EHR v Covid-19. Patient portal trends, 6 months into pandemic

EHR Patient Portal Advocates! I need your brains.

EHR Patient Portal Advocates! I need your brains.

This is the curve of percent of patient appointments each month for the past 3 years, with patient portal accounts. I blogged a version of this back in March. Back then, if you drew a straight line from 2017 through FEB 2020, it looks pretty linear. Then, BOOM, a sharp uptick in March and April. The percentage increases from 71% to 77% in 2 months. Then it has stabilized and flattened in the 76-77% range since then.

On the one hand, one could hope that the increase in patient portal sign up would continue until we got to 80 or 90%. We know that 90% of healthcare ORGANIZATIONS offer a patient portal and that 52% of patients in an ONC survey have a patient portal account (2017 data).

So, in 2017 we were around 56%, right in the ballpark.

I think we understand the bump in portal usage in March and April: our dramatic upscaling of telehealth by 200x from 20 per day to 4000. In order to schedule patients for a telehealth visit, we required the patient to register for and log in to our My Health Connection (Epic’s MyChart) patient portal at UCHealth. Nothing like a pandemic and an available well-oiled telehealth service to bump patient portal stats.

Now, more of our patients can take advantage of: messaging their provider, refilling their prescriptions online, accessing price transparency estimates of anticipated procedures or services, viewing and requesting changes of the: medication list, diagnosis list, view their provider’s progress notes (Open Notes), view their radiology reports AND actual images (UCHealth is one of the first patient portals in the country to offer this).

However, what explains the flattening since then?

Theory #1: It’s those surgeons!

The theory: well, all surgery clinics completely shut down during most of March, April. And, WE ALL KNOW that surgeons are terrible with patient portals (rampant overgeneralization). The answer: Actually, NO. Once we select ONLY primary care practices and exclude surgeons and medical specialists, the same curve occurs. It is not the opening and closing of surgery clinics.

Theory #2: its those Seniors!

The theory: well, since most older patients have been staying home, and a good number of them don’t have access to smartphones or laptops or PC’s to do telehealth visits, it must be ONLY younger patients coming in, who of course have excellent rates of signing up for the patient portal for telehealth, right?

The answer: Again, NO. Turns out, if you filter out all patients over age 65, the same curve occurs.


So, what is happening here? Are we bumping up against the natural limit of Coloradoans who own smartphones and/or computers? Have we indeed registered ALL patients who will ever agree to signing up for a patient portal for any reason?

Or, have we gotten lazy and gone back to “hey lets encourage patients to come back to clinic!” and thus relaxed our vigilance at setting up patients for a free portal account?

Or is there another theory, another slice of the data I haven’t thought of?

CMIO’s take? I’m asking for YOUR help! Send me an idea, a theory I can slice on this data and see if it explains the plateau!


Author: CT Lin

CMIO, UCHealth (Colorado); Professor, University of Colorado School of Medicine

5 thoughts on “EHR v Covid-19. Patient portal trends, 6 months into pandemic”

  1. I don’t think you are bumping up against “the natural limit of Coloradoans who own smartphones and/or computers,” but rather, all those who are WILLING to practice on the portal (or interact with clinicians on the portal) have been converted. It’s the diffusion of innovation theory. Your 80+% includes the innovators, early adopters, early majority, late majority. The missing audience are the laggards.

    Of course, you need to keep the enrollment efforts up for all new patients–you can’t let up. Never let up.

  2. I tried to mimic your query- took patients with a office or Telehealth visit, AND on our primary care registry.
    trended % Acivated over 2 years. Pretty flat at 85-87% until April, got up to low 90s. Then it dropped a little to high 80s in past month. While not as pronounced, we did see a rise, then a flattening.
    One thought is the criteria is only pulling patients with encounters, and because we were doing so much Telehealth (which requires MyChart), that artificially enriched the population. Now we are seeing patients without MyChart in the office….
    In fact, when I remove tele-visits, I see a drop during lockdown; flat otherwise.

  3. Hi CT. Great questions. Here are some potential answers:
    1) Diffusion of innovation. If we assume all the non-users are all “laggards” and won’t budge until forced then that brings you down to ~86% (in-line with Dr. MacDonald’s comment above). Couple that with a lack of access to mobile devices that may get you to 77%. Love that man, Rodgers, and his curve.
    2) What percentage of your population would you expect to have needed to log-in by now based on their last appointment? For example, I last saw my PCP two years ago and have not needed anything since then, so may not “need” to create an account yet. If relatively healthy patients were seen in February, you may not expect them to need to create an account yet.

    1. @Liz: Agree, never let up. Will do. @Scott: thanks for the insights. @Tyler, I like your thinking. Fraction of patients seen, who need to be seen: hard to say, right? Healthy patients would not need a visit for up to 2 years, so maybe: in 6 months, about 1/4 of continuity patients have come back since Feb? More to come!

      1. @Liz is right. If you have ever done marketing campaigns and know when those occurred, look at your statistics in the weeks after a campaign. There are great reasons to encourage portal account sign-up and usage before the risks of the coming months may come to reality (e.g., COVID-19, Flu, RSV).

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