Appl Clin Inform 2023; 14(04): 654-669
DOI: 10.1055/s-0043-1770901
State of the Art/Best Practice Paper

The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating

Tera L. Reynolds
1   Department of Information Systems, University of Maryland, Baltimore County, Baltimore, Maryland, United States
Jared Guthrie Cobb
2   Vanderbilt University Medical Center, Nashville, Tennessee, United States
Bryan D. Steitz
3   Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
Jessica S. Ancker
3   Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
S. Trent Rosenbloom
2   Vanderbilt University Medical Center, Nashville, Tennessee, United States
3   Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
4   Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
5   Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
› Author Affiliations
Funding This work was funded in part by Patient-Centered Outcomes Research Institute (PCORI) grant COVID-2020C2-10791.


Background and Objective Recent external factors—the 21st Century Cures Act and the coronavirus disease 2019 (COVID-19) pandemic—have stimulated major changes in the patient portal landscape. The objective of this state-of-the-art review is to describe recent developments in the patient portal literature and to identify recommendations and future directions for the design, implementation, and evaluation of portals.

Methods To focus this review on salient contemporary issues, we elected to center it on four topics: (1) 21st Century Cures Act's impact on patient portals (e.g., Open Notes); (2) COVID-19's pandemic impact on portals; (3) proxy access to portals; and (4) disparities in portal adoption and use. We conducted targeted PubMed searches to identify recent empirical studies addressing these topics, used a two-part screening process to determine relevance, and conducted thematic analyses.

Results Our search identified 174 unique papers, 74 were relevant empirical studies and included in this review. Among these papers, we identified 10 themes within our four a priori topics, including preparing for and understanding the consequences of increased patient access to their electronic health information (Cures Act); developing, deploying, and evaluating new virtual care processes (COVID-19); understanding current barriers to formal proxy use (proxy access); and addressing disparities in portal adoption and use (disparities).

Conclusion Our results suggest that the recent trends toward understanding the implications of immediate access to most test results, exploring ways to close gaps in portal adoption and use among different sub-populations, and finding ways to leverage portals to improve health and health care are the next steps in the maturation of patient portals and are key areas that require more research. It is important that health care organizations share their innovative portal efforts, so that successful measures can be tested in other contexts, and progress can continue.

Authors' Contributions

S.T.R. and J.S.A. conceived and designed this state-of-the-art review. T.L.R., B.D.S., J.S.A., and S.T.R. developed the search strategy and participated in the first round of screening. T.L.R. conducted the second round of screening with input as needed from the other co-authors. T.L.R. led the thematic analysis with input from the other co-authors. T.L.R. drafted the manuscript. All co-authors contributed to the final manuscript.

Protection of Human and Animal Subjects

No human or animal subjects were involved in the project.

Publication History

Received: 20 February 2023

Accepted: 26 May 2023

Article published online:
23 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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