In an effort to improve health outcomes and patient quality of life at lower costs, provider groups around the country are increasingly focused on developing a deeper connection with patients. Expanding digital engagement is central to this effort, with online patient portals at the center of virtual physician-provider relationships. Portals offer patients immediate access to their health records, allow them to schedule appointments and pay bills, and enable secure conversations with providers.
But, as many providers have discovered, simply offering patients an online portal does not mean they will use it.
Over the past few months, my colleagues and I have focused on portal adoption as part of the athenahealth Peak Performance Initiative, a program that combines big-data analytics, consultations with leading providers, and best-practice research to help provider groups improve various aspects of their practices. For the patient portal study, we analyzed more than 1,100 provider groups on the athenahealth network to determine exactly what distinguishes physician groups with very high portal adoption rates from average programs.
Over the course of our research, we uncovered four key insights:
All age groups use patient portalsProviders with low portal adoption rates often think the age of their patient mix is to blame. The assumption is that older patients are less likely to participate, but that’s not true. Although portal adoption rates are highest for 30-39 year-olds, patients in their 60s have a reasonable propensity to use portals – in fact, they do so at nearly the same rate as patients in their 40s. Adoption rates do not trail off significantly until patients reach their 70s, but even then the decline is not as steep as you might assume: 70-somethings are only about a third less likely than younger adults to have portal accounts. And, in fact, these patients sign in more often than others – that means that even into their 70s, many patients regularly check their medical records, communicate with providers, and request prescription refills.
Practice size neither hinders nor helps portal adoptionPortal adoption rates do not correlate with the size of the practice. As shown in the chart below, we see similar adoption rates for practices ranging from single-provider offices to large health systems with hundreds of providers.
Although their adoption rates are similar, small practices and large medical groups may be taking different routes to the same place. Providers in small practices may be more likely to have ongoing, personal relationships with their patients, and so their patients may be more receptive to a tool that deepens those connections. Larger groups, conversely, can drive portal adoption through their greater resources: some health systems we work with have achieved high portal adoption by creating high-quality marketing materials and hiring dedicated portal onboarding staff. Whatever the path to high adoption, practice size is not an excuse.
Top-performing groups are getting better, fasterIn general, top performers in patient portal software adoption continue to improve rapidly over time. Across athenahealth practices, those in the highest adoption tier – roughly 150 provider groups, with an average adoption rate of 75% – improved their adoption by 2.1% in March 2015. Conversely, those in the bottom tier actually saw adoption decline by 0.2% during the same period. Across the four segments shown in Figure 3, the higher the adoption rate, the greater the increase.
When working with practices across the athenahealth network, we find that driving high portal adoption rates is largely a matter of managerial resolve: those practices determined to increase portal adoption can do so, and substantial improvements can occur in relatively short order. We have seen practices that aspire to high portal adoption achieve top-decile performance in a matter of months, while practices with more limited commitments have registered only a negligible portion of their patients onto the portal after several years.
High-touch, in-office registration works bestMost patient portals offer several registration methods, from automated emails sent to patients after their visits to hands-on registration support in the physician’s office. Practices using the athenaCommunicator patient portal have consistently achieved significantly higher yield when registering patients at their offices – for example, by having patients register on the spot using computers provided by the practice.
As illustrated in Figure 4, more than half of patients who begin the registration process in the provider’s office ultimately create portal accounts. For those patients who receive text messages with portal login information before they leave the practice, the portal conversion rate is about 25%. Finally, those receiving automated reminder emails are far less likely to register for the portal -- only 4% of patients do so.
We believe there are two explanations for this disparity: First, in-office registration allows practice staff to answer questions and guide patients through the portal registration process. For busy patients or those less comfortable with technology, support from a receptionist or other staff member is invaluable. More important, in-office registration typically follows a thoughtful, personal conversation about the benefits of patient portals. In our opinion, any serious commitment to achieve high portal adoption rates should include in-office registration.
The use of patient portals is a necessary first step toward greater patient engagement, giving patients easier access to their providers and a deeper understanding of their health histories and care plans. This level of engagement seems to influence patients’ physician visits. Next month, we’ll explore this idea further and share data and insights on the impact portals have on patient loyalty.
athenaResearch Vice President Josh Gray contributed to this report.
Submitted by Jennifer - Tuesday, May 17, 2016
Very nice article. I agree with all your observations. My question is aside from a higher rate for registration of the patient portal, what are the long term benefits that have been realized? Also, are the patients actually using the portal instead of calling. In other words, have the practices with higher patient portal engagement rate actually demonstrated a lower call volume? I am very interested in any feedback as I am new at this process.