New research needed to guide patient portal development

Healthcare organizations can often find it difficult to implement online patient portals. Unfortunately, few research studies in the literature can provide much help in overcoming these thorny challenges, according to an article by a Dutch team published online in the Journal of the American Medical Informatics Association.

A research team from the Institute of Health Policy and Management at Erasmus University Rotterdam in the Netherlands found that only five of the 109 papers included in their literature review evaluated solutions to problems encountered in adopting patient portals.

"As a result, the review does not provide an evidence base for portal development," they wrote. "Yet, our findings support a set of recommendations for advancement of the evidence base: We posit that future research should build on existing evidence, draw on principles from design sciences conveyed in the problem-solving cycle, and seek to produce evidence within various different organizational contexts."

Significant benefits

Patient portals can offer significant benefits to patients, providers, and the healthcare system as a whole, lead author Terese Otte-Trojel told AuntMinnieEurope.com.

"However, they are not being developed with the consistency and pace as we would hope based on the many benefits they can create," she said.

As a result, Otte-Trojel and colleagues thought it would be useful to develop an overview of the evidence in order to develop an evidence-based framework for patient portal development (JAMIA, 2 September 2015).

They relied on five questions to guide their literature review of patient portal research:

• What categories of problems related to patient portal development have been defined?
• What causal factors have been identified by problem analysis and diagnosis?
• What solutions have been proposed to ameliorate these causal factors?
• Which proposed solutions have been implemented and in which organizational contexts?
• Have implemented solutions been evaluated and what learning has been generated?

The researchers found 109 relevant articles via their search of PubMed, ScienceDirect, and LISTA, and identified five main categories of problems relating to achieving patient engagement, provider engagement, appropriate data governance, security and interoperability, and a sustainable business model.

Problems, but not many solutions

Of the 109, 45 of the 109 articles proposed solutions to patient portal problems.

"Interestingly, however, few of these solutions have been implemented in an actual portal and even fewer evaluated to determine their effects," she said.

Only 18 of the 45 articles that proposed solutions had actually implemented them. What's more, only five of these solutions were evaluated to learn about their effects, according to the researchers.

"With this review, we conclude that few studies systematically report on the patient portal development process," the authors wrote.

The researchers offered three main recommendations for future research efforts on patient portals. First, they encourage researchers to base their portal design on existing evidence and report on their implementation and evaluation. This would help to validate, advance, and generalize existing evidence, according to the group.

"Where there is no evidence, such as on how to secure financial sustainably, we encourage research that identifies and analyzes problems in addition to designing, implementing, and evaluating solutions so as to create a more well-rounded evidence base," they wrote.

Noting that patient portal development occurs through multiple iterations of the problem-solving cycle, the authors called for studies that have a longer time horizon and encompass several iterations of the process.

Lastly, the authors said the patient portal evidence base "could benefit from research that accumulates knowledge from different types of patient portals, patient populations, and across organizational contexts (and especially within fragmented care delivery contexts where portal development problems may be most severe)."

Lead author Otte-Trojel has since left Erasmus University and is now working for NNIT, an IT implementation advisory company in Copenhagen, Denmark. In her new role, she will be working on implementation of an electronic medical record (EMR) from Epic Systems in two Danish regions. The EMR will include a patient portal that will likely also support exchange of radiology images, she said.