Are health portals friend or foe for older adults?
The Digital Divide in Patient Communication
Are health portals user-friendly for older adults? Most hospital systems now have health portals that allow communication between patients and healthcare providers. For older adults who may not be very computer savvy, the daunting task of creating an account and then using it in the portal can be anxiety-producing, preventing them from communicating as intended through the portal.
Growing geriatric population in need of health maintenance
“In 2014, the adult population aged 65 years or older in the United States was 46.2 million, and this number is projected to increase to 98 million by 2060” (Bosold, et.al., 2017). Attempts to support such a growing group of individuals who oftentimes have many chronic conditions is a difficult endeavor. Overseeing patients with those conditions usually entails many healthcare visits, tests, and medication management, just to mention a few. Healthcare providers of today usually do not call their patients with basic test results but rely on patient portals to give, not only test results but summaries of visits as well.
Why were health portals created?
The objective of creating healthcare portals was to create better patient/provider communication and engagement. The thought behind this was driven by the idea that the more patients were involved in their care, the more proactive they would be in working with healthcare providers to manage their illnesses. In doing this, the patient would be able to make more informed decisions about how they wanted or expected their health to progress. Better accessibility was the main intent for portal use. The ability to share information quickly and accurately with both the provider and the patient, sometimes simultaneously, was advantageous. The ability to see lab results along with their reference ranges might help alleviate concerns a patient has about whether anything was abnormal. This could potentially eliminate any frantic inquiry phone calls. By the same token, being able to see abnormal results right away might prompt an urgent phone exchange before the provider has even seen the results. The same occurs for radiology results. If the patient views the test interpretation by the radiologist and can understand the medical terminology, it can either allay fears or create a bunch of questions. Here are some of the additional advantages of health portal usage:
Viewing visit notes and summaries
Secure messaging from patient to provider (although the message normally goes to the team and not directly to the provider. A team member will escalate to the provider if the communication warrants direct provider contact.)
Patients can download and transmit health record data if they need to
Portal provides specific patient education on health condition
Portal can generate reminders for appointments
Portal can provide medication reconciliation services
When successful in accessing the portal
Creating a portal account is the first hurdle patients must navigate. Once they’ve cleared this step, they face the challenge of learning to move through the portal’s interface to access the information they need. Fortunately, most health portals prioritize user-friendly design by organizing key sections under clear, intuitive headings like Visit Summary, Lab Results, or Medications—allowing patients to click and view details with ease. Common actions, such as printing or downloading test results, are streamlined through universally recognized symbols (like a printer or download icon). Similarly, messaging a provider is typically straightforward, with options neatly labeled under the familiar term “Message” (Curran, et.al., 2015).
Hurdles to successful portal use
Some of the barriers individuals encounter have to do with internet access, computer skills, and health literacy. Other factors may exist related to either language barriers or disabilities (Curran, et.al., 2015). What the creators of patient portals did not foresee was the inundation of patients having to interact with multiple portals. While speaking with an 88-year-old computer-savvy male patient, he mentioned he is the only one in the household who accesses the portals for not only his healthcare records but also those of his wife. Since she is unable to, due to her lack of computer literacy, he must interact with more than 6 portals to keep abreast of their health information. Although some of these healthcare providers are part of the same health system, their specialty has a separate portal patients must access. Along with their primary care portal, they have 4 or more other specialty portals for their care in cardiology, gastroenterology, ophthalmology, and ENT. This sharing or Proxy Access is common, however granting such access is not automatic and must abide by the HIPAA Privacy Rule in the US. Either through verbal consent or completing specific forms designating access for another individual.
Advantages versus disadvantages
The 88-year-old and his wife appreciated being able to see the results of their tests right away when available. However, they both expressed displeasure in not knowing whether their providers had also seen the results. Not knowing this fact has often left them wondering whether to wait and be contacted or to reach out and contact the provider directly. Some new features in portals “explain results in layman’s terms and tell the patient if additional care is needed.” (AMA, 2019). After a recent hospital stay for the wife, another portal was introduced to their portal group requiring additional new navigational skills. This put the total portal usage for them up to 8 or more. Keeping track of usernames and passwords and the particular link to access the portal has been very challenging. They also miss the lack of human contact by using the portals and wish it was different for them in their advancing years. In a Health Affairs article, some interesting data was reported. There were 5 reasons why patients skip using the patient portal. The top reason weighing in at 70% was that patients preferred to speak directly with a physician or nurse practitioner. About 22% had privacy concerns with using a health portal and 57% expressed no need to use the portal (AMA, 2019).
Is there an answer to making it easier?
For some individuals, having a Proxy Access person may be the permanent solution if they are lucky enough to have one available as often as they need to. Those without a Proxy Access person may be able to seek out technical assistance through the health system offering portal access. In one study, the participants preferred the help of a person versus a Web video, therefore having individuals available for this kind of one-on-one service is important and should be factored into health system IT departments (Bosold, et.al., 2017). Patients could avoid using the portal altogether, and resort to using the phone like they used to. However, phone communication with the provider usually ends up in the proverbial “phone tag” where each person winds up calling the other multiple times and leaving voicemail messages without getting to talk to one another. For the patient AND the provider, this can be as equally frustrating as using the portal. A phone conversation can be problematic and not ideal for those who are hearing impaired. Information can be misconstrued, and the right questions may not be asked.
Are there viable options going forward?
As our older population grows and managing their chronic illnesses becomes more demanding, there must be a sustainable alternative for keeping patients and providers talking to one another. Portal platform developers must remain vigilant about what works for people and what doesn’t and adapt accordingly. If portal usage doesn’t work for some individuals, other methods of communication may need to be implemented. Video calls with text-to-speech options or the implementation of other accommodations might be necessary from now on. As our geriatric population continues to grow, their problems with communication are not going to disappear. The importance of having patients involved in their own care and having the ability to make informed decisions with their healthcare provider, cannot be understated. Being able to adapt to the needs of this population of patients as well as others, is imperative to patient-centered care.
Resources
American Medical Association (AMA). (2019) Retrieved from Most of your patients still aren’t using the portal. Here’s why. | American Medical Association
Baldwin, J., Giardina, T., Singh, H. & Sittig, D. (2017). Retrieved from Patient portals and health apps: Pitfalls, promises, and what one might learn from the other - PMC
Bosold, A., Choi, Y., Sakaguchi-Tang, D. & Turner, A. (2017). Patient Portal Use and Experience Among Older Adults: Systematic Review Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC5662789/
Curran,C., DeVito, A., & Irizarry, T. (2015). Patient portals and patient engagement: A state of the science review. Retrieved from Patient Portals and Patient Engagement: A State of the Science Review - PMC
https://uh.edu/news-events/stories/2023/august-2023/08032023-patient-health-portals-age-disconnect