title: Encouraging Patient Portal Use in the Patient-Centered Medical Home: Three Stakeholder Perspectives.
abstract: Health care organizations are increasingly offering patients access to their electronic medical record and the ability to communicate with their providers through Web-based patient portals, thus playing a prominent role within the patient-centered medical home (PCMH). However, despite enthusiasm, adoption remains low.
  
  
  
  We examined factors in the PCMH context that may affect efforts to improve enrollment in a patient portal.
  
  
  
  Using a sociotechnical approach, we conducted qualitative, semistructured interviews with patients and providers from 3 primary care clinics and with national leaders from across a large integrated health care system.
  
  
  
  We gathered perspectives and analyzed data from 4 patient focus groups and one-on-one interviews with 1 provider from each of 3 primary care clinics and 10 program leaders. We found that leaders were focused on marketing in primary care, whereas patients and providers were often already aware of the portal. In contrast, both patients and providers cited administrative and logistical barriers impeding enrollment. Further, although leadership saw the PCMH as the logical place to focus enrollment efforts, providers and patients were more circumspect and expressed concern about how the patient portal would affect their practice and experience of care. Further, some providers expressed ambivalence about patients using the portal. Despite absence of consensus on how and where to encourage portal adoption, there was wide agreement that promoting enrollment was a worthwhile goal.
  
  
  
  Patients, clinicians, and national leaders agreed that efforts were needed to increase enrollment in the patient portal. Opinions diverged regarding the suitability of the PCMH and, specifically, the primary care clinic for promoting patient portal enrollment. Policymakers should consider diverse stakeholder perspectives in advance of interventions to increase technology adoption.
authors.affiliation: Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.|Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States.
authors.forename: Gemmae M
authors.identifier: 0000-0001-6055-4177
authors.initials: GM
authors.lastname: Fix
authors.affiliation: Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.|Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Timothy P
authors.identifier: 0000-0002-6888-0927
authors.initials: TP
authors.lastname: Hogan
authors.affiliation: Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
authors.forename: Daniel J
authors.identifier: 0000-0003-1488-9624
authors.initials: DJ
authors.lastname: Amante
authors.affiliation: Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.|Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, United States.
authors.forename: D Keith
authors.identifier: 0000-0002-9941-5470
authors.initials: DK
authors.lastname: McInnes
authors.affiliation: Veterans Health Administration, Veterans and Consumers Health Informatics Office, Office of Connected Care, US Department of Veterans Affairs, Washington, DC, United States.
authors.forename: Kim M
authors.identifier: 0000-0002-0966-5602
authors.initials: KM
authors.lastname: Nazi
authors.affiliation: Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.|Section of General Internal Medicine, VA Boston Healthcare System, Boston, MA, United States.
authors.forename: Steven R
authors.identifier: 0000-0002-4624-4364
authors.initials: SR
authors.lastname: Simon
mesh_terms: D057286:Electronic Health Records; D017144:Focus Groups; D064650:Home Health Nursing / Q000379:methods*; D006801:Humans; D000072638:Patient Portals; D018802:Patient-Centered Care / Q000379:methods*
keywords: enrollment; patient-centered medical home; personal health record; portal; primary care; qualitative