No evidence that messaging portals reduce costs, improve outcomes, review of studies shows
A key to the patient-centered medical home model is enhanced patient-physician communication—often through using a secure-messaging portal connected to an electronic health record. But according to a systematic review of 46 studies published over 22 years, there is insufficient evidence that portals improve outcomes or lower costs.
In the Veterans Affairs Department-funded review, researchers from VA and academic medical centers in Los Angeles and Indianapolis did find that portal use was associated with improved outcomes for patients with chronic diseases such as diabetes, hypertension and depression, but these improvements were also linked to portals used in case management. The researchers were unable to discern whether the portals themselves made a difference.
“Portals are being created as part of a movement to make patients more active participants in their care,” the researchers wrote. “Our review suggests that there are some potential barriers to achieving this goal, including disparities in who accesses these portals and instances of suboptimal patient attitudes of their worth. More widespread acceptance will require attention to overcoming these disparities and addressing usability and patient-perceived value to engage certain populations that are not readily embracing personal health-record systems.”
The review searched for related studies published between January 1990 and Jan. 24, 2013. It included 14 randomized control trials and 21 observation studies. The studies included investigations by researchers at the University of Washington, Seattle; Partners HealthCare, Boston; University of Colorado Hospital, Denver; and Group Health Cooperative, Seattle.
The authors noted that the diversity of products complicated the review, but EHR portals generally shared common functions such as giving patients the ability to view test results and visit summaries, refill prescriptions, make appointments, receive educational materials and communicate with their doctor. The review showed an increasing use of portals with case management, remote healthcare delivery and non-face-to-face services.
“Preliminary evidence suggests that, like many health IT tools, enhanced outcomes are realized when the tools are implemented as elements of more comprehensive programs that link the tool with other approaches, such as case management,” the researchers concluded. “On the basis of current evidence, we consider it unlikely that patient portals will have substantial effects on utilization or efficiency, at least in the near term, and more studies are needed to evaluate their cost implications.”
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