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Report: Older Adults Hesitant to Use Patient Portals

June 4, 2018
by Rajiv Leventhal
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About half of older adults aged 50 to 80 years old reported they have set up a patient portal, but there are concerns with the technology among this age group, according to the University of Michigan’s National Poll on Healthy Aging report.

The report specifically found that about half of older adults (51 percent) in this age group reported they have set up a patient portal, with similar rates for those 50 to 64 years old (52 percent) and 65 to 80 years old (49 percent). The survey was administered earlier this year to approximately 2,000 adults in the 50 to 80 age group.

There were some demographic differences, however, with higher proportions setting up a patient portal among women vs. men (56 percent vs. 45 percent), among adults with some college vs. high school only (59 percent vs. 40 percent), and among those with higher vs. lower household income (59 percent for income greater than $60,000 vs. 42 percent for income less than $60,000).

Common reasons cited for not setting up a patient portal included: older adults do not like communicating about their health by computer (40 percent); do not have a need for a portal (38 percent); did not know they needed to set something up (33 percent); have not gotten around to setting up a portal (29 percent); are not comfortable with technology (26 percent); and/or their provider does not offer the option of a portal (26 percent).

To this end, some adults who have not set up a patient portal had concerns about doing so: 26 percent were very concerned that there is a greater chance of error with a portal compared to talking with someone by phone or in person. About one in five (18 percent) were very concerned that they would not know which member of the office staff was answering their question, while 16 percent were very concerned that it might take too long to get a response to their question or request.

What’s more, among adults who have set up a patient portal, the most common use of the portal was to see test results (84 percent). Other common uses were requesting a prescription refill (43 percent), scheduling an appointment (37 percent), requesting reminders about upcoming appointments (34 percent), getting advice about a health problem (26 percent), updating insurance or contact information (22 percent), and requiring a referral (13 percent).

Older adults did note advantages to portals compared with contacting their doctor’s office by phone. With regard to the ability to explain their request, 21 percent rated the portal as better, 47 percent rated phone as better, and 32 percent rated them as about the same. For the amount of time it takes to get a response, 34 percent said the portal is better, 36 percent said the phone is better, and 30 percent said they are about the same. In terms of their ability to understand the information they get from the provider’s office, 30 percent said the portal is better, 27 percent said the phone is better, and 43 percent said they are about the same.

According to the report’s researchers, the data showed that many older adults prefer communicating with their doctor’s office by telephone. They stated, “It is understandable that some patients may prefer a communication method where they can respond in real-time to questions about symptoms or ask for clarification if they do not understand the practice’s instructions. Eliminating barriers to patient portals, while maintaining the option to continue telephone communication, may be the most appropriate strategy to meet the varied needs of older adults.”

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PCCI Combines Predictive Modeling, Patient Engagement to Address Pediatric Asthma

August 16, 2018
by David Raths
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Over three years, effort leads to 31 percent drop in ED visits and 42 percent drop in admissions for pediatric asthma cohort
Steve Miff

The Parkland Center for Clinical Innovation (PCCI) in Dallas has spent the past three years developing and testing predictive models to identify children at risk for asthma exacerbations. Combining those models with clinical and population health interventions has led to improved outcomes, says PCCI, which is now turning its efforts to pre-term births.

This targeted population health effort was funded by Parkland Community Health Plan, the largest Medicaid plan in the Dallas area. PCCI has eight clinicians on staff, including two pediatricians by training. “They intuitively knew that for the population we are serving pediatric asthma is typically not well managed and is a high-cost condition,” said Steve Miff, president and CEO of PCCI.

A deep-dive analysis of the data for the health plan identified areas that had the largest expenditures and where there was the most variation in care and potential overutilization for services, such as emergency room visits for asthma, he said.

“We had to understand the disease itself and where these children receive care in the community.”

PCCI has built a predictive model to risk-stratify the children into different cohorts based on the likelihood that their asthma condition would exasperate over the next three months and likely require emergency department visits or hospitalizations. The model itself uses claims data, EHR data, social determinants of health information, which might include gaps in insurance coverage. “We also ingested and used data from EPA sensors in the community about air quality,” Miff said. That has been only marginally useful so far because the sensors are not specific enough to be able to attribute to an individual,” he said, “so we are working with local universities and some companies that are deploying sensors to get data on air quality that is more real-time and more specific.”

Part of the project involves being more proactive with clinicians and patients.  It sends alerts to the 21 physician practices involved before visits with these patients. Because the payer is involved, the case manager at the health plan gets a risk-stratified list of patients. The risk manager use that to focus on the very high-risk cohort, Miff said.

“We also engage directly with the children and families themselves in their home,” he said. “We enroll the very high-risk cohort into a texting program.” They receive texts multiple times per week with reminders about upcoming appointments, reminders about the need to take their medication, and ongoing education about their condition so it stays top of mind. “What is cool is that they 70 percent rated it very useful in a survey, and over a 12-month period, we saw only 15 percent attrition, which is pretty fantastic when you think about the frequency of engagements.”

Miff said that over the last three years, this has proven to be an effective way to engage individuals. “We have expanded the number of clinics and individuals involved and we have continued to refine the model.

He pointed to some key improvements: The program is saving the health plan around $6 million per year in costs for this population. “Contributing to that is that we have seen a 31 percent drop in ED visits and we have seen a 42 percent drop in in-patient admissions for the population,” he said.  Alerts embedded in clinicians’ EHRs and monthly progress reports have led to up to 50 percent improvement in asthma controller medication prescriptions and a 5 percent improvement in the asthma medication ratio.

PCCI also did a cross-market analysis to compare apples to apples with other Medicaid insurers. The overall Dallas-Fort Worth Medicaid managed care market saw ED visits decline 5 percent over the past three years in a similar population. The overall market is making progress, Miff said, but a similar cohort within Parkland Community Health Plan had a 31 percent drop.

PCCI also found that the children most actively engaged with texting had even better outcomes in terms of reduced ED utilizations.

PCCI did have a cohort of high-risk children they could not get engaged via the texting program. They designed a pilot to use Amazon Echo Alexa as a personal assistant and a group interaction to gamify this process for those individuals. The Echo is programmed to ask questions about their asthma. The children win together as a group if they participate on a regular basis and their knowledge about their condition improves. “The results are not in on that pilot in terms of how long they stay engaged,” Miff said, “but it is an interesting way to engage them in the home.”

Looking at other cohorts that are costly, have high utilization and are not favorable for patients, they chose pre-term birth as a next target. “Nine months ago, we launched a pilot to look at that population,” Miff said, “and we are rolling out a subgroup of that population looking at gestational diabetes using a similar approach and model.”

“For the sub-cohort on gestational diabetes, we need additional information if we are going to engage with them at home. It is not enough to build these models based on the most recent clinical or claims data or social determinants,” Miff said. “We need more real-time information about their condition, so we have included remote monitoring devices to extract real-time data about three things: blood pressure, blood glucose and weight so we can monitor those.” PCI is designing the predictive models that take those into account. For the general diabetic population, they are focusing on the diabetic foot ulcer population.

PCCI’s impressive results with predictive modeling and patient outreach have drawn interest from other Medicaid plans.

“We are at a point where this is ready to be tested in other environments,” Miff said. “We are in advanced discussions with two other Medicaid plans in other parts of the country, and in advanced discussions with one commercial payer with an employer population to test these models. They will have to figure out to adjust the predictive models and the work flows and the in-home outreach from a technology perspective.”


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Apple Health Records Project Continues to Gain Provider Participants

August 6, 2018
by Rajiv Leventhal
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In the last few weeks, nine more health systems have signed on to support Apple’s new “Health Records” initiative.

The new institutions were announced on Twitter by Ricky Bloomfield, M.D., who is working at Apple as a clinical and health informatics lead.

In January, Apple announced that it would be testing the Health Records feature out with 12 hospitals, inclusive of some of the most prominent healthcare institutions in the U.S. Then in March, Apple tripled the number of health systems participating, from 12 to 39, and announced that the new capability was available to all iPhone users with the latest iOS 11.3 update. Now, as of an Aug. 2 update from Apple, approximately 80 provider institutions are on board with the project.

According to Apple, the updated Health Records section within the Health app brings together hospitals, clinics and the existing Health app, with the aim to make it easy for consumers to see their available medical data from multiple providers whenever they choose.

Consumers who are participating will now have medical information from various institutions organized into one view covering allergies, conditions, immunizations, lab results, medications, procedures and vitals, and will receive notifications when their data is updated. Health Records data is encrypted and protected with the user’s iPhone passcode, Apple officials attest.

In May, Apple also introduced a Health Records API (application programming interface) for developers and researchers. The new API, set to be delivered starting this fall, will enable developers building health apps to individualize experiences, with the user’s permission, based on the user’s unique health history, Apple officials have said.

Related Insights For: Patient Engagement


Patient Portals Commonplace in Healthcare Organizations, Survey Finds

July 27, 2018
by Rajiv Leventhal
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Nine out of 10 healthcare leaders surveyed in a recent Medical Group Management Association (MGMA) poll said that their organization offers a patient portal.

The remaining 10 percent that do not offer one said they are working to implement one soon or have the software as part of their EHR (electronic health record) but it has not yet been implemented. The poll was conducted this week, with more than 1,750 applicable responses.

Also of note, of the 90 percent that offer a patient portal, 43 percent accept patient-generated health data (PGHD) for clinician review. Additionally, 37 percent reported their patient portal does not accept PGHD for review and the remaining 20 percent were unsure.

In an insight article accompanying the survey results, Pamela Ballou-Nelson, R.N., MSPH, Ph.D., principal, MGMA Consulting, noted that while she is an advocate of patient portals, as it stands today, many she has observed “are clunky and offer nothing more than secure message exchanges.” For a patient portal to categorically assist in patient activation, it should include the following five functions, Ballou-Nelson wrote:

  • The ability for patients to view their health data, such as immunizations, lab work and imaging results
  • Online appointment scheduling
  • Online billing
  • Prescription refill requests, which can eliminate the need to make a phone call
  • Data update capabilities, so that patients can upload blood pressure readings and/or other patient generated health data

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