JMIR Publications

ABSTRACT

Background:

Patient portals can improve care delivery and optimise health service efficiency but they are not always adopted by patients and staff. To improve adoption of patient portals, existing research has focused on examining implementation processes from the perspectives of end-users. However, the views of the implementers, who have in-depth insight into inter-organisational and intra-organisational factors impacting implementation, have not been previously explored.

Objective:

The aim of this study was to identify implementers’ perspectives on the key facilitators and barriers to implementing a patient portal.

Methods:

This was a qualitative study conducted at a dental hospital in Sydney, Australia. Participants were implementers of a patient portal who were a) administrative staff managers working at the dental hospital, or b) Information Technology (IT) staff members, who either worked within the district where the hospital is located or with the vendor. All implementers of the portal (thirteen participants) took part in the interviews. Data were analysed thematically and mapped to the Consolidated Framework for Implementation Research.

Results:

Nineteen factors were reported to affect the implementation of the patient portal, eight factors acted as facilitators, eight as barriers, and three factors both facilitated and hindered implementation. Many of the facilitators related to the implementation process which included planning and project management, leadership support, stakeholder engagement and the co-design process. Most barriers occurred at the inter-organisational level, including delayed training for new staff, varying workflow and clinic characteristics, challenges with timeline and budget, and lack of direct vendor access to end-users. While participants saw potential benefits of the portal to patients and the health service, they had concerns about increased staff workload related to the portal implementation.

Conclusions:

In addition to factors directly impacting clinicians and patients, our study highlighted that a large number of organisational factors at multiple levels within and across organisations impacted successful patient portal implementation and adoption. Portal implementations would benefit from being interoperable with existing systems, adequate resourcing, regular policy review related to technological change, and strategies to improve inter-agency communication with portal implementers.