Hospitals lacking cohesive adolescent patient portal engagement strategies


In a recent study, strategies and goals for adolescent engagement with patient portals differed across US hospitals.

Hospitals lacking cohesive adolescent patient portal engagement strategies | Image Credit: © tatsianamaphoto - © tatsianamaphoto -

Hospitals lacking cohesive adolescent patient portal engagement strategies | Image Credit: © tatsianamaphoto - © tatsianamaphoto -

According to a recent study published in JAMA Network Open, the amount of effort in having adolescents engage with patient portals varies in the United States between hospitals.

Online portals are available for adolescents to access health information in many health care systems. These portals contain clinical notes, results, medication lists, and messaging with clinicians. Better adherence, perceived control over health, and medical understanding have been seen in patients engaging with portals.

While portals can improve adolescent engagement in health care, self-management, and transition into adulthood, the portals will not be effective if they remain unused. However, there is little data on adolescent engagement with portals.

To evaluate adolescent engagement with patient portals in the United States, investigators conducted a qualitative study using structured interviews with informatics administrators from children’s hospitals. Children’s hospitals were found using the Children’s Hospital Association (CHA) database.

Inclusion criteria included being informatics administrators, employed by a health care system managing a children’s hospital with at least 50 pediatric beds, and involved in developing or implementing adolescent portal policies. Participants were recruited through the distribution of recruitment material across 2 informatics email groups.

The CHA database and hospital websites were evaluated to determine the number of pediatric beds in a hospital. An interview guide was developed to examine engagement efforts, barriers, and engagement goals in adolescents. Interviews were conducted by a pediatric oncologist and communication researcher over telephone or video-conferencing software.

There were 58 interviews conducted, ranging from 12 to 43 minutes. Sixty-five informatics administrators participated in these interviews, representing 63 hospitals, 58 health care systems, and 14,379 pediatric beds. The median number of pediatric beds in a hospital was 189, with the number ranging from 51 to 664.

Investigators identified 6 themes of approach for engaging adolescents in portal use, the first being promoting and educating adolescents on portal enrollment. This often involved passive approaches, including flyers, posters, videos, and websites. Educational campaigns encouraging staff to discuss portal enrollment with patients was also found in some hospitals.

Another approach was establishing workflows to support enrollment. This included registration instructions in visit summaries and allowing online enrollment. The third approach observed was seeking and incorporating feedback, accomplished through teen advisory boards and forums, research studies, clinical programs, or a portal satisfaction survey.

The fourth approach observed was creating a culture that supports engagement. This is vital because of the reliance on frontline clinical staff to promote enrollment. Increasing portal utility is another theme of approach, providing important information to adolescents through portals.

The final approach observed was limited efforts. This was seen in 19 of 58 health care systems and was described as taking limited or no steps to increase portal use among adolescents. In comparison, the first approach discussed was used by 25 systems, the second by 16, the third by 17, the fourth by 17, and the fifth by 9.

Barriers to adolescent portal use included stakeholder investment and interest reported by 40 systems, and intersecting technical, legal, and ethical factors reported by 32 systems. Portal access became more difficult if stakeholders failed to perform their roles or if portal access was restricted by state confidentiality laws.

Ideal future engagement efforts included developing private means of communicating with an adolescent, using an adolescent-centric user design for communication, enhancing promotion and education about portal use, simplifying workflows, providing education on current health, preparing for transition into adulthood, and improving digital health education of adolescents.

These results indicated variety in efforts to engage adolescents in using patient portals. Investigators recommended a role be integrated for parents to increase the prevalence of successful strategies.


Sisk BA, Antes AL, Bereitschaft C, et al. Engaging adolescents in using online patient portals. JAMA Netw Open. 2023;6(8):e2330483. doi:10.1001/jamanetworkopen.2023.30483.

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