With the widespread use of electronic e-mail communication, health care experts are increasingly interested in employing newer technology to improve and lower the costs associated with medical care.22,23
Whereas our study of a patient portal is consistent with this trend,24
our results also highlight the importance of the more traditional interactions that exist between providers and patients. A good relationship with providers and the ready availability of advice and feedback that it brings diminished the perceived utility of the patient portal.
Recent studies have found that patients have adapted to the introduction of technologies, such as telemedicine and e-mail.25,26
Despite privacy concerns, e-mail messages are perceived as an attractive option to communicate with health care providers, as shown by a high percentage of patients in favor of using e-mail to interact with physicians in other studies.27,28
Participants appeared more willing to branch out to alternative methods of computer-based communication, such as the patient portal, if they had a dissatisfying relationship with their provider.29
Importantly, some participants in our study were worried that the use of the portal would gradually erode their ability to communicate with their health care team. The suspicion of the portal supports the relative importance participants place on the traditional patient–provider relationship, as they continued to send messages to their providers directly rather than wanting to rely on a portal system, such as our HealthTrak, which processed e-mail messages without a specific provider “send to” designation.14
Interestingly, study participants did not express concerns about confidentiality as either an advantage of the new portal or a disadvantage of the current e-mail system. It might be, as Moyar et al.22
and Hassol et al.25
suggest, that patients either do not understand the lack of privacy in traditional e-mail or they do not care. Either way, the promise of a more secure and encrypted form of communication appeared to add little in terms of motivating participants to use the new portal system.
This study is limited in that it provides the views of self-selected participants in focus group discussions conducted during two different waves (pre- and postportal) in the implementation of a patient portal. As is true with all focus groups, the information here was self-reported and is constrained by the conversations within which it occurred. Participants were also largely from an urban area. Studies demonstrate unique challenges for patients in rural environments. In this case, even a satisfactory provider relationship may not be a barrier to portal use.30,31
Our sample was also younger and more highly educated than the population with diabetes that was sampled in the national NHANES III trial, reflecting the bias of those interested in discussing computer technologies.32
Our sample was heterogeneous in terms of their years living with diabetes.32
We also did not capture the participants’ use of multidisciplinary health care teams. In addition, for the postportal focus groups, we specifically recruited participants interested in discussing a computerized patient portal. Therefore, the sample may be skewed toward those interested in adopting new technologies. However, even within this wave, we found that participants with satisfactory clinical relations appeared less interested in using the patient portal. Thus, our sample may actually understate the affect that a satisfying provider relationship might have in terms of reducing portal use.
In conclusion, there are substantial societal interests in developing computer programs designed to facilitate contact between patients and their health care teams.33–35
A patient portal with information, such as laboratory values and general advice, can function as a valuable resource for patients.36
However, it cannot replace the provider–patient relationship, which can offer both personal interaction and individualized advice. Considering the costs associated with the implementation of patient portals and the current mixed results,37–40
further studies are needed to determine their impact on the quality of care. As the provider–patient relationship can affect the use of the portal, studies should include detailed assessments of interactions at the different implementation phases. Future studies should also consider collecting information on attitudes providers have toward patients’ use of portal technology. Few studies focus on provider attitudes toward patients’ use, examining instead medical practitioners’ practice patterns.41–43
For those that have, the results have been mixed. Some studies have found a positive provider view,44–46
whereas others have shown concerns about the uncompensated burdens of communicating with patients via e-mail.24,25,47
Developers of such systems should also take into account the needs of patients. Our study indicates that options such as direct provider e-mail may reduce patient reluctance to use the system. Others and we also found that patients have few concerns about the loss of privacy that can occur within traditional e-mail.22,25,48
Further patient education about the importance of secure, encrypted e-mail may entice reticent individuals to increase their portal use. Finally, further work is needed to understand the impact of portal technology on issues involving a “digital divide.”49
It is unclear whether the portal may empower those with limited resources and transportation difficulties to better control their disease, or whether the lack of access to the technology itself will instead widen racial and economic disparities. One can only hope that with increased services that all patients may reap the benefits that such bioinformatics technology can provide.