There’s Nothing Engaging About My First Patient Portal…It’s Actually Pretty Disengaging


Stop the presses!   I now have access to my very own personalized patient portal courtesy of my personal physician.  The big event occurred this last Tuesday.   I have to admit I was a bit excited that my doctor was slowly merging onto the information super highway.  Heck he even sprang recently for an out-of-the box EMR system which he is forever complaining about.

But my excitement was short lived.  Very short lived in fact after reading the e-mail from E-Clinicalworks (the patient portal vendor) which I am sharing with you here.


Patient Portal email

Now I realize that my doctor works in a solo practice as part of a large IPA…not the Mayo Clinic. But this email…and presumably everything associated with this patient portal is…well…very amateurish and totally disengaging.

First Impressions Matter

A couple of things immediately jumped out at me while reading this e-mail invitation to my patient portal.

The patient portal claims to offer me “the power of the web to track all aspect of my care through my doctor’s office.”That’s pretty powerful!

But I read on to discover that my physician’s concept of what I should have the “power” to do and what he thinks I should be able to do is very different. Why am I surprised…?

Firstthere is no mention of any kind of access to my actual health information…and certainly not my “physician’s notes.”But that doesn’t mean I am willing to leave my doctor for someone who offers this capability.

Secondand perhaps most galling…is that I can’t actually communicate with my doctor via the portal.  I can email his office staff…and maybe they will respond and maybe not. In the non-digital world they would get back to me at their own leisure.

Third… I can’t actually do anything on the portal (as configured by my doctor) other than request that the surly office staff intervene with the doctor to refill my prescriptions. Asking is certainly different than doing in my book. How the heck is this supposed to make me feel engaged?

Finally the email presumes to tell me that up until today my physician apparently does not think that I have been taking an active role in my own health care.   Let me get this right…I am 100% compliant with my medications, exercise, see my doctor regularly and am in good shape…yet I am not actively involved in my own health. Come on now.

In its favor…the email was personalized – it got my first name right. It never did mention my doctor’s name or his office address.

Upon getting this email from my doctor I was immediately reminded of a quote from a recent Dave Chase Forbes article about the value of physician-patient communications in which he said this about patient portals:

The smart healthcare providers realize simplistic patient portals, however, won’t get the job done. Simple patient portals are like a muddy puddle of water in the Sahara Desert — a big improvement but far from ideal.

Kudos to physicians everywhere that are trying…   But please recognize that your patients are not simpletons and that they are already engaged in their health at least from their perspective.   For portals like this to be successful – (meaning that patients actually use them more than once) – they need to offer real value (from the patient’s perspective), they need to be relevant to patients (not you or your staff) and they need to respect my intelligence.

Take Aways

Most patients are already engaged in their own health care.   The biggest challenge for providers today is not so much engaging patients but rather to avoid disengaging them.

Have A Patient Portal Experience You Want To Share?

I realize that my experience offers but one example of a patient portal gone wrong.   If you have samples of patient portal experiences you would like to share e-mail me at stwilkins at


  1. Stephen, great post. I totally agree with your observations that just having something called a patient portal doesn’t mean anything. It’s what functionality it offers and how it is implemented and used that affects the value. I also agree that this particular invitation is insulting in that it implies you have not been engaged in your health (implying that you can’t without a portal).

    I quibble with your statement that most patients are engaged in their health. In my experience that depends upon the population. There is certainly a great deal of apathy about health and lifestyle out there (including among many of my patients).

    There are several patient portal components that are crucial and have the potential to add value:

    1. Communication

    2. Convenience transactions

    3. Education/resources

    4. Access to your record, appointments, etc. (the more the better)

    The value achievable from the portal is proportional to the number of these features that are offered and the richness and completeness of the implementation.

    I should note that many doctors are now implementing portals hastily so that they can fulfil the Stage 2 Meaningful Use criteria to get their incentive payments. Stage 2 requires that a small proportion of patients seen communicate with the physician or staff online and a proportion also view/download/and transit their electronic medical record information.

    Thanks for the post.

    • stwilkins says:


      Thanks for the comments! Quibble away.

      Here’s what I mean when I say that most people are already engaged. Some 83% of people see their personal physician at least once a year – the average being 3 and 6-7 for people with chronic conditions. Then there are those people who never see a physician. Would you be inclined to ascribe a greater sense of engagement among those who visit their doctor vs. those who do not? Of course you would. This is the exact same logic used by Susannah Fox when she infers that 80%+ of patients are information seekers because they go online search for health info.

      This logic begs the question as to the level or intensity of one’s engagement…with some being high and some being low. My premise is that those in the low category can be “moved” if physicians focus on engaging them in a way that’s relevant to them, e.g. communications, etc.

      Everyone is different. I for example am what I consider to be engaged. Yet I have no interest in seeing my doctor’s notes. I fail to see what I would learn beyond my face to face conversations and a long term relationship with him. I guess you could say I trust him and as such don’t suspect him nor have a reason to check up on him via open notes.

      re: patient portals and Stage 2 MU…if Mayo Clinic can’t convert 5% of their registered users to regular users…what chance will Joe Blow MD have at reaching 5%??

      Great conversation.


      • Steve, I agree that looking or not looking at your notes does not define engagement. But when patients and their providers collaborate on the note content and the care plan that does engender greater engagement. But engagement can’t happen without adequate communication, mutual respect, and trust.

        The Pew data shows that >80% of ONLINE patients have gone online to look for health information (or about 2/3 of the US population). Information seeking is not necessarily engagement, but may be curiosity (or, as Pew shows, it’s sometimes to find information for others).

        And many people to do go to see doctors are not engaged in their health. I wish they were but again going to the doctor is not the same as engagement in health. As you say, it may be more than in people who never see their physicians but it is not the same as meaningful engagement.

  2. stwilkins says:

    So how would you define the high end of the meaningful engagement continuum? What patient behavioral characteristics would need to be present before you would say one is meaningfully engaged? The act of seeing you doctor exhibits the following criteria for something approximating meaningful to me anyway.. For example there’s cognition..the person has to think about the need to see you…they may do some research or talk to a friend to see what they would do. Then they would have to make an appt., take time off work , arrange transportation and show up. So now that cognition and directed action…what about this does not suggest meaningful engagement?

    Is it that they don’t ask questions or exhibit a certain level of enthusiasm during the visit? Is it that they don’t do what you want them to do…or what any right thinking person would do?

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