Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review.

BACKGROUND

Patient portals tied to provider electronic health record (EHR) systems are increasingly popular.

PURPOSE

To systematically review the literature reporting the effect of patient portals on clinical care.

DATA SOURCES

PubMed and Web of Science searches from 1 January 1990 to 24 January 2013.

STUDY SELECTION

Hypothesis-testing or quantitative studies of patient portals tethered to a provider EHR that addressed patient outcomes, satisfaction, adherence, efficiency, utilization, attitudes, and patient characteristics, as well as qualitative studies of barriers or facilitators, were included.

DATA EXTRACTION

Two reviewers independently extracted data and addressed discrepancies through consensus discussion.

DATA SYNTHESIS

From 6508 titles, 14 randomized, controlled trials; 21 observational, hypothesis-testing studies; 5 quantitative, descriptive studies; and 6 qualitative studies were included. Evidence is mixed about the effect of portals on patient outcomes and satisfaction, although they may be more effective when used with case management. The effect of portals on utilization and efficiency is unclear, although patient race and ethnicity, education level or literacy, and degree of comorbid conditions may influence use.

LIMITATION

Limited data for most outcomes and an absence of reporting on organizational and provider context and implementation processes.

CONCLUSION

Evidence that patient portals improve health outcomes, cost, or utilization is insufficient. Patient attitudes are generally positive, but more widespread use may require efforts to overcome racial, ethnic, and literacy barriers. Portals represent a new technology with benefits that are still unclear. Better understanding requires studies that include details about context, implementation factors, and cost.