Editor’s Note: This article is the second in an occasional series that will be published over the next year on Health Affairs Blog responding to and reflecting on the latest findings of the University of Michigan’s National Poll on Healthy Aging.

Patient portals—secure online connections to personal health information—have been hailed as a simple and efficient way for patients and providers to exchange information in between face-to-face visits. For example, portals allow patients to view test results, schedule appointments, request prescription refills, and exchange secure messages with providers. Patient portals can increase patient engagement, with the potential to generate positive health outcomes.

Despite widespread availability of patient portals and incentives for providers to offer portals to patients, recent results from the University of Michigan’s National Poll on Healthy Aging suggest that only about half of adults ages 50–80 use them. Among older adults who reported using patient portals, most had used a portal to view tests results (84 percent). Fewer had used a portal to request a prescription refill (43 percent), schedule an appointment (37 percent), or get advice from a provider (26 percent).

Who Is Using Portals?

The poll results highlight important differences in portal use among older adults. For example, higher-income individuals (59 percent of those with greater than or equal to $60,000 annual income versus 42 percent of those with less than $60,000 annual income) and those with more education (59 percent of those with some college versus 45 percent of those with high school only) are more likely than their counterparts to set up portal access. Given that lower-income adults often have more complex health needs, these findings raise concerns about whether patient portals are equitably reaching all populations in need of assistance with managing their health care outside of face-to-face encounters. 

Barriers To Accessing Patient Portals

A common sentiment about why older adults may not use patient portals at high rates is that many of these individuals lack access to the necessary technologies. Although technology gaps exist for many older adults, these gaps are rapidly narrowing. About half of older adults now have broadband at home. Two-thirds use the Internet, up from 12 percent in 2000. By 2017, 42 percent of adults ages 65 and older had smartphones, as compared to 18 percent in 2013. Rates of Internet and smartphone use, as well as broadband access, are all higher in patients 65–69 years old as compared to those ages 80 and older. 

Beyond access to technologies, other barriers include older adults’ attitudes about use of technology to communicate about their health. Poll respondents older than age 65 were more likely than people ages 50–64 to report that they don’t like using the computer to communicate about their health or that they are not comfortable with technology in general. Among older adults who had not yet set up access to a patient portal, 52 percent cited concerns about communicating online about health information. Fifty percent said that they didn’t see the need for this kind of access to their health information. 

Efforts To Increase Portal Use 

There are several ways that health systems could better support older patients and their caregivers to increase use of patient portals. As demonstrated by the poll results, older adults have particular concerns about the security and utility of electronic communication. These and other concerns should be explored in depth by routinely eliciting the perspectives of older patients. Many institutions have Patient and Family Advisory Councils that include older adults as well as their caregivers and health care providers. Patient portals could be a discussion topic at these meetings with a dual focus on improving portal design and determining better strategies to facilitate use by older adults. Surveys of older patients who do use portals should also inform these efforts, as has been done with veterans who use the Veteran Health Administration’s MyHealtheVet patient portal. 

Because many older adults prefer phone communication, one way to increase use of portals would be to position these tools as complements to, rather than substitutes for, phone contact. For example, older adults could be encouraged to use the portal to request medication refills, schedule routine appointments, and view test results, but also reminded that they can call the office when they develop new symptoms or need an urgent appointment. This identification of recommended ways to use portals, while maintaining the option to communicate by phone, may be the most appropriate strategy to meet the varied needs of older adults.

Many older adults who might be interested in using patient portals may benefit from a personalized orientation. In a recent review of factors contributing to optimal patient portal use, technical or logistical difficulties with the enrollment process (for example, difficult navigation and lack of information technology support) often prevented interested patients from completing registration. Some of these technical issues can be overcome with a more hands-on approach at the time of enrollment. For example, after an office visit, administrative staff or a navigator could physically show older adults how to sign on to the patient portal in the clinic. Alternatively, check-in kiosks could feature guided tutorials. If a health system or group practice is already holding group visits, such as for advance care planning or Medicare annual wellness visits, portal use could be added as a component.

The poll’s results identify other communication-related concerns that must be addressed in broader efforts to increase portal usage. For instance, 27 percent of those who hadn’t set up a portal account were “very concerned” that online communication would bring a higher chance of error than talking with someone on the phone or in person would. Nineteen percent were “very concerned” that they wouldn’t know who from the provider’s staff was answering their question, and 17 percent were “very concerned” that getting a response to an online communication would take too long. Within health systems, educational campaigns and modifications to portal communication processes could address these concerns to help older patients be more confident in using portals to communicate with health care providers.

Another sign that older adults may be missing out on potential portal functions showed up when respondents were asked who else they have authorized to see their health information. Of those who have a portal account, 43 percent said they had authorized someone else to log in to see their information–mostly spouses and partners but also adult children and other family members, some of whom may be caregivers. Among those who hadn’t authorized another user, 22 percent said that they didn’t know how to set this up, and 35 percent said that they prefer to keep their information private. The other 43 percent said that they don’t have anyone else who helps with their medical care.

Since 2011, federal programs such as meaningful use under the Health Information Technology for Economic and Clinical Health Act, and now the Merit-based Incentive Payment System (MIPS) under the Medicare Access and CHIP Reauthorization Act of 2015, have encouraged the use of electronic health records (EHRs) by offering financial incentives to providers who offer patients timely electronic access to their health information. For example, providers could meet more than half of the current MIPS measures through a patient portal, including portal access, health information exchange, patient education, secure messaging, and patient-generated health data. As of 2016, more than 90 percent of hospitals and more than 60 percent of office-based practices have participated in these incentive programs through certified EHRs. Under the 21st Century Cures Act, the Trusted Exchange Framework and Common Agreement now seeks to build on these early successes by enhancing patients’ ability to access and use their electronic health information across multiple health care providers. 

While older adults use patient portals less often than the general population, their access to necessary technologies is quickly increasing. Recent National Poll on Healthy Aging results identify promising opportunities to help older adults use these technologies to access patient portals in ways that could drive efficiencies and improve health outcomes. 

Authors’ Note

The National Poll on Healthy Aging is conducted by the University of Michigan Institute for Healthcare Policy and Innovation and sponsored in part by AARP and Michigan Medicine, the University of Michigan’s academic medical center.