title: Characteristics of patient portals developed in the context of health information exchanges: early policy effects of incentives in the meaningful use program in the United States.
abstract: BACKGROUND
  In 2014, the Centers for Medicare & Medicaid Services in the United States launched the second stage of its Electronic Health Record (EHR) Incentive Program, providing financial incentives to providers to meaningfully use their electronic health records to engage patients online. Patient portals are electronic means to engage patients by enabling secure access to personal medical records, communication with providers, various self-management tools, and administrative functionalities. Outcomes of patient portals have mainly been reported in large integrated health systems. This may now change as the EHR Incentive Program enables and supports the use of patient portals in other types of health systems. In this paper, we focus on Health Information Exchanges (HIE): entities that facilitate data exchange within networks of independent providers.
  
  
  OBJECTIVE
  In response to the EHR Incentive Program, some Health Information Exchanges in the United States are developing patient portals and offering them to their network of providers. Such patient portals hold high value for patients, especially in fragmented health system contexts, due to the portals' ability to integrate health information from an array of providers and give patients one access point to this information. Our aim was to report on the early effects of the EHR incentives on patient portal development by HIEs. Specifically, we describe the characteristics of these portals, identify factors affecting adoption by providers during the 2013-2014 time frame, and consider what may be the primary drivers of providers' adoption of patient portals in the future.
  
  
  METHODS
  We identified four HIEs that were developing patient portals as of spring 2014. We collected relevant documents and conducted interviews with six HIE leaders as well as two providers that were implementing the portals in their practices. We performed content analysis on these data to extract information pertinent to our study objectives.
  
  
  RESULTS
  Our findings suggest that there are two primary types of patient portals available to providers in HIEs: (1) portals linked to EHRs of individual providers or health systems and (2) HIE-sponsored portals that link information from multiple providers' EHRs. The decision of providers in the HIEs to adopt either one of these portals appears to be a trade-off between functionality, connectivity, and cost. Our findings also suggest that while the EHR Incentive Program is influencing these decisions, it may not be enough to drive adoption. Rather, patient demand for access to patient portals will be necessary to achieve widespread portal adoption and realization of potential benefits.
  
  
  CONCLUSIONS
  Optimizing patient value should be the main principle underlying policies intending to increase online patient engagement in the third stage of the EHR Incentive Program. We propose a number of features for the EHR Incentive Program that will enhance patient value and thereby support the growth and sustainability of patient portals provided by Health Information Exchanges.
authors.affiliation: Health Services Management & Organization, Institute of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands. ottetrojel@bmg.eur.nl.
authors.forename: Terese
authors.identifier: http://orcid.org/0000-0002-4565-058X
authors.initials: T
authors.lastname: Otte-Trojel
authors.forename: Antoinette
authors.identifier: http://orcid.org/0000-0002-0745-4537
authors.initials: A
authors.lastname: de Bont
authors.forename: Joris
authors.identifier: http://orcid.org/0000-0003-4151-5089
authors.initials: J
authors.lastname: van de Klundert
authors.forename: Thomas G
authors.identifier: http://orcid.org/0000-0002-3175-8864
authors.initials: TG
authors.lastname: Rundall
mesh_terms: D057286:Electronic Health Records; D066275:Health Information Exchange; D006801:Humans; D062527:Meaningful Use; D033283:Patient Access to Records; D012052:Reimbursement, Incentive; D012648:Self Care; D014481:United States
keywords: electronic health records; meaningful use; medical informatics; patient-centered care