title: Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review.
abstract: BACKGROUND
  Patient portals tied to provider electronic health record (EHR) systems are increasingly popular.
  
  
  OBJECTIVE
  To systematically review the literature reporting the effect of patient portals on clinical care.
  
  
  METHODS
  PubMed and Web of Science searches from 1 January 1990 to 24 January 2013.
  
  
  METHODS
  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.
  
  
  METHODS
  Two reviewers independently extracted data and addressed discrepancies through consensus discussion.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Limited data for most outcomes and an absence of reporting on organizational and provider context and implementation processes.
  
  
  CONCLUSIONS
  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.
authors.forename: Caroline Lubick
authors.initials: CL
authors.lastname: Goldzweig
authors.forename: Greg
authors.initials: G
authors.lastname: Orshansky
authors.forename: Neil M
authors.initials: NM
authors.lastname: Paige
authors.forename: Ali Alexander
authors.initials: AA
authors.lastname: Towfigh
authors.forename: David A
authors.initials: DA
authors.lastname: Haggstrom
authors.forename: Isomi
authors.initials: I
authors.lastname: Miake-Lye
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Beroes
authors.forename: Paul G
authors.initials: PG
authors.lastname: Shekelle
mesh_terms: D001294:Attitude to Health; D003362:Cost-Benefit Analysis; D004526:Efficiency; D057286:Electronic Health Records; D006801:Humans; D020407:Internet / Q000191:economics / Q000706:statistics & numerical data; D033283:Patient Access to Records / Q000191:economics; D010349:Patient Compliance; D063868:Patient Outcome Assessment; D017060:Patient Satisfaction