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Electronic Patient Portals: Evidence on Health Outcomes, Satisfaction, Efficiency, and Attitudes: A Systematic Review

Caroline Lubick Goldzweig, MD, MSHS; Greg Orshansky, MD; Neil M. Paige, MD, MSHS; Ali Alexander Towfigh, MD; David A. Haggstrom, MD, MAS; Isomi Miake-Lye, BA; Jessica M. Beroes, BS; and Paul G. Shekelle, MD, PhD
[+] Article, Author, and Disclosure Information

From the Veterans Affairs Greater Los Angeles Healthcare System, David Geffen School of Medicine at the University of California, Los Angeles, and University of California, Los Angeles, Fielding School of Public Health, Los Angeles, California; and Indianapolis Veterans Affairs Medical Center and Indiana University School of Medicine, Indianapolis, Indiana.

Grant Support: By the U.S. Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Health Services Research and Development, Evidence-based Synthesis Program (VA-ESP project 05-226).

Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-0982.

Requests for Single Reprints: Caroline Lubick Goldzweig, MD, MSHS, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, 111-G, Los Angeles, CA 90073; e-mail, caroline.goldzweig@va.gov.

Current Author Addresses: Drs. Goldzweig, Orshansky, Paige, Towfigh, and Shekelle; Ms. Miake-Lye; and Ms. Beroes: Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, 111-G, Los Angeles, CA 90073.

Dr. Haggstrom: Roudebush Veterans Affairs Medical Center, 1481 West 10th Street, 11H, Indianapolis, IN 46202.

Author Contributions: Conception and design: C.L. Goldzweig, G. Orshansky, D.A. Haggstrom, P.G. Shekelle.

Analysis and interpretation of the data: C.L. Goldzweig, G. Orshansky, N.M. Paige, A.A. Towfigh, D.A. Haggstrom, P.G. Shekelle.

Drafting of the article: C.L. Goldzweig, G. Orshansky, I. Miake-Lye, P.G. Shekelle.

Critical revision of the article for important intellectual content: C.L. Goldzweig, N.M. Paige, D.A. Haggstrom, P.G. Shekelle.

Final approval of the article: C.L. Goldzweig, G. Orshansky, D.A. Haggstrom, P.G. Shekelle.

Obtaining of funding: P.G. Shekelle.

Administrative, technical, or logistic support: C.L. Goldzweig, A.A. Towfigh, I. Miake-Lye, J.M. Beroes.

Collection and assembly of data: C.L. Goldzweig, G. Orshansky, N.M. Paige, A.A. Towfigh, D.A. Haggstrom, I. Miake-Lye, J.M. Beroes.

Ann Intern Med. 2013;159(10):677-687. doi:10.7326/0003-4819-159-10-201311190-00006
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Background: Patient portals tied to provider electronic health record (EHR) systems are increasingly popular.

Purpose: To systematically review the literature reporting the effect of patient portals on clinical care.

Data Sources: PubMed and Web of Science searches from 1 January 1990 to 24 January 2013.

Study Selection: Hypothesis-testing or quantitative studies of patient portals tethered to a provider EHR that addressed patient outcomes, satisfaction, adherence, efficiency, utilization, attitudes, and patient characteristics, as well as qualitative studies of barriers or facilitators, were included.

Data Extraction: Two reviewers independently extracted data and addressed discrepancies through consensus discussion.

Data Synthesis: From 6508 titles, 14 randomized, controlled trials; 21 observational, hypothesis-testing studies; 5 quantitative, descriptive studies; and 6 qualitative studies were included. Evidence is mixed about the effect of portals on patient outcomes and satisfaction, although they may be more effective when used with case management. The effect of portals on utilization and efficiency is unclear, although patient race and ethnicity, education level or literacy, and degree of comorbid conditions may influence use.

Limitation: Limited data for most outcomes and an absence of reporting on organizational and provider context and implementation processes.

Conclusion: Evidence that patient portals improve health outcomes, cost, or utilization is insufficient. Patient attitudes are generally positive, but more widespread use may require efforts to overcome racial, ethnic, and literacy barriers. Portals represent a new technology with benefits that are still unclear. Better understanding requires studies that include details about context, implementation factors, and cost.

Primary Funding Source: U.S. Department of Veterans Affairs.


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Summary of evidence search and selection.

IT = information technology; RCT = randomized, controlled trial.

* Categories are not mutually exclusive.

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