Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Apr 1;24(e1):e47-e54.
doi: 10.1093/jamia/ocw098.

Online patient websites for electronic health record access among vulnerable populations: portals to nowhere?

Lina Tieu  1 , Dean Schillinger  1 , Urmimala Sarkar  1 , Mekhala Hoskote  2 , Kenneth J Hahn  2 , Neda Ratanawongsa  1 , James D Ralston  3 , Courtney R Lyles  1
Affiliations

Online patient websites for electronic health record access among vulnerable populations: portals to nowhere?

Lina Tieu et al. J Am Med Inform Assoc. .

Abstract

Objective: With the rapid rise in the adoption of patient portals, many patients are gaining access to their personal health information online for the first time. The objective of this study was to examine specific usability barriers to patient portal engagement among a diverse group of patients and caregivers.

Materials and methods: We conducted interviews using performance testing and think-aloud methods with 23 patients and 2 caregivers as they first attempted to use features of a newly launched patient portal.

Results: In navigating the portal, participants experienced basic computer barriers (eg, difficulty using a mouse), routine computer barriers (eg, mistyping, navigation issues), reading/writing barriers, and medical content barriers. Compared to participants with adequate health literacy, participants with limited health literacy required 2 additional minutes to complete each task and were more likely to experience each type of navigational barrier. They also experienced more inaccuracies in interpreting a test result and finding a treatment plan within an after-visit summary.

Discussion: When using a patient portal for the first time, participants with limited health literacy completed fewer tasks unassisted, had a higher prevalence of encountering barriers, took longer to complete tasks, and had more problems accurately interpreting medical information.

Conclusion: Our findings suggest a strong need for tailored and accessible training and support to assist all vulnerable patients and/or caregivers with portal registration and use. Measuring the health literacy of a patient population might serve as a strong proxy for identifying patients who need the most support in using health technologies.

Keywords: chronic disease; electronic health records; health literacy; personal health records; safety net providers.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Need for assistance to complete portal navigation tasks.
Figure 2.
Figure 2.
Frequency of barriers to portal navigation. Note. This figure shows the frequency of barriers experienced by participants in each task, stratified by health literacy status. Per task, each participant could experience multiple barriers within each category and barriers from multiple categories. LHL: Limited health literate participants AHL: Adequate health literacy participants
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Charles D, Gabriel M, Searcy T. Adoption of Electronic Health Record Systems among U.S. Non-Federal Acute Care Hospitals: 2008-2014. Washington, DC: The Office of the National Coordinator for Health Information Technology; 2015.
    1. Payne TH, Detmer DE, Wyatt JC, Buchan IE. National-scale clinical information exchange in the United Kingdom: lessons for the United States. J Am Med Inform Assoc. 2011;181:91–98. - PMC - PubMed
    1. Jha AK, Doolan D, Grandt D, Scott T, Bates DW. The use of health information technology in seven nations. Int J Med Inform. 2008;7712:848–854. - PubMed
    1. de Lusignan S, Seroussi B. A comparison of English and French approaches to providing patients access to Summary Care Records: scope, consent, cost. Stud Health Technol Inform. 2013;186:61–65. - PubMed
    1. Mold F, de Lusignan S, Sheikh A, et al. Patients' online access to their electronic health records and linked online services: a systematic review in primary care. Br J Gen Pract. 2015;65632:e141–e151. - PMC - PubMed