title: Patient Portals and Patient Engagement: A State of the Science Review.
abstract: BACKGROUND
  Patient portals (ie, electronic personal health records tethered to institutional electronic health records) are recognized as a promising mechanism to support greater patient engagement, yet questions remain about how health care leaders, policy makers, and designers can encourage adoption of patient portals and what factors might contribute to sustained utilization.
  
  
  OBJECTIVE
  The purposes of this state of the science review are to (1) present the definition, background, and how current literature addresses the encouragement and support of patient engagement through the patient portal, and (2) provide a summary of future directions for patient portal research and development to meaningfully impact patient engagement.
  
  
  METHODS
  We reviewed literature from 2006 through 2014 in PubMed, Ovid Medline, and PsycInfo using the search terms "patient portal" OR "personal health record" OR "electronic personal health record". Final inclusion criterion dictated that studies report on the patient experience and/or ways that patients may be supported to make competent health care decisions and act on those decisions using patient portal functionality.
  
  
  RESULTS
  We found 120 studies that met the inclusion criteria. Based on the research questions, explicit and implicit aims of the studies, and related measures addressed, the studies were grouped into five major topics (patient adoption, provider endorsement, health literacy, usability, and utility). We discuss the findings and conclusions of studies that address the five topical areas.
  
  
  CONCLUSIONS
  Current research has demonstrated that patients' interest and ability to use patient portals is strongly influenced by personal factors such age, ethnicity, education level, health literacy, health status, and role as a caregiver. Health care delivery factors, mainly provider endorsement and patient portal usability also contribute to patient's ability to engage through and with the patient portal. Future directions of research should focus on identifying specific populations and contextual considerations that would benefit most from a greater degree of patient engagement through a patient portal. Ultimately, adoption by patients and endorsement by providers will come when existing patient portal features align with patients' and providers' information needs and functionality.
authors.affiliation: School of Nursing, University of Pittsburgh, Pittsburgh, PA, United States. tai19@pitt.edu.
authors.forename: Taya
authors.identifier: http://orcid.org/0000-0002-0773-327X
authors.initials: T
authors.lastname: Irizarry
authors.forename: Annette
authors.identifier: http://orcid.org/0000-0003-3325-435X
authors.initials: A
authors.lastname: DeVito Dabbs
authors.forename: Christine R
authors.identifier: http://orcid.org/0000-0001-5374-0836
authors.initials: CR
authors.lastname: Curran
mesh_terms: D000367:Age Factors; D017028:Caregivers; D004522:Educational Status; D057286:Electronic Health Records; D005006:Ethnicity; D057220:Health Literacy; D055991:Health Records, Personal; D006301:Health Services Needs and Demand; D006304:Health Status; D006801:Humans; D010358:Patient Participation; D012106:Research
keywords: electronic personal health record; meaningful use; patient engagement; patient portal