Most Patients Don't Use EHR Portals, GAO Finds

July 31, 2017

Hard to navigate and find information. Too many passwords to remember for too many systems. Down for maintenance.

No, these aren't gripes that physicians have about electronic health records (EHRs). They're what many patients say about accessing their medical information online through a portal that typically comes with an EHR system, according to a study issued in March by the Government Accountability Office (GAO). These complaints help explain why only 30% of Medicare beneficiaries who could have visited an EHR portal in 2015 actually did so.

Granted, these finding are slightly dated. And seniors may not be the heaviest computer users out there. Still, the study shows that patients and physicians share some of the same frustrations about digital medicine.

In numerous surveys, the general public has expressed a high demand to communicate with clinicians online. A Medscape survey in 2016 found that 63% of patients believed an online portal into their EHR improves the relationship with their physician.

The federal government also thinks these portals are beneficial, and it  promotes them. To comply with the Medicare incentive program for EHR meaningful use in 2015, for example, physicians had to give at least 50% of their patients the ability to electronically access health information, such as test results and current medications, in a timely manner, and at least one patient had to actually do it. Sharing digital data with patients remains a requirement of Medicare's Merit-based Incentive Payment System, which incorporated elements of the meaningful-use program.

The prodding from Washington, DC, has been effective. Ninety-nine percent of the 194,000 clinicians who successfully participated in the meaningful-use program in 2015 gave at least half of their patients online access to their health records (the remaining 1% were exempted from the requirement for various reasons).

However, of the patients with a pipeline into their chart, only 30% logged in.  The percentage was even lower for physicians in rural areas (21%) and for practices with 10 members or fewer (20%). In contrast, the rate of online patient access hit 38% for physicians in group practices with more than 50 members.

Patient-Friendliness of EHR Portals Varies Widely

To better understand this dimension of telehealth, the GAO interviewed 33 patients who have electronically delved into their medical records. These individuals said the technology had its benefits, such as the ability to review their physician's instructions, track lab results to spot a change in their condition, and share information with other clinicians. However, they also cited frustrations:

  • Having multiple physicians means using multiple EHR portals. Patients told the GAO that it's difficult to manage all the different passwords and master each portal's interface.

  • Some patients complained about the time and effort needed to set up access to their physician's portal.

  • It's not always clear how to download or transmit health information.

  • Information is sometimes incorrect — and hard to correct.

  • Technical difficulties, such as downtime for maintenance, or a portal not being optimized for a mobile device, can put data out of reach.

  • Some portals are clunkier than others when it comes to navigating and finding information.

The GAO took this last complaint seriously. Noting that user interfaces vary from portal to portal, the GAO broke down patient access rates for each of the 10 most frequently used EHR vendors in the meaningful-use program. The agency found that for physicians aligned with one particular vendor — not identified — only 10% of their patients took advantage of the EHR portal. With another vendor, that percentage shot up to 48%.

"Our analysis…confirms that the type of portal itself may affect the extent to which patients access their available health information," the GAO report stated.

Patients also complained that they could not collect all their health data information — scattered in various EHR systems— and put it at their fingertips in a single longitudinal record. The GAO noted that clinicians can acquire software programs to aggregate data from various EHRs, but they're not in high demand. There also are personal health record (PHR) programs that patients can buy to round up data from their physicians' digital charts, but they're not widely used, owing to a variety of technological limitations, including lack of EHR standardization. "Relatively few hospitals and healthcare professionals we surveyed reported having the ability to submit information to PHR products," the GAO said.

But if someone builds a better PHR, will patients come? The Department of Health and Human Services (HHS) hopes so. As part of its work to connect patients to their health information, the department's Office of the National Coordinator for Health Information Technology (ONC) recently issued a cash-prize challenge to software designers to develop a PHR that could easily siphon data from different EHRs. First place and $50,000 went to a company called PatientLink Enterprises.

The GAO noted ONC's efforts to make patient portals more of a success story but said that ONC hasn't developed ways to measure success. HHS told the GAO that it concurred with the agency's recommendation to create such performance metrics.

The GAO report is available on the agency's website.

Follow Robert Lowes on Twitter @LowesRobert


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