Adult Patients’ Experiences of Using a Patient Portal With a Focus on Perceived Benefits and Difficulties, and Perceptions on Privacy and Security: Qualitative Descriptive Study

Abstract

Background Patient portals can facilitate patient engagement in care management. Driven by national efforts over the past decade, patient portals are being implemented by hospitals and clinics nationwide. Continuous evaluation of patient portals and reflection of feedback from end users across care settings are needed to make patient portals more user-centered after the implementation. Objective The aim of this study was to investigate the lived experience of using a patient portal in adult patients recruited from a variety of care settings, focusing on their perceived benefits and difficulties of using the patient portal, and trust and concerns about privacy and security. Methods This qualitative descriptive study was part of a cross-sectional digital survey research to examine the comprehensive experience of using a patient portal in adult patients recruited from 20 care settings from hospitals and clinics of a large integrated health care system in the mid-Atlantic area of the United States. Those who had used a patient portal offered by the health care system in the past 12 months were eligible to participate in the survey. Data collected from 734 patients were subjected to descriptive statistics and content analysis. Results The majority of the participants were female and non-Hispanic White with a mean age of 53.1 (SD 15.34) years. Content analysis of 1589 qualitative comments identified 22 themes across 4 topics: beneficial aspects (6 themes) and difficulties (7 themes) in using the patient portal; trust (5 themes) and concerns (4 themes) about privacy and security of the patient portal. Most of the participants perceived the patient portal functions as beneficial for communicating with health care teams and monitoring health status and care activities. At the same time, about a quarter of them shared difficulties they experienced while using those functions, including not getting eMessage responses timely and difficulty finding information in the portal. Protected log-in process and trust in health care providers were the most mentioned reasons for trusting privacy and security of the patient portal. The most mentioned reason for concerns about privacy and security was the risk of data breaches such as hacking attacks and identity theft. Conclusions This study provides an empirical understanding of the lived experience of using a patient portal in adult patient users across care settings with a focus on the beneficial aspects and difficulties in using the patient portal, and trust and concerns about privacy and security. Our study findings can serve as a valuable reference for health care institutions and software companies to implement more user-centered, secure, and private patient portals. Future studies may consider targeting other patient portal programs and patients with infrequent or nonuse of patient portals.

Patient and Health Care Provider Perspectives on Patient Access to Test Results via Web Portals: Scoping Review

“…(5) focused on software development and implementation as well as portals developed for research purposes (one example is the study by Fraccaro et al [24]); (6) used hypothetical scenarios on simulated patients (one example is the study by Bar-Lev and Beimel [25]); and (7) were situated outside of high-resource countries (this was seen as contextually unique). We also excluded review papers and gray literature.…”

“…A large body of research including primary studies [4][5][6][7][8][9][10][11] and reviews [1,2,[12][13][14] aimed to evaluate the effects of patient access to EHR. A systematic review of 10 randomized controlled trials concluded that the effects of portals are uncertain when compared with usual care [1].…”

“…Patients' perceptions of a Finnish portal [5] and Norwegian portal [10] were positive, with managing prescriptions and viewing test results and medical notes being the most useful [5]. Portals facilitate communication with health care teams and the monitoring of health status and care activities [7,8,10] by motivating patients to ask questions, prepare for medical appointments, and share documents with other providers [8,10]. Liu et al [6] found an indirect relationship between portal use and cancer survivors' psychological and physical health, mediated by patient-centered communication and self-efficacy.…”