THE RELATIONSHIP BETWEEN PATIENT PORTALS, ENGAGEMENT, AND OUTCOMES: IS HEALTH LITERACY AN IMPORTANT LINK?

Abstract

The use of technology to enhance the health care experience was emphasized through the HITECH Act of 2009 and was reinforced by the Center for Medicare and Medicaid Services in stipulating meaningful use requirements. An important element of these requirements is the engagement of patients and families in their care. In response, healthcare facilities have taken steps to this demand by embracing health information technology like patient portals with the goal of increasing patient knowledge and engagement. The purpose of this review is to examine the broad use of patient portals by patients, and more specifically the importance of its patient education function in improving patient outcomes. We hope to understand if there is a causal relationship between patient engagement and providing education materials via patient portals. A search was conducted in PubMed and Cinahl for articles published in English between 2008-2018. Articles meeting the initial search criteria were kept for further review. After identifying and removing duplicates, the titles and abstracts of each article were reviewed to further narrow the list. The researchers then performed an extensive review of the remaining articles to determine which ones contribute to a better understanding of how patient portals influence patient engagement and outcomes. We included 18 studies that described the relationship between patient portal use and patient engagement with emphasis on patient education. Whether prior health literacy improved engagement and subsequently outcomes remained ambiguous. Research showed that patient portals as an educational tool were accepted and gave patients a heightened sense of self efficacy. While these factors could lead to better health outcomes, research also supported the idea that health literacy is a vital piece in improving patient engagement. One study stated that health literacy was a missing factor in a patient’s ability to understand information in patient portals. Lack of prior health literacy could negatively impact health outcomes. The usefulness of patient portals is apparent across the existing literature, but the factors that influence successful delivery and understanding of information in portals vary. There does seem to be a relationship between education through patient portals, increased engagement, and patient outcomes. Further research is needed to gain a clearer understanding of the role health literacy plays in this relationship.