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Clinician Article

Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review.



  • Goldzweig CL
  • Orshansky G
  • Paige NM
  • Towfigh AA
  • Haggstrom DA
  • Miake-Lye I, et al.
Ann Intern Med. 2013 Nov 19;159(10):677-87. doi: 10.7326/0003-4819-159-10-201311190-00006. (Review)
PMID: 24247673
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Disciplines
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 6/7
    Newsworthiness - 5/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 6/7
    Newsworthiness - 5/7
  • Internal Medicine
    Relevance - 6/7
    Newsworthiness - 4/7
  • Public Health
    Relevance - 5/7
    Newsworthiness - 4/7
  • Cardiology
    Relevance - 5/7
    Newsworthiness - 3/7
  • Endocrine
    Relevance - 4/7
    Newsworthiness - 4/7

Abstract

BACKGROUND: Patient portals tied to provider electronic health record (EHR) systems are increasingly popular.

PURPOSE: To systematically review the literature reporting the effect of patient portals on clinical care.

DATA SOURCES: PubMed and Web of Science searches from 1 January 1990 to 24 January 2013.

STUDY SELECTION: Hypothesis-testing or quantitative studies of patient portals tethered to a provider EHR that addressed patient outcomes, satisfaction, adherence, efficiency, utilization, attitudes, and patient characteristics, as well as qualitative studies of barriers or facilitators, were included.

DATA EXTRACTION: Two reviewers independently extracted data and addressed discrepancies through consensus discussion.

DATA SYNTHESIS: From 6508 titles, 14 randomized, controlled trials; 21 observational, hypothesis-testing studies; 5 quantitative, descriptive studies; and 6 qualitative studies were included. Evidence is mixed about the effect of portals on patient outcomes and satisfaction, although they may be more effective when used with case management. The effect of portals on utilization and efficiency is unclear, although patient race and ethnicity, education level or literacy, and degree of comorbid conditions may influence use.

LIMITATION: Limited data for most outcomes and an absence of reporting on organizational and provider context and implementation processes.

CONCLUSION: Evidence that patient portals improve health outcomes, cost, or utilization is insufficient. Patient attitudes are generally positive, but more widespread use may require efforts to overcome racial, ethnic, and literacy barriers. Portals represent a new technology with benefits that are still unclear. Better understanding requires studies that include details about context, implementation factors, and cost.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

Very interesting intervention about providing patients with information to access their care electronically, even if there isn`t sufficient information to yet tell whether it is improving care.

Family Medicine (FM)/General Practice (GP)

Very balanced analysis of current thinking on a very topical subject.

General Internal Medicine-Primary Care(US)

This study shows that the available data doesn't say much about the real effect of electronic patient portals. It would seem that increased electronic access to medical information will occur due to patient demand, regardless of whether outcomes are improved. Among patients who use the portals, satisfaction with them is reasonably high. There are many patients who do not have access to portals due to lack of computer access, lack of health or computer literacy, or other barriers, and one would like to see these barriers addressed in further studies.

General Internal Medicine-Primary Care(US)

This review identifies limitations in the current evidence base on the efficacy of patient portals. It makes the point that portals are often deployed in conjunction with other programmatic efforts to improve care, making it challenging to isolate the effects of the portal. Perhaps the greatest challenge in designing effective portals will be making them useful to the patients most in need of this additional support; that is, those with chronic and co-morbid disorders.

Internal Medicine

New technology that still has unclear impact. Further research is needed for full exploration of potential.

Internal Medicine

This is an important area of medicine that deserves more attention but this paper says we do not know how to use and evaluate this area.

Public Health

A well carried out review that concludes there is not sufficient evidence to define the benefit of patient portals. Not entirely surprising.

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