Too Many Don’ts and Not Enough Do’s? A Survey of Hospitals About Their Portal Instructions for Patients

Abstract

Background: Patient portals present the opportunity to expand patients' access to their clinicians and health information. Yet patients and clinicians have expressed the need for more guidance on portal and secure messaging procedures to avoid misuse. Little information is currently available concerning whether and how expectations of portal and messaging usage are communicated to patients. Objective: To identify the information made available to patients about patient portal use, and to assess ease in accessing such information. Design: A national survey of publicly available portal information from hospital websites. The study team followed up with phone calls to each hospital to request any additional patient-directed materials (e.g., pamphlets) not located in the web search. Participants: A random sample of 200 acute-care hospitals, 50 from each of four US Census regions, selected from the US Centers for Medicare & Medicaid Hospital Compare dataset. Main measures: Availability of patient portals, secure messaging, and related functionality; the content and ease of access to patient-directed information about portals. Key results: Of the hospitals sampled, 177 (89%) had a patient portal; 116 (66%) of these included secure messaging functionality. Most portals with secure messaging (N = 65, 58%) did not describe appropriate patient messaging conduct. Although many included disclaimers that the service is not for emergencies, 23 hospitals only included this within the fine prints of their "Terms and Conditions" section. Content analysis of additional patient-directed materials revealed a focus on logistical content, features of the portals, and parameters of use. Of the three categories, logistical content (e.g., creating an account) was the most thorough. Conclusions: Although most of the sampled hospitals had patient portals, many fail to educate patients fully and set expectations for secure messaging. To improve patient engagement and minimize harm, hospitals and clinicians need to provide more information and set clearer guidelines for patients.