Patient Portal Messages Need Streamlined Delivery for Patient Activation

The patient portal might be too clunky or onerous to be useful in closing care gaps, with new research finding that patient portal messages didn’t do much to get patients in for preventive care.

Particularly, receiving a patient portal message didn’t compel patients to get their flu shots during the 2020-2021 flu season. The UCLA researchers posited that this is because folks have to log into the patient portal and open the message in order for it to be effective, and most patients don’t want to walk through those steps.

Instead, text message patient outreach might be more effective, the researchers suggested.

Healthcare providers are always trying to motivate their patients to get a flu shot, but that goal was particularly salient during the 2020-2021 flu season, which overlapped with the first year of the COVID-19 pandemic. Providers feared a twindemic and worked overtime to get their patients in for the flu shot, hopefully lessening the burden health systems would feel in the wake of the coronavirus.

The UCLA researchers looked into how the patient portal, which not only allows for patient data access but also secure direct messaging and patient outreach, could influence flu shot rates. The team split more than 200,000 patients into three cohorts: those who didn’t receive a patient portal message, those who did with a link to book an appointment, and those who did without a link to book an appointment.

Generally, the flu vaccination rate during the study period of October 2020 to March 2021 was abysmal, coming in at 39 percent.

And that low flu vaccination rate was low for everyone, not just the people who didn’t get a patient portal message (38.9 percent of whom got a flu shot during the study). Among participants who received direct flu shot appointment scheduling messages, 39.1 percent got their flu shots. The same proportion of participants who got pre-appointment flu shot reminders got the jab.

After adjusting for sociodemographic factors, the researchers said the patient portal messages made no difference in flu vaccination rates.

This could be because the patient portal is not the most intuitive patient outreach channel. The researchers did indicate that around three-quarters of the patients in the UCLA Health system use the patient portal, but opening up a patient portal message has a lot of steps compared to other outreach channels, like text messages.

“Portal messages can only be effective if they are opened,” the researchers said. “Studies are needed to improve the engagement with portal messages—perhaps by making messages similar to items that appear on people’s cell phones.”

The beauty of text message patient outreach is that patients can view the text immediately; they do not need to receive the message notification, navigate to the patient portal, log in (and potentially reset a forgotten password), and then navigate to the inbox. Those steps might mean that patient portal messages remain unopened, and the researchers emphasized that unopened messages can’t change patient behavior.

There could have been other factors at play, including vaccine hesitancy. This intervention rolled out as the world awaited the COVID-19 vaccine, and extremists sowed vaccine hesitancy in some segments of the population. That hesitancy may have trickled into the flu shot conversation, and some of the patients who opened the patient portal messages may have been reticent to get the shots.

Moreover, the messages may have only been effective on those with already high patient activation levels; they may have gotten their flu shots even without the text message.

And none of that is to mention the fear many patients felt about visiting a medical facility in the first stretch of the pandemic. Patient access to care across most specialties fell, most prominently preventive care.

But fundamentally, the researchers asserted that these results indicate a need for further investigation into the patient portal as an outreach channel. The patient portal has a lot of benefits because it is tethered to the EHR. Considering strategies to push patient portal messages directly to text message inboxes could make the portal a more effective patient engagement tool.