People Don’t Like Patient Portals

A patient portal is a healthcare tool (mobile app or website) that allows people to track, understand, and manage their health. These tools also streamline administrative tasks for doctor’s offices and help facilitate better communication between doctors and patients. Sounds like a win-win situation for everyone.

There’s just one problem—most people don’t want to use patient portals. According to a 2020 study done by the ONC (Office of the National Coordinator of Health Information Technology), 63% of patients said they didn’t see a need to access their patient portal. Yet most healthcare organizations have embraced patient portals, pushing vital communications and scheduling to these platforms. The COVID-19 pandemic has greatly accelerated this move.

Objectively, patient portals are the wave of the future; they’re a new, convenient tool for managing and understanding our health that can alleviate administrative burdens for busy providers. But they must undergo many improvements before they will be effective and widely accepted by users.

Patient Portals and Human Emotion

When it comes to our health, there’s plenty to feel stressed about—prescriptions, appointments, test results, and our overall wellbeing. And when we’re anxious, it’s harder for us to use complex tools. Additionally, we often avoid new technology that disrupts the status quo. From the ONC study, 69% of patients said they didn’t use a portal because they preferred face-to-face communication with their doctor. Patient portals are just another new, confusing tool to learn, so we avoid them.

Acknowledging User Anxiety

We might be going to an online portal already nervous, upset, and frustrated. And anxious or not, people crave welcoming, easy, helpful online experiences. Portals must show understanding and empathy from the start if they hope to win us over. This means planning for a warm, human-centered experience and basing every single interface decision on the emotional needs and behaviors of real people. This starts with acknowledging existing attitudes as valid and consequential. This realization should guide portal organization, design, and content. But current portals fall short on each front.

The Biggest Patient Portal Issues (And What to Do About Them)

Sign-up is often brutal.

Most people struggle with sign-up and log-in, notoriously tough processes to handle. Years of user testing have unequivocally proven this to us. Even simple log-in processes are invariably problematic. Patient portals make this problem even more difficult because they hold access to our private healthcare records, which means we must jump through extra security hoops.

To use a portal, we must often request access from our care team and fill out long-winded, exhausting forms. We must traverse paragraphs of dense disclaimers that nobody reads. We answer multiple, detailed questions about our personal information and medical history, none of which we typically have at our fingertips. We must set up authentication, performing digital cartwheels to prove that we are who we say we are. For many people, it’s too annoying, laborious, and time-consuming compared to just calling the doctor’s office.

Mitigate the sign-up/log-in disaster.

The sign-up/log-in problem is complicated and won’t be solved with a few tweaks. But portals should make the process less painful.

• Make important instructions brief and noticeable — People are quick to dismiss anything that resembles fine print or seems too long to read. Make valuable instructions and next steps a concise, obvious part of the form process, so they clearly understand what to do and expect.
• Design for multiple touchpoints — Sign-up and log-in is not a one-and-done process. We often bounce between the sign-up/log-in screen, our emails, and our text messages to complete the verification process. To users, this should be one seamless experience despite involving different devices. Our experiences in other channels matter. Attention must be paid to every text or email to ensure a consistently easy process.  
• Plan for failure — People are going to struggle, even if sign-up/log-in is a simple process. Your forms must account for this. Spend time testing how people fail and how you handle error messages so you can create solutions that help them recover. The failure path experience is more important than the success path.
  
  

Dashboards are often wildly ineffective.

When we finally access a patient portal, the first screen we see (usually the dashboard) is vital to our experience. Instantly, this screen should orient and guide us. But many patient portal dashboards fail, doing either too much or too little.

Some dashboards inundate us with icons, notifications, appointments, care team lists, and medications. The crowded interface leaves us overwhelmed. Other dashboards show irrelevant marketing information, like hospital-related news, surveys, and welcome messages, none of which is vital to managing our care. Neither approach helps us easily do what we came to do.

Offer patients’ top tasks and relevant information upfront.

Patient portal dashboards should only show relevant information and promote core actions, nothing more and nothing less. Dashboards should be action-oriented, giving people an immediate way to accomplish common, expected tasks that require immediate attention—upcoming appointments, prescriptions that need refills, and bill due dates, for instance.

Cut the welcome messages, large images, news sections, and marketing nonsense. Patient portals are about the patient, not the healthcare organization. Avoid the temptation to throw everything and the kitchen sink onto a dashboard. Don’t bury important actions with irrelevant or untimely information (e.g., appointments over a year away)—keep things lean.

Navigation can be daunting.

Finding anything in a typical patient portal can be mind-numbing. Managing our health is already nerve-wracking. Now we must either trust the efficacy of search bars (and hope results are decipherable) or scale dreaded navigation walls, chock full of similar sounding, repetitive, jargon-filled options. This makes us feel lost and confused, as if we’re on a not-so-fun treasure hunt.

Limit navigation options.

Seeing a wall of options doesn’t help us better understand what’s available—it throws us further into a pit of confusion and indecision.

• Keep lists short and sweet — Limit lists to around around 5–7 simple options. Yes, even for navigation menus.
• Use plain, expected language — Clearly categorize and name navigation items according to the terms favored by your users (not your organization) so they can understand exactly what each option offers. Avoid any and all jargon, whether technical, medical, or marketing in nature.
• Don’t repeat the same options in different categories — Each item should be assigned a main category (that makes sense to your users), rather than duplicated under multiple headings.
  
  

Most portal interfaces feel disruptive and inconsistent.

Most patient portals lack strong, user-centered organization and design. Layouts neglect thoughtful design or content strategy. Text styles lack consistency. They can be hard to read. Some features act oddly, breaking expected behavior. Pop-ups jump in our face, disrupting our experience.

In short, patient portals still fell like badly designed software products. They feature jumbled, inconsistent screens that lack the simplicity of the best online tools we use to order food, call rideshares, or book vacation rentals.

Redesign with users in mind.

Portals must be redesigned from the ground-up, with an eye toward how real people think about their health and interact with technology. Surface-level changes will not be enough. There needs to be a thorough, carefully crafted plan that revolves around users’ tasks, needs, and expectations. And there is no way around this. Significant evolution is needed, across the board. This is undoubtedly difficult but utterly necessary.

Test new designs with real users.

Observe real people interacting with new designs from the prototype stage through launch and beyond. Watch how they react to your changes; notice what is easy for them, what confuses them or gives them problems. Use their feedback to make more improvements on an ongoing basis.

Patient portals are riddled with esoteric medical jargon.

Most people read at a 6^th grade or lower level, yet patient portals routinely use terminology that only trained medical professionals would understand.

Consider what can happen when we view medical test results, a common portal task. This should be one of the most clearly communicated, simple things we do in our portal. But it is often the most opaque and indecipherable. Test results often present us with a screen full of highly technical medical terms. Unless we have medical training, we don’t have any idea what any of it means. This renders results all but useless, raising questions rather than providing answers.

We’re forced to trust a doctor’s initial comments on the results (often terse and vague, if offered at all), wait until we can speak with our doctor to ask follow-up questions, or do the research ourselves. Technology should make our lives better and easier. Throwing highly technical language at us does the exact opposite.

Drastically limit medical terminology.

The best doctors speak to us plainly. Face-to-face, they can give diagnoses in human speech. We can ask questions. They can further clarify in simple terms we can understand.

Patient portals must extend this same courtesy. All content must be offered in simple, direct, plain language that is no higher than a middle school reading level. This is particularly important for content that pertains directly to our day-to-day health such as vaccinations, test results, and prescription refills.

Provide simple explanations.

We can’t avoid all medical terms. When difficult terminology is offered, it must be accompanied by a clear, visible, brief explanation. Even the addition of a plain language summaries alongside test results would be welcome.

Limit app-specific marketing lingo.

Healthcare professionals are not the only obscure language culprits. Patient portals themselves use terms written by either software development teams or marketing departments. What exactly is the difference between an E-visit, Video Visit, or Online Visit? What is a Document Center? What does the navigation option “Letters” lead to?

Encourage and embrace broad-based change.

Use of simple language by doctors, organizations, and healthcare tools requires systemic change for how medical professionals, healthcare organizations, and makers of patient portals share and communicate information with patients. Until this happens, people won’t use portals to their fullest advantage.

Educational content is often unhelpful.

Patient portals seem to recognize that users may struggle. They attempt to alleviate this problem by providing glossaries or other educational content.

However, this is often poorly executed and doesn’t help users in the moment. For instance, “Learn More” links for treatments might lead to a medical dictionary rather than the concise summary we need. This can feel more like a time-consuming, college-level reading assignment than true help.

Simplify content where possible.

Medical terminology can’t be avoided, but clear, plainspoken definitions can always be offered. Glossaries should include plainspoken summaries, while detailed educational contentshould be written with the average person in mind, not medical professionals. This information must be easy to find and provide instant clarity for it to be useful. If the goal is to empower patients with knowledge and truly help people, this must be done.

The Challenge Facing Patient Portals

Patient portals represent a new way of managing our health care. They have the potential to connect us to doctors and help us understand our health like never before. But portals are currently in an early stage of their evolution, to put it mildly.

Usage rates are on the rise, but this is likely more due to the COVID-19 effect than outstanding user experience. We will not see mass adoption of this new technology until it becomes much less difficult to use. Portals must provide an easy, effortless experience akin to what we expect from our favorite, signature apps. Only when this happens will adoption rates growing to meaningful numbers that signal widespread interest.