, ethnic, and literacy barriers.

AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D's Evidence-Based Synthesis Program (ESP 05-226). Drs. Goldzweig and Shekelle are part of HSR&D's Center for the Study of Healthcare Innovation, Implementation and Policy, Los Angeles, CA.

Goldzweig C, Orshansky G, Paige N, Towfigh A, Haggstrom D, Miake-Lye I, Beroes J, and Shekelle P. A Systematic Review of Electronic Patient Portals: Evidence on Health Outcomes, Satisfaction, Efficiency, and Attitudes. Annals of Internal Medicine November 19, 2013;159(10):677-87.