Patient Perspectives on Usability of Health Portals

If you have been a patient at any doctor’s office or healthcare system, you almost certainly received an invitation to join their electronic medical record communication system, or “portal.” Clinicians have their own opinions about medical record systems, but what about patients?  

What’s the Purpose of a Patient Portal?
Most users log into their portal with one specific purpose, then log off, and do not wish to spend too much time engaging in a health portal system. If the system is too cumbersome or difficult to use, it would reduce engagement and not achieve its intended purpose. The primary intended purpose of the portal should be communicated with the patient. For example, if the clinic uses the portal for its primary method of communication, appointment requests, billing, and refill requests, then the patient should be made aware of this and be required to make an account on the portal. 

Ease of Use of a Patient Portal
Unlike clinicians, patients do not expect there to be any onboarding or training associated with using the portal. Therefore, it is paramount that the portal system uses standard representations of visual elements and functionality. Labels, icons, and layouts need to be typical of what the average user is expecting. Most average users have familiarity with using email systems such as Gmail, so labels and layouts that closely mimic an email system to be most easily understood. 

Portals may perpetuate treatment inequalities in favor of those with high technology literacy, and therefore should be designed for universal usability.

Thus, a user workflow for primary patient objectives should be designed and tested with customary usability considerations in mind:

• Reducing number of clicks needed
• Grouping of items with similar purpose
• Using appropriate levels of white space
• Choice of font style and color visibility  

Feedback can be easily solicited from users with a customary question mark icon that allows users to easily send feedback without needing to fill out too many fields. This will allow programmers to continuously make improvements to usability. Usability can be tracked over time to see how often patients log in relative to the number of appointments they have, which device they use, number of interactions with features, and how long they spend in the portal. 

Sharing of Data in a Patient Portal
Most patients are familiar with HIPAA and of course expect data to be kept securely in accordance with HIPAA requirements. Now, there is a trend toward an expectation that patients are able to either download or share their data on demand. Some states have even put into
legislature that patients own their data and have a right to access their medical record. 

If a patient enters data into the portal, the patient expects that it would be automatically shared with the doctor or office who invited them to use the portal. Patients may want to enter their medications and pharmacy information into the portal and believe that doing so would transfer that information to their doctor to have for future visits. It would not be customary for the data to be visible solely by the patient, but if so, the data should be marked as private and they should be given the option to share it with the provider if desired.

There is a tremendous benefit to viewing one’s health data in one secure place, where your doctor has access to it. Prescriptions from other members of the care team can be reviewed and checked for drug-drug interactions, and clinicians can have a record that this has been shared with the patient. The data can be referenced by the patient at the pharmacy, in an emergency, by a caretaker, or when establishing care with a new provider. 

Prescription issues are a common experience for patients and a patient portal has the potential to alleviate some of these issues. Often, a patient is told the pharmacy “doesn’t have” the prescription, when in fact, the patient may have a duplicate profile under a different name or
address. Or, maybe the medication wasn’t covered by insurance and actually needs an authorization so it wasn’t filled yet. If the patient can view all the details of the prescription, confirm it was sent and received by the correct pharmacy, then it may reduce the amount of miscommunication that takes place when troubleshooting prescription issues.  

Communication with the Care Team
Patients have varying opinions on health portals. Some find them convenient, while others have concerns about their ease of use. But if there is one primary objective for a patient portal, it should be to communicate with the care team. As a patient, I was invited to a health portal system and was not able to communicate with my doctor. Under the “compose” button, I was only allowed to submit a technical question. I started to ask myself, what is the actual purpose of this, other than billing? As a patient, we believe that the main purpose of the portal system is providing a convenient method of secure communication. There must be some way to communicate with the doctor, and if not the doctor, some member of the care team. If this feature is not enabled, then it should be very obvious to the user that the feature is disabled, and other options for communication should be displayed.

Otherwise, the user will grow increasingly frustrated trying to troubleshoot this issue thinking the problem is on their end. They may ask themselves, am I looking in the right place? Is it my browser? Should I call the office instead or should I submit a ticket?   

Thus, if a clinic decides to turn off communication with the providers, or has disabled some feature, there should be a message displayed to the patient that this feature is turned off, and they should instead be given alternative solutions, such as communication by phone or text message (with the number listed). Any additional features that are disabled should be completely removed, rather than allowing buttons and links to persist with no purpose.

After a message is sent, a confirmation should appear that the message has been transmitted successfully, when to expect a response from the care team, and what to do in case of an emergency.

One of the most important features of a health portal is the ability to connect with a doctor. Patients want to be able to message their doctor directly, and they also want to feel confident that their doctor will respond in a timely manner. Some health portals make it easy to connect with a doctor, while others make it difficult.

Why is Patient Portal Usability so Important?
Overall, health portals can be a helpful tool for patients to manage their health and communicate with their care team. Portals give patients an overall impression regarding the clinic’s organization, attention to detail, and thereby overall satisfaction with that doctor. Portals have the
ability to improve patient’s health outcomes by reducing prescription errors and increasing patient education. All clinicians should be equally concerned with patient portal usability, as well as usability of the charting system, when choosing an EHR system.