A Tale of Two Perspectives: Harvesting System Views and User Views to Understand Patient Portal Engagement

Patient engagement is recognized as a key factor in promoting care quality and experience. Although patient portals as a prevalent information infrastructure provide a viable means to achieve engaging patients, there is still a limited understanding of how to objectively and systematically evaluate engagement levels in the context of patient portals. We develop the Patient Portal Engagement Framework (PPEF) to objectively and systematically evaluate patient portal engagement and demonstrated its utilization and effectiveness in two scenarios: portal utilization and user feedback. Four engagement levels included in the PPEF are - Inform Patients that allows patients to access health information; Involve Patients that encourages patients to take initiatives; Partner with Patients that supports long-term collaboration between patients and providers; and Support Ecology of Care that extends the scope beyond hospitals into personal and social factors. We find more portal utilization and user feedback focus in lower levels of patient portal engagement (i.e., patients receiving information and taking active actions in managing care). Our thematic analysis of online user reviews reveals four core themes: conflicts between system and user views, evolving benefits and needs towards patient portals, debates about balancing emotional and informational needs, and reconsideration of power, accessibility, and privacy. We discuss how PPEF can help harvest and synthesize data from the system and user levels, as well as the design implications for patient portals. These results show that patient portals can be designed with practical guidance for engaging patients, complementing current efforts that focus on conceptualizing engagement or rely on psychometrics.