Online portals allow patients to interact with their health information and communicate with providers outside the traditional office visit. Such systems offer powerful benefits: encouraging patients to become more engaged in their own care and helping providers to improve efficiency, quality, and access.
However integrating a portal into a clinical practice is not easy. The California Health Care Foundation (CHCF) has worked with early adopters to capture key lessons learned, as well as tools and resources to help guide other safety-net clinics considering their own patient portals.
The tools in this resource center are presented in these three phases of adoption:
Patient Portals: Benefits to Providers
In this short video, doctors and clinic staff talk about the benefits of using patient portals to engage with patients and to coordinate care.
Patient Portals: Patients' Perspectives
In this short video, patients discuss the advantages of using patient portals to manage their health and to communicate with clinic staff.
CHCF is interested in helping community health centers understand the unique challenges of adopting a patient portal to connect patients with their electronic health records. This online Patient Portals Resource Center was developed based on the work of the CHCF Patient Portals Initiative (PPI).
WHAT: Giving patients easy access to electronically stored and personalized medical information has the potential to transform health outcomes. By providing a portal, or electronic doorway, through which to access health information and communicate with providers, patients can better monitor their conditions and seek appropriate services.
WHY: A 2010 national survey found that consumers who have electronic access to their personal health records (PHRs) feel like they know more about their health (56%) and the care their doctors give them (52%), feel more connected to their doctors (38%), and led them to do something to improve their health (32%) as a result. (For more information, see Consumers and Health Information Technology: A National Survey.) Early interventions, improved access to their care team, and increased efficiency of care delivery can ultimately lead to reduced costs and improved quality of care.
WHO: While patient portals are becoming widespread in large medical delivery networks, adoption is less pervasive among safety-net providers. To engage California safety-net providers in the implementation of patient portals to improve patient and family engagement, clinical outcomes, and operational efficiency, in 2011 CHCF sponsored the Patient Portal Initiative.
WHERE: Three California health centers with relatively mature electronic health record (EHR) systems, but no patient portal yet in place, participated in the PPI:
|Health Center (location)
|Open Door Community Health Centers (Humboldt and Del Norte Counties)
|Shasta Community Health Center (Redding)
|West County Health Centers (Occidental, Sebastopol, and Guerneville)
HOW: In the planning phase, grantees explored the benefits and feasibility of deploying a patient portal in their respective organizations. During the implementation phase, PPI grantees planned and executed their portal rollouts and integrated portal use into daily operations. As they progressed, the health centers defined and collected metrics that were aimed at assessing patient input, provider and staff feedback, and use of the portal. Grantees participated in regular meetings to share ideas, solve common challenges, identify best practices, and learn from experts in the field.
RESULTS: The tools presented in this Patient Portals Resource Center were used or created during the PPI and are provided here for use by community health centers across the state and nationally. All resources have been linked to original sources and are available for unlimited reuse and reproduction.
Also as part of this resource center, three papers (see right column) summarize the experiences of the early adopter health centers in launching their patient portals. They share lessons learned and serve as a resource for clinic managers, IT staff, medical directors, nurses, patient coordinators, and CEOs at other health centers considering such an undertaking.
The tools and papers are presented in three developmental phases: (1) planning, (2) implementation, and (3) optimization.
Phase 1. Planning
Safety-net clinics that have decided to implement a patient portal will need to thoroughly assess and plan for the process. Comprehensive planning includes identifying a portal team and champion, developing a rollout strategy, setting goals, and establishing metrics for success. The more carefully this advance work is done, the more the resulting system will benefit patients. The following resources and tools will support a clinic's assessment and planning process.
To read details on the experiences of the early adopter clinics and hear lessons from the field, see Patient Portals in the Safety Net, Phase 1: Assessment and Planning (PDF).
Tools & Resources
Patient-Centered Health Information Technology (Part A) (PDF)
Slide presentation on the driving forces behind the EHR and the patient portal. Includes screen shots of patient portal examples. (Seth Emont)
Measuring the Impact of Patient Portals (Part B) (PDF)
Slide presentation on what the current published literature tells us about measuring the impact of patient portals at both the patient and organizational level. Includes portal value calculation and meaningful use examples. (Seth Emont)
Assessing Implementation in Safety-Net Clinics (Part C) (PDF)
Slide presentation on sample portal adoption logic models and examples of implementation and impact evaluation measures. (Seth Emont)
At the Quality Crossroads: Integrating EHRs and Patient Portals (PDF)
Presentation on the rationale for an EHR, personal health record, and patient portal. (Paul Tang)
Measuring the Impact of Patient Portals: What the Literature Tells Us
Comprehensive review of published methods to measure the impact of patient portals. (Seth Emont)
MedlinePlus Connect Overview
This overview provides basic information on this health education site for patients. It is a free service and has already been successfully integrated with several of the most prevalent patient portal products. (National Library of Medicine and the National Institutes of Health)
Frequently Asked Questions About the Patient Portal (PDF)
Informational brochure (National Learning Consortium – HealthIT.gov)
Using Patient Portals in Ambulatory Care Settings (PDF)
Informational brochure (National Learning Consortium – HealthIT.gov)
Phase 2. Implementation
Not all patient portals look alike, have the same applications, or intend to meet the same patient and support team needs. Successful portals are tailored to the operations of specific community clinics and their unique patient populations. The following are tools and resources intended to support the tailoring and initial operations of a patient portal.
To read details on the experiences of the early adopter clinics and hear lessons from the field, see Patient Portals in the Safety Net, Phase 2: Implementation (PDF).
Tools & Resources
Patient Portal Policies and Procedures (PDF)
An example of one clinic's policies and procedures manual that addresses the main activities in support of patient portal operations. (Shasta Community Health Center)
Implementation Lessons Learned and Change Management at Kaiser (PDF)
Slide presentation on the key lessons learned in both implementation and change management for Kaiser Permanente and their patient portal. (Judy Derman, Internet Services Group, Kaiser Permanente)
Flowchart of Clinic Workflow from Open Door (PDF)
A flowchart of tasks that track a patient portal query from receipt through task completion in an outpatient clinic. (Tammy Flint, Open Door Community Health Centers)
Glossary of Computer and Internet Terms (PDF)
Curriculum guide to basic computer terms for first-time computer users. (National Institute on Aging)
Phase 3. Optimization
After rolling out the patient portal, community health centers need to continue to nurture how the system works within larger clinic operations. Optimization includes adding advanced capabilities, along with initiating efforts to increase the number of enrolled patients and the frequency with which they use the portal. Soliciting feedback from both patients and providers, and incorporating that feedback into portal processes, will ensure the long-term success of the patient portal.
To read details on the experiences of the early adopter clinics and hear lessons from the field, see Patient Portals in the Safety Net, Phase 3: Optimization (PDF).
Tools & Resources
An Interactive Preventive Care Record: A Handbook for Using Patient-Centered Personal Health Records to Promote Prevention (PDF)
Provides practical steps for selection, implementation, and maintenance of IPHRs as components of electronic health records. This guidebook gives targeted advice for practice leaders, informatics staff, and practice personnel and discusses how to work as a team to fully use IPHRs. (Agency for Healthcare Research and Quality [AHRQ])
eHealth Equity (PDF)
Slide presentation on the disparities of access and use of internet-based health applications. Includes a suggested strategic planning approach to "meaningful access." (Kieschnick, Internet Services Group, Kaiser Permanente)
Creating Patient and Family Advisory Councils (PDF)
General guide with a planning checklist for starting patient advisory councils. (Institute for Patient- and Family-Centered Care)
Patient Satisfaction Survey Example (PDF)
This patient portal online survey for patients was developed with the staff at the Shasta Community Health Center. (Seth Emont and Charles Kitzman)
Clinician and Staff Satisfaction Survey Example (PDF)
This patient portal online survey for providers and staff was developed with staff at each of the patient portal initiative grant sites. (Seth Emont)
Patient Portals: Considerations for Minors (PDF)
Basic overview of legal (California law) and operational issues associated with young people using a patient portal. (Deven McGraw)
Marketing a Patient-Provider Website in Community Health Clinics (PDF)
A complete marketing plan for the deployment and sustainment of a patient portal. (CHCF)
Patient Portal Marketing Templates (ZIP)
This collection of 14 templates provide promotional examples of posters, presentation slides, and flyers in both English and Spanish. Permission is granted to adapt, revise, and use all materials as needed. (CHCF)
The terms "personal health record," or PHR, and "patient portal" are often used synonymously, particularly in surveys where consumers are asked about electronic connections with their care providers. For our purposes here, PHRs and patient portals are distinguished as follows:
Personal health record:
- Is owned by the patient (or proxy for the patient)
- May have information that is not contained in a medical record
- Is often a standalone application
- Allows for patient input of information
- Is used for managing health information, promoting health maintenance, and assisting with chronic disease management
- Is focused on health information, behavior change/prevention, and self-management
- Is a secure website through which patients can access a PHR
- Often contains information from a patient's EHR
- Is usually "tethered" to a health care organization with applications that build on an EHR
- Enables users to complete forms online, communicate with providers, request prescription refills, review lab results, or schedule medical appointments
- Can enhance patient access and increase administrative efficiency and productivity
For more information, see Measuring the Impact of Patient Portals: What the Literature Tells Us.
PHRs and patient portals can be viewed as a spectrum of applications that range from a standalone application, in which the patient enters the bulk of information, to one that is connected to a health care organization and builds on an existing EHR. Regardless of the architecture, all PHRs aim to increase patient access to personal health information in a secure fashion to enable greater patient participation in the care process.
All three PPI health centers implemented PHRs/patient portals that are tethered to their organization and offered through their EHR system vendor, which allows for patient-provider communication and display of key information from the EHR. For this reason, the technology is referred to simply as a patient portal, or portal, throughout.