Can we make patient portals useful to all patients?

Published online: October 14, 2019

Communication between patients and clinicians is essential for favorable asthma outcomes. Increasingly this communication relies on information technology including the patient portal of the electronic heath record. For patients with chronic disease living in low-income neighborhoods, the benefits of such portal communication remain unclear.

Recently in The Journal of Allergy and Clinical Immunology: In Practice, Apter et al described the use, after formal training, of the portal over 12 months in low-income patients with asthma and examined the association of portal use and health outcomes.

In this longitudinal observational study within a randomized controlled trial, 301 adults with uncontrolled asthma were taught 7 portal tasks: reviewing upcoming appointments, scheduling appointments, reviewing medications, locating lab results, locating immunization records, requesting refills, and messaging. Half of patients were randomized to receive up to 4 home visits by community health workers. Patients’ portal use by activities, rate of usage over time, frequency of appointments with asthma physicians, asthma control, and quality of life were assessed over time and estimated as of 12 months from randomization.

Fewer than 60% of all patients used the portal independently. Among users, more than half used less than one episode per calendar quarter. The most frequent activities were reading messages and viewing lab results and least frequent were sending messages and making appointments. Higher rates of portal use were not associated with keeping regular appointments during follow-up, better asthma control, or higher quality of life at 12 months’ post intervention.

Patients with uncontrolled asthma used the portal irregularly if at all, despite in-person training.  Lack of portal access was an important barrier. Patient portals need modification to accommodate low-income patients with uncontrolled asthma.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

Graphical Abstract