Patient and Health Care Provider Experiences With a Recently Introduced Patient Portal in an Academic Hospital in the Netherlands: Mixed Methods Study

Abstract

BackgroundIn the Netherlands, the health care system and related information technology landscape are fragmented. Recently, hospitals have started to launch patient portals. It is not clear how these portals are used by patients and their health care providers (HCPs).ObjectiveThe objective of this study was to explore the adoption, use, usability, and usefulness of a recently introduced patient portal in an academic hospital to learn lessons for the implementation of patient portals in a fragmented health care system.MethodsA mixed methods study design was used. In the quantitative study arm, characteristics of patients who used the portal were analyzed, in addition to the utilization of the different functionalities of the portal. In the qualitative study arms, think-aloud observations were made to explore usability. Focus group discussions were conducted among patients and HCPs of the dermatology and ophthalmology outpatient departments. Thematic content analysis of qualitative data was carried out and overarching themes were identified using a framework analysis.ResultsOne year after the introduction of the portal, 24,514 patients, 13.49% of all patients who visited the hospital, had logged in to the portal. Adoption of the portal was associated with the age group 45 to 75 years, a higher socioeconomic status, and having at least one medical diagnosis. Overarching themes from the qualitative analyses were (1) usability and user-friendliness of the portal, (2) HCP-patient communication through the portal, (3) usefulness of the information that can be accessed through the portal, (4) integration of the portal in care and work processes, and (5) HCP and patient roles and relationships.ConclusionsOne year after the introduction of the patient portal, patients and HCPs who used the portal recognized the potential of the portal to engage patients in their care processes, facilitate patient-HCP communication, and increase patient convenience. Uncertainties among patients and HCPs about how to use the messaging functionality and limited integration of the portal in care and work processes are likely to have limited portal use and usefulness.

Health Care Professionals’ Experiences of Patient-Professional Communication Over Patient Portals: Systematic Review of Qualitative Studies

“…Experiences related to health care professionals’ work were divided into 5 subthemes, which related to the increased workload [ 39 , 41 , 42 , 44 - 48 , 50 ], more efficient work [ 42 , 44 , 47 , 48 , 50 , 51 ], experiences of fear and discomfort [ 41 , 43 , 46 , 49 , 50 ], increased awareness of patients’ situations [ 41 , 43 , 48 ], and lack of time and expertise required for portal communication [ 42 , 43 , 50 ].…”

“…The health care professionals in the studies were concerned about the patient-professional communication increasing their workload [ 41 , 42 , 44 , 46 , 48 , 50 ]. Although they saw patient participation as a positive outcome of portal communication, having greater patient participation increased the workload [ 41 ].…”

“…Sometimes health care professionals received messages from patients who did not actually need their help [ 46 ], and some of the patients overwhelmed the health care professionals by inappropriately sending them repeated messages [ 47 ]. There were organizations where answering the portal messages was not formally incorporated into the daily work process of the professionals, and thus, some of the health care professionals had multiple portal messages waiting for responses, causing them an additional workload [ 43 , 50 ].…”

“…Some health care professionals reported that web-based patient-professional communication increased the efficiency of their work [ 42 , 44 , 47 , 48 , 50 , 51 ]. Not only was the web-based communication itself more effective but it also improved the efficiency and quality of face-to-face office visits because patients were able to communicate with professionals before the visits [ 42 , 47 , 48 , 50 ]. Face-to-face visits were improved because communicating with the patients on the internet before the visits helped the professionals to be more prepared for the consultation [ 42 ].…”

Population’s perceptions and availability of primary care services in Romania- a pilot survey in County Brasov.

“…correlated with changes in disease profiles, a higher prevalence of chronic diseases, the introduction of new and innovative treatments and health technologies, and the emergence of new social and economic contexts [1][2][3][4][5][6][7][8][9] . Healthcare systems need to adapt to these trends and aim to cover the health needs of the population 10 .…”