It is well known that health and care systems are complex and notoriously difficult to navigate, even for the most experienced users. Opening 24/7 digital access to the healthcare record enables people to interact with their care team and their healthcare information. Access to integrated healthcare data is just as important to healthcare consumers as it is to healthcare professionals. It shifts power to individuals to allow them to play a greater role in their own care. As with all innovation, healthcare user portals also carry the risk of creating conditions for inequalities to occur with the introduction of unintended new access barriers, e.g. for people who lack digital access, skills, or reduced physical or cognitive ability.¹

While ensuring accessibility to healthcare is addressed, other social digital access needs are known and need to be considered and addressed. Research by the Good Things Foundation² demonstrates the challenges faced by a lack of digital access in society:

• 1.5 million UK households don't have internet access at home
• 2 million households struggle to afford internet access
• 10 million people still lack foundation-level digital skills
• 14.9 million have very low levels of digital engagement

Healthcare user portals give people access to their information within a healthcare organisation or group of organisations. The functionality enables the user to retrieve information like appointments and discharge letters. It also allows them to enter data, such as appointment changes, requests for care, medication, vital signs, and preprocedure checklists.

Government policy is to drive people to consumer-facing health applications to improve access to healthcare.³

Based on people’s experiences of other industries consumer applications, expectations are high. However, healthcare portals are in early development and far behind industries, such as banking and retail. In these sectors, data analysis, business strategy alongside user experience (UX) have driven the priority of UX, large-scale change, and the subsequent transformation of consumer engagement.

On the back of healthcare organisations’ implementation of electronic patient records (EPRs), first-generation healthcare user portals have emerged in the market, enabling people to access their records. Healthcare portal development is a fast-moving area, driven by a clear healthcare purpose that emerged during the COVID-19 pandemic: of the three-years-old NHS App’s 22 million users, 18 million registered after the NHS COVID Pass was added in May 2021⁴.  Where there is a clear purpose, people engage and when they subsequently experience value, their engagement is then sustained.

Similar to the NHS App uptake numbers, early adopter engagement is comparable in local healthcare portal adoption, averaging at around 80%. This opens the opportunity for local healthcare organisations to use patient engagement intelligence to gain a deeper understanding of local access issues. This, alongside usage/non-usage behaviours with the opportunity for a targeted local response, will help address local digital access inequity and ensure health inequalities are not further exacerbated.

It is critical for these issues to be addressed to ensure non-health-specific barriers are removed or reduced.⁵  While the ways to fix them are somewhat beyond the sole control of healthcare providers and suppliers, portal user experience design is firmly within their sphere of influence.

The person-centric, personalised, and outcomes-based model creates more focus on healthcare providers to provide easily accessible ways for patients to engage in their own care, build trust, and become effective healthcare partners.⁶

Simply giving access to the healthcare portal is not enough. It is essential that technology is humanised, regardless of user ability. This includes helping people to overcome potential barriers, such as language and literacy within a multicultural society, and neurodiversity. This covers brain function and behavioural traits that address diversity in how people interact, learn, and process information, as well as physical disabilities, e.g. sight and motor skills. (Figure 1)

Figure 1

Despite being at the embryonic stages of digital engagement, it is important to implement first-generation portals with a focused effort. It is vital that they are created with purpose, incorporate the impact of portal usage into care coordination and workflow design, and align patients’ and providers’ needs, e.g., people with long-term conditions where multiple interactions occur between patient and healthcare professionals.

In their research into the subject, Zhong, Park et al concluded that, “There exists a lack of match in the patient portal market in the sense that patients who benefit the most from using patient portals are not actively adopting patient portals.”⁷  While early adopters are important, inclusive adoption⁸  is the critical goal and where UX needs to become a new clinical speciality in healthcare.

Alongside other digital tools, healthcare portals give healthcare organisations greater depth in understanding their consumers and how active they are in their healthcare.

Figure 2

Using portal usage data puts healthcare organisations in a place where they can shift patient engagement intelligence into a new era, akin to banking and retail.

Zhong, Park et al note that inclusive engagement gives an understanding of how “Unique needs and usage habits of different patient populations can contribute to a better and user-friendly design of the portal that can cater its service and functionality to patients’ various tastes and preferences.”

While first-generation consumer portals are implemented, the learning both from healthcare and other industries is forming the future of digital healthcare consumer engagement in supporting fair access to healthcare. The retail industry is a strong example of how brand, data, and engagement has been utilised to build market engagement and expand the customer base through incentivisation and personalisation. Where customers sign up for digital incentives based on rewards, with personalised offerings for members providing the greatest engagement.⁹  In healthcare, those with digital access barriers could have personalised digital incentivises, such as a mobile data subscription.

Healthcare organisations and portal developers can take learning from other industries and translate it for the healthcare redesign process.  This will augment the therapeutic relationship, driving inclusion and transparency, personalisation and culturally sensitive engagement, and improved healthcare outcomes for all.

To remove and prevent the creation of new digital access barriers as care pathways are digitised, it is key that digital access is considered. During the implementation of a digital pathway service, it is necessary to actively address the risk and response to digital exclusion, and following deployment, the use of data to drive an understanding of who is and is not accessing care via digital pathways to enable proactive removal of barriers to healthcare information.

^{1 https://www.cerner.com/gb/en/industry-perspectives/engaging-and-involving-people-in-their-care-through-portals
2 https://www.goodthingsfoundation.org/insights/a-blueprint-to-fix-the-digital-divide
3 https://www.gov.uk/government/publications/a-plan-for-digital-health-and-social-care/a-plan-for-digital-health-and-social-care#section-1-embedding-digital-technologies
4 https://digital.nhs.uk/news/2021/nhs-app-turns-three-with-22-million-users
5 https://www.goodthingsfoundation.org/insights/building-a-digital-nation
6 https://informatics.bmj.com/content/23/2/534
7 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064955
8 Inclusive engagement; religion, gender, age, language, literacy, disabilities, income, culture, sexual orientation, neurodiversity, and physical ability
9 https://www.globaldata.com/media/consumer/supermarket-loyalty-schemes-will-key-customer-retention-uk-cost-living-crisis-says-globaldata}