CRD summary

There was insufficient evidence to support the use of patient portals to improve health outcomes, cost or use. Patient attitudes were generally positive, but any benefits were unclear and further research was required. The authors' cautious conclusions reflect the mixed evidence and are likely to be reliable.

Authors' objectives

To review the effects, on clinical care, of patient portals, to allow secure access to health information, with secure communication and information sharing.

Searching

PubMed and Web of Science were searched for articles from January 1990 to January 2013; search strategies were reported. Key articles were checked and experts were contacted for further studies. Only articles published in English were considered for inclusion.

Study selection

Qualitative or quantitative studies of any design were eligible provided they focused on patients who accessed their health records through a portal tethered to a health provider. They had to report clinical or health outcomes, satisfaction, adherence, efficiency, use, attitudes, or barriers and facilitators.

The included studies were randomised controlled trials (RCTs), cross-sectional surveys, case-control studies, cohort studies, and qualitative studies. The patient portals varied considerably; most provided access to test results, secure messaging, access to notes or visit summaries, and education or disease management information. A few studies (five) had an explicit theory or logic model underlying the patient portal; only two provided details of the implementation components. Most studies were based in the USA; others were based in the Netherlands, Canada, Sweden, or New Zealand.

It was unclear how many reviewers selected the studies.

Assessment of study quality

Evaluative studies were assessed for quality, based on modified criteria developed to assess patient safety strategies that included information technology. Criteria covered study design and execution, context, implementation, and use of theory or logic models.

It was unclear how many reviewers assessed quality.

Data extraction

Two reviewers independently extracted the data. Discrepancies were resolved through discussion.

Methods of synthesis

Evidence tables were generated, grouping studies by the outcomes reported, and including critical analysis of characteristics, methods and results. A summary of the findings, for each combination of functions and general class of outcome, was produced and used to draw conclusions. Studies based in the USA were given priority, followed by studies in other English-speaking countries and Western Europe.

Results of the review

In total, 46 studies were included in the review. Fourteen were RCTs, 21 were observational studies, five were descriptive quantitative studies, and six were qualitative studies. The studies addressed health outcomes, satisfaction and adherence (18 studies); efficiency or use (seven studies); patient characteristics (10 studies); and attitudes, barriers and facilitators (19 studies) – some studies addressed more than one item.

Health outcomes, satisfaction and adherence: There were 12 RCTs and six observational studies, with mixed results from the RCTs for various health conditions (diabetes, congestive heart failure, hypertension, depression, and prevention). There was no consistent evidence that access to a patient portal significantly improved clinical outcome, satisfaction or adherence to treatment. The evidence from the observational studies was also mixed, but more favourable towards patient portals. Where improvements were seen, the portals were generally used with case management.

Efficiency or use: There were five RCTs and two observational studies. The evidence was mixed on the effects of portals on health care use and efficiency, for routine and emergency health care services. None of the RCTs reported significant benefits, while the two observational studies reported opposing results.

Attitudes, barriers and facilitators: There were two RCTs, and 17 surveys or qualitative studies. A varied group of articles dealt with attitudes and barriers to the use of patient portals. Some findings suggested more acceptance of portals by patients who were younger and had more trust in the Internet, or who were more computer literate. There was more enthusiasm for portals from patients than physicians, with administrative and human factors cited as barriers to use.

Authors' conclusions

There was insufficient evidence to support the use of patient portals to improve health outcomes, cost or use. Patient attitudes were generally positive, but any benefits were unclear and further research was required.

CRD commentary

This review addressed a complex question, with appropriate inclusion criteria, and included a range of study designs. The search covered few databases and had language restrictions, which were justified by the focus on the USA, but potentially eligible studies could have been missed.

The review processes were poorly described and reviewer error and bias cannot be excluded. Studies were described in detail, but the quality assessment did not appear to directly assess bias and reliability in the reported outcomes, and the results were not incorporated into the synthesis. A narrative synthesis was appropriate, but it was superficial in places.

The authors' cautious conclusions reflect the mixed evidence and are likely to be reliable.

Implications of the review for practice and research

Practice: No recommendations for practice were made.

Research: The authors stated that more high-quality studies were required to evaluate patient portals and assess their cost-effectiveness, while reporting the context and implementation processes.

Funding

Funded by the US Department of Veterans Affairs.

Bibliographic details

Goldzweig CL, Orshansky G, Paige NM, Towfigh AA, Haggstrom DA, Miake-Lye I, Beroes JM, Shekelle PG. Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review. Annals of Internal Medicine 2013; 159(10): 677-687. [PubMed: 24247673]

Original Paper URL

http://annals.org/article.aspx?articleID=1770672

Indexing Status

Subject indexing assigned by CRD

MeSH

Health Records, Personal; Internet; Patient Care; Patient Satisfaction; Humans; Electronic Health Records; Patient Participation; Patient Access to Records; Access to Information

AccessionNumber

12013066436

Database entry date

21/11/2013

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.