JMIR Publications

ABSTRACT

Background:

Patient portals have emerged as a recognized digital health strategy. To date, research on patient portals is rapidly growing. However, there has been limited evaluation of the growing body of evidence on portal availability, use, clinical/health behavior and outcomes, and portal adoption over time.

Objective:

Our objectives are to: 1) comprehensively consolidate the current state of evidence on patient portals using umbrella review methodology; 2) introduce our approach for evaluating evidence for quantitative and qualitative findings presented in included systematic reviews; and 3) present a roadmap that can be used to inform all stages of patient portal adoption.

Methods:

We used a modified version of the Joanna Briggs Institute umbrella review (UR) method. Multiple databases were searched for systematic reviews focused on patient portals and a final sample included 14 reviews. We conducted a meta-level synthesis of findings from quantitative, qualitative and mixed-method primary studies reported in systematic reviews while managing overlaps in primary studies. We organized UR findings according to the Clinical Adoption Meta-Model (CAMM). Vote counting, GRADE (Grading of recommendations, assessment, development and evaluations) and GRADE-CERQual (Confidence in evidence from review of qualitative research) were used to assess UR evidence.

Results:

Our findings are organized in the form of an evidence-based roadmap following CAMM categories. The roadmap describes the following factors that influence portal adoption and effects over time: patient contexts, patient's interest and satisfaction, portal design, facilitators and barriers, providers' attitudes, service utilization, behaviors, clinical outcomes and patient-reported outcomes. The roadmap lists the theories and mechanisms recognized in the included portal research, while identifying the need for business models and organizational theories that can inform all stages of portal adoption and use. Our GRADE and CERQual umbrella review evaluation resulted in the majority of the evidence being rated as moderate to low, which reflects methodological issues in portal research, insufficient number of studies, and/or mixed results in specific focus areas. Two findings with high rating of evidence are patients' interest in using portals for communication and the importance of simple display of information in portals. Evidence on portal-related changes to healthcare provider workload has very low strength. Included systematic reviews identified a range of portal features, with communication through secure-messaging and appointment booking mentioned in all reviews.

Conclusions:

Our umbrella review provides a meta-level synthesis to make sense of the evidence on patient portals from published systematic reviews. Unsystematic and variable reporting of portal features undermines the ability to evaluate and compare portal effects, and overlooks specific context of portal use. Research designs sensitive to the social, organizational, policy, and temporal dimensions are needed to better understand the underlying mechanisms and context that leverage the identified factors to improve portal adoption and effects over time.