title: Applying Multiple Methods to Comprehensively Evaluate a Patient Portal's Effectiveness to Convey Information to Patients.
abstract: BACKGROUND
  Patient portals have yet to achieve their full potential for enhancing health communication and improving health outcomes. Although the Patient Protection and Affordable Care Act in the United States mandates the utilization of patient portals, and usage continues to rise, their impact has not been as profound as anticipated.
  
  
  OBJECTIVE
  The objective of our case study was to evaluate how well portals convey information to patients. To demonstrate how multiple methodologies could be used to evaluate and improve the design of patient-centered portals, we conducted an in-depth evaluation of an exemplar patient-centered portal designed to promote preventive care to consumers.
  
  
  METHODS
  We used 31 critical incident patient interviews, 2 clinician focus groups, and a thematic content analysis to understand patients' and clinicians' perspectives, as well as theoretical understandings of the portal's use.
  
  
  RESULTS
  We gathered over 140 critical incidents, 71.8% (102/142) negative and 28.2% (40/142) positive. Positive incident categories were (1) instant medical information access, (2) clear health information, and (3) patient vigilance. Negative incident categories were (1) standardized content, (2) desire for direct communication, (3) website functionality, and (4) difficulty interpreting laboratory data. Thematic analysis of the portal's immediacy resulted in high scores in the attributes enhances understanding (18/23, 78%), personalization (18/24, 75%), and motivates behavior (17/24, 71%), but low levels of interactivity (7/24, 29%) and engagement (2/24, 8%). Two overarching themes emerged to guide portal refinements: (1) communication can be improved with directness and interactivity and (2) perceived personalization must be greater to engage patients.
  
  
  CONCLUSIONS
  Results suggest that simple modifications, such as increased interactivity and personalized messages, can make portals customized, robust, easily accessible, and trusted information sources.
authors.affiliation: Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, VA, United States. jordan.alpert@vcuhealth.org.
authors.forename: Jordan M
authors.identifier: http://orcid.org/0000-0002-7066-4748
authors.initials: JM
authors.lastname: Alpert
authors.forename: Alex H
authors.identifier: http://orcid.org/0000-0003-4060-9155
authors.initials: AH
authors.lastname: Krist
authors.forename: Rebecca A
authors.identifier: http://orcid.org/0000-0002-4726-4359
authors.initials: RA
authors.lastname: Aycock
authors.forename: Gary L
authors.identifier: http://orcid.org/0000-0001-5980-129X
authors.initials: GL
authors.lastname: Kreps
mesh_terms: D022126:Access to Information; D000293:Adolescent; D000328:Adult; D000368:Aged; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D058015:Health Communication / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072638:Patient Portals / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: case study; eHealth; health communication; patient portal; qualitative study