Patient portals are a convenient, secure tool for empowering patients — allowing them to check up on their medical information, ask their doctor questions, and handle some paperwork online — while reducing clinician workloads.

Despite all those benefits, it's not always easy for practices to convince patients to use portals — or even to sign up in the first place. A recent study of 5,000 Americans found that just 20 percent were able to schedule medical appointments online and only 15 percent could email their doctor.

How to boost adoption rates? Reinforce the value of the portal to patients, and provide them with specific training, according to practices in the athenahealth network that successfully engage with their patients online.

A 2017 athenaResearch study of nearly 600 primary care practices across the network evaluated how successful practices were in getting their patients to register for and engage with their portals.

The portal adoption rate determines the percentage of patients who registered for the portal prior to, or within 30 days of, a visit with their doctor. Portal usage rates reflect the percentage who interacted with their portal within 30 days of a visit.

Researchers found that small practices — those with six or fewer physicians — had better portal adoption and usage rates than larger regional and national health systems. On average, 45 percent of patients at small practices adopted the portal, and 65 percent used it within 30 days of an appointment, while national and regional health systems reported only 30 percent adoption and 35 percent usage rates.

While small practices typically have the resources and close patient relationships to be able to engage their clients more fully, practices of any size can benefit from adopting a few simple steps to increase portal use among their patient populations. Here's what two practices with high adoption and usage rates are doing to engage patients on their portals:

1. Make portals indispensable for both staff and patients

Whitney Kennedy, M.D., heads up Highlands Health for Life, a family medicine practice in Denver that boasts an 86 percent portal adoption rate and 86 percent usage rate among its patient population, which ranges from young, active individuals to older Medicare patients. Kennedy and her team of two physician assistants, front desk staff, and medical assistants drive home the importance of the portal by being straightforward about its role in doctor-patient communication.

“This is how we get your labs back to you," Kennedy tells patients. “This is how we function."

Practices with high portal adoption and usage rates like Kennedy's not only emphasize that the portal is the primary mode of communication for updates, lab results, and appointments, they go as far as possible in making signup mandatory.

"As of this year, if a patient calls to schedule a new-patient appointment, we say, 'Look, you have to go on and register on the portal,' " Kennedy says. “If we notice a week ahead of time they haven't [registered], we call them to remind them to apply on the portal."

Erin Zielinski, Feingold's practice manager, says this rapid response time helps patients feel more comfortable with the technology, facilitates easier communication, and encourages them to use the portal more regularly. All of which have helped drive the practice's 75 percent portal adoption and 89 percent usage rates.

2. Show and tell

High-performing practices find that the real sticking power for portals comes from showing patients how easy and useful these tools are with a hands-on approach.

Zielinski and the front desk staff will help patients register for the portal when they're in the office. They even create email accounts for patients who don't already have one. If the patients are unsure of how to use the portal, the team takes them through the step-by-step process of logging in and accessing their information.

Kennedy uses a large-screen display during patient visits to review portal-based charts and lab results with patients, showing how they've progressed, and explaining the data so they can further digest it at home. This extra effort reduces work for practices in the long run by making patients better agents of their own care.

“We found that if we discuss [the portal] with the patients, and show them right then and there, they are a lot more attuned to doing it at home," Zielinski says.

At Feingold's practice, the goal is to make sure patients understand the portal before they leave the office.

“We try to go above and beyond, which is I think why the patients are so supportive of the portal," Zielinski says. “We really try to make it as easy as possible for them."

3. Integrate the portal into each phase of the patient visit

High-performing practices train staff members on every aspect of their portal, the first step to integrate the portal into each phase of a patient's visit, from check in to check out and beyond.

Kennedy decorated her practice's waiting room herself with printed and framed posters about its portal, and a portal promotional video also runs all day on an iPad.

At Feingold's practice, Zielinski says, they are “constantly driving it home."

When patients check in, the front desk staff reminds them of the portal and helps them sign up. In the exam room, the doctor offers to send additional information, lab results, and answers to questions via the portal. At check out, the front desk staff reminds patients that they can pay bills and ask follow-up questions online.

“Portal. Portal. Use the portal. You get a faster response [from your doctor] through the portal," Zielinski says, repeating the practice's mantra.

4. Always improve

Despite boasting high portal adoption and usage numbers, Feingold's practice still seeks out ways to improve the scope of the tool.

The practice, which has been on its portal for upwards of five years, recently signed on with Solutionreach, a partner in athenahealth's More Disruption Please program, to send text messages to patients when they have lab results to view in the portal. Zielinski hopes that this next step will continue to boost portal usage and encourage even faster communication.

“We're always trying to come up with different ways of doing things to keep [patients] engaged," Zielinski says.

Combining these strategies helps practices take advantage of the portal's ability to save their time and energy, a welcome convenience in any setting where workloads are high. Streamlined communication allows for "improved continuity of care," says Zielinski, and keeps the practice running smoothly.

"Everyone is connected through their cell phones. Everyone is pretty tech-savvy now," Zielinski says. "So there is no reason not to use it."

Olivia Rybolt is a staff writer at athenaInsight.