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Adoption of Patient Portals Growing in Older Populations

Patient portal use by older patients is on the rise due not only to chronic disease management needs, but an overall comfort with technology.

By Sara Heath

- The use of patient portals by older patients could very well be understated. According to data out of athenaResearch, patients in their 60s are just as likely as younger patients to register for their patient portal, with nearly 30 percent of patients over 65 reporting portal use.

Use of patient portals

In an interview with EHRIntelligence.com, athenaResearch Vice President Josh Gray and  Manager David Clain addressed the significance of these patterns and what they mean for EHR use and health adoption on the whole.

“You do hear from time to time from physician practices that are a little hesitant to encourage their patients to use the portal because they’ll say, ‘hey I serve a very old patient mix, and they don’t like to use portals,’” Gray said. “We found that our empirical data really contradicted that point of view.”

Patients in their 60s are adopting these technologies for several different reasons. Between managing chronic diseases, an eagerness communicate with their physicians, and an overall abundance of time, the industry is seeing notably more older patients engaging with technology.

However, Gray and Clain credit another phenomenon to why patients in their 60s are registering for their patient portals – generations who are comfortable with technology are getting older.

READ MORE: Patient Access to Health Information Low But Interest High

“If you look at patients in their 60s and up to 65, a lot of those patients are still in the workforce. They’ve had iPhones for 10 years since they were in their mid-50s,” Clain explained. “So I think that a lot of those patients are comfortable with using technology, and a patient portal may be a new approach to working with their physicians in a way that they didn’t do before, but they’re comfortable getting online, they’re comfortable using their phones to get on a portal, or using a computer.”

The pair predicted that this trend will continue, with older and older patients reporting engaged portal adoption. After all, a 65-year-old patient who is comfortable using technology is likely to still be comfortable by the time they’re 66.

Patient portal adoption also reveals a notable phenomenon – patients who are sicker are more likely to engage with their portals. Among those over 60 who have registered for their patient portals, Clain identified a subset of super users who use their portals all the time. In total, these users are signing into their portals almost once per week, nearly 39 times per year.

“Among older patients there’s actually a subset of them – I’m looking at about the top 20 percent – who are using the portal all the time,” Clain reported. “So on average they’re sending I think more than two secure messages per year to their physicians. They are viewing labs I think 13 time throughout the year.”

athenaResearch's Josh Gray and David ClainClain, Gray, and their team at athenaResearch have been able to determine that these super users are clearly getting value out of their portal, primarily because they are struggling a bit more with their health.

READ MORE: Industry Groups Respond to Patient-Centered EHR Legislation

“I think part of the value they’re getting is just their health needs are more complex. They have more lab results, they have more occasions to email a doctor,” Clain explained. “We know those patients are a bit sicker on average, or at least they’re going into a doctor more often. So they have 12 in person appointments per year, versus about six for the median senior.”

But the benefits move beyond chronic disease management. According to Gray, patient portals are making patient lives easier.

“It seems like what they’re doing is shifting a lot of their interactions online,” Clain confirmed. “I think in a lot of cases it’s an easier way to get in touch with doctors, it’s an easier way to see lab results and ask questions when you need to.”

Ideally, these benefits are also driving positive care outcomes.

“I think our theory would be that that is probably driving some health outcomes,” Clain told us. “If you have easier access to your doctors, or at least there can be shifts in how you’re getting meds, you can get your prescriptions refilled more easily, you can avoid unnecessary appointments, you can go into the doctor when the doctor tells you need to by secure message when you otherwise might not have.”

READ MORE: What Forms Should Patient Access to Health Information Take?

Although Gray and Clain made it clear that patient benefits are huge drivers toward patient portal adoption, they also reported there is a final piece of the puzzle that entails physician encouragement. If the patient is told by her physician that registering for the portal is important, she is more likely to do so.

Gray and Clain saw proof of this when examining Medicaid patients versus privately insured patients.

“Turns out [Medicaid patients] use portals a bit less, but those that use them use them just as frequently,” Gray stated. “I have a personal hypothesis which is subjective, but I think a lot of it has to do with the expectations and the communication of sufficiency at the front desk.”

One mistake some Medicaid providers commit is assuming that Medicaid patients would be less likely to register for the portal and consequently not suggesting they do so.

“I think from our interviews with top performers, the way that a practice frames the question of whether or not a patient enroll in the portal is extraordinarily important,” Gray told us. “We don’t have hard evidence for that, but my hypothesis would be that providers are a bit less forward-leaning with their patients on Medicaid to get them to register for the portals.”

That said, those providers who do emphasize the patient portal to all patients are seeing success across all payer classes.

“We have talked to a small number of practices that are equally aggressive about patients in each payer class, and as a result they see essentially very equivalent portal adoption rates. Again, once Medicaid patients do enroll in the portal, they’re just as likely as commercially insured individuals to use it,” Gray confirmed.

The pair explained that there are some logistical steps providers can take to support adoption while the patient is in the office. By adopting patient engagement strategies, it could become more likely that a patient of any payer class would register for the patient portal.

There are a few very predictable steps that practices can take to boost their enrollment rates,” Gray concluded. “It is very helpful to get patients to enroll in your portal when they’re still in the office. So these are practices where the front desk person might pivot her laptop to work with a patient to register them on the spot. Or to have some kind of tablet type device circulating around the waiting room so patients with assistance could enroll in the portal.”

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