FAP_CGarner_8-2-15

Running head: THE PATIENT PORTAL: ENROLLMENT AND USE STRATEGIES 1
The College of St. Scholastica
Duluth, Minnesota
The Patient Portal: Enrollment and Use Strategies for a Paradigm Shift
by
Christina Garner
Final Applied Project Advisor: Ryan H. Sandefer, MA, CPHIT
Final Applied Project Committee:
Pamela K. Oachs, MA, RHIA
Amy L. Watters, MA, RHIA, FAHIMA
Ryan H. Sandefer, MA, CPHIT
Approved:
Submitted in partial fulfillment of the requirements for the degree of Master of Science in Health
Information Management, The College of St. Scholastica, Duluth, Minnesota.

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THE PATIENT PORTAL: ENROLLMENT AND USE STRATEGIES
Acknowledgements
Special thanks to Madonna LeBlanc, MA, RHIA, FAHIMA, who served as a second
reader and whose insight into patient engagement is greatly appreciated, and Ryan Sandefer,
MA, CPHIT who diligently answered my many queries and faithfully guided me through the
completion of this project.

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Abstract
A patient portal is typically attached to the organization’s electronic health record (EHR), but
can be purchased as a stand-alone system. Implementing the patient portal is half the battle. If
you built it they will not come; they must be convinced that there is something in it for them. The
patient portal will facilitate patient-provider communication and enable patients to be more
active participants in their own healthcare. It is crucial for providers to spread awareness of this
service. Before disseminating the patient portal initiative throughout the organization, a plan
must be developed. Follow-up must be executed to ensure compliance. Standardizing training
and recruiting physician and staff champions will contribute to a smooth transition. Strategies to
increase patient enrollment and use should be developed, as well as a coherent enrollment
process. With meaningful use incentives, process improvement, and improved health outcomes
dependent on the patient portal, organizations must be proactive and embrace the transformation.
To assist in this endeavor, the website “Patient Portal Basics”
(http://www.patientportalbasics.com/) has been developed to provide tips and tools for an
organization’s patient portal initiatives.

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Table of Contents
Figure 1: MU Stage 1 Mandatory Criteria ………………………………………………………..9
Figure 2: MU Stage 1 Chosen Objectives..………………………………………………………10
Figure 3: MU Stage 2 Mandatory Criteria.………………………………………………………11
Chapter 1 Problem Statement……………………………………………………………………..5
Chapter 2 Literature Review...……..……………………………………………………………..6
Chapter 3 Project Description……………………………………………………………………20
Chapter 4 Project Methodology…….……………………………………………………………21
Chapter 5 Project Product………………………………………………………………………..22
References…………………...…………………………………………………………………..24
Appendix A: Homepage……………………………………………………………………........27
Appendix B: About – The Patient Portal…...……………………………………………………28
Appendix C: About – Benefits……...………………………………………………...…………29
Appendix D: Toolbox – Assess……….…………………………………………………………30
Appendix E: Toolbox – Plan..……………………………………………………………………31
Appendix F: Toolbox – Implement and Evaluate………..………………………………………32
Appendix G: Toolbox – Outside Resources..……………………………………………………33
Appendix H: Contact.……………………………………………………………………………34
Appendix I: Wireframes…………………………………………………………………………35

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The Patient Portal: Enrollment and Use Strategies for a Paradigm Shift
Chapter 1: Problem Statement
In 2009, the Health Information Technology for Economic and Clinical Health
(HITECH) Act was enacted as part of the American Recovery and Reinvestment Act (ARRA).
This set in motion an epic transformation in healthcare and set the foundation for meaningful use
(MU) incentives. HITECH includes standards and regulations for the secure and detailed
accounting of the medical record in an electronic format. The idea was to promote privacy,
security, and accountability for healthcare organizations. Initially the focus was on provider
documentation, and has since expanded to include incentives for enhancing physician-patient
engagement and value-based care.
A patient portal is typically attached to the organization’s electronic health record (EHR),
but can be purchased as a stand-alone system. Implementing the patient portal is half the battle.
If you built it they will not come; they must be convinced that there is something in it for them.
The key to success is letting the patient know that the portal is the office’s new preferred mode
of communication. Patients will get their answers quicker without having to wait for a call. It is
crucial for providers to spread awareness of this service. Before disseminating the patient portal
initiative throughout the organization, a plan must be developed. Follow-up must also be
executed to ensure compliance.
Standardizing training and recruiting physician and staff champions will contribute to a
smooth transition. Strategies to increase patient enrollment and use should be developed, as well
as a coherent enrollment process. Challenges exist not only with patient enrollment issues, but
staff pushback as well. Staff should be assured that the patient portal will not make their job
harder, it will make it more efficient.

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Chapter 2: Literature Review
The emergence of the patient portal represents a paradigm shift in healthcare. The days of
tightly guarded medical records are over, replaced by an age of collaboration and teamwork
between physician and patient. Healthcare is becoming a value-based system and as such,
providers now have additional responsibilities and standards to adhere to. One of these standards
is giving patients the coveted access to their medical record—online, on their time. Patients can
view test results, procedure instructions, clinical summaries, and more. They can request
prescription refills, ask questions and get answers. This gives patients a long-overdue control of
their own healthcare, rather than relying solely on others for their answers. The goal is to
“enhance patient-provider communication, empower patients, support care between visits, and,
most importantly, improve patient outcomes” (ONC, 2014). This paper will describe benefits, identify
challenges, and offer strategies to increase enrollment and use of the patient portal.
Patient Portal Benefits
Early adopters have demonstrated that patient portals streamline medical office
workflows and increase patient satisfaction. The following definition from the Office of the
National Coordinator for Health Information Technology (ONC) provides a benefit overview,
though not all patient portals possess every function:
A patient portal is a secure online website that gives patients convenient 24-hour access
to personal health information from anywhere with an Internet connection. Using a
secure username and password, patients can view health information such as:
 Recent doctor visits
 Discharge summaries
 Medications

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 Immunizations
 Allergies
 Lab results
Some patient portals also allow patients to:
 Exchange secure e-mail with their health care teams
 Request prescription refills
 Schedule non-urgent appointments
 Check benefits and coverage
 Update contact information
 Make payments
 Download and complete forms
 View educational materials (ONC, 2014)
Encryption standards and password protection make the patient portal more secure than
fax, email, or even voicemail. In a study by the Veteran’s Administration (VA), it was found that
patients like the privacy of secure messaging to ask about sensitive topics such as sexually
transmitted diseases (STDs) or impotence (Haun et al., 2014). Providers can also push
preventative healthcare notifications to patients and provide links to websites like the National
Library of Medicine (NLM) for more information on the patient’s condition. There is even a
technology that can send data from a patient’s personal medical device to the patient portal
(Dooling, 2012). Texas Neurology’s billing phone calls decreased by 15% when they put in a
link to view statements and pay bills (Butcher, 2014).
Meaningful Use (MU) is an ARRA initiative designed to monetarily incentivize
healthcare organizations to use their EHRs in a meaningful way to improve their healthcare

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delivery. It is governed by Centers for Medicare and Medicaid Services (CMS) and providers
and hospitals that receive Medicare and/or Medicaid payments are eligible. Payments started in
2011 and go through 2016 for eligible professional’s (EP’s) Medicare option and 2021 for
Medicaid MU payments (CMS, 2015). There are three stages, and each stage has quality and
compliance measures called objectives. EPs have a core set of 13 required objectives and five
chosen objectives from a 9-item menu set, for a total of 18 objectives. One of the required
objectives is providing the patient the ability to view their medical records online, which can be
accomplished through the patient portal (see Figure 1). One of the chosen objectives is pushing
preventative health notifications to patients, which can also be facilitated through the patient
portal (see Figure 2).

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Figure 1. MU Stage 1 mandatory criteria. Copyright CMS 2014

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Figure 2. MU Stage 1 chosen objectives. Copyright CMS 2014
When the EPs attest to CMS that they have demonstrates these objectives, they receive
incentives. The patient portal is an important piece of MU. Stage 1 MU requires that eligible EPs
provide the ability to view medical records online to at least 50% of their patients (CMS, 2014a).
Stage 2 also requires 50% accessibility with an addendum—5% actually have to log on to patient
portal during the reporting period and “view, download, or transmit to a third party their health
information” (CMS, 2014b). Stage 2 MU objectives include providing patients educational
resources and sending secure messages to patients, both of which can be accomplished through
the patient portal (see Figure 3). Providers attest to this by measuring their patient portal activity.
In 2015, eligible professionals will be penalized yearly by a 1% reduction in Medicare payments
if they do not attest to MU, increasing to a maximum penalty of 5%. Hospitals will also be
penalized starting in 2015. In addition to monetary penalties, failure to use EHRs in a meaningful
way puts the organization in an unfavorable position behind others in the healthcare industry. As
of April 2015, 54% of in-office physicians and 95% of eligible hospitals have attested to MU
(ONC, 2015).

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Figure 3. MU Stage 2 mandatory criteria. Copyright CMS 2014

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Enrollment and Use Challenges
As of April 2015, 62% of physicians have an EHR (ONC, 2015). Adopting an EHR and
patient portal is the easy part, enrolling patients in the portal and getting them to use it presents
more challenges. Many organizations are struggling with not only enrollment—a requirement for
Stage 1 MU—but also with getting patients to actually use the portal, a requirement for Stage 2.
Cleveland Clinic has 11 hospitals, over 75 ambulatory clinics, and around 3,500 physicians.
According to Butcher, about one half of their 500,000-plus patients have enrolled but only about
one third use it (2014). Cleveland Clinic’s patient portal director, Lori Posk, MD, says “There’s
a difference between an active and an engaged patient…‘Active’ only means that the patient has
set up a portal account. We still have a lot of work to do to engage our active patients” (Butcher,
2014).
Mayo Clinic, known for their exemplary business models, is even having trouble meeting
these measures (Wilkins, 2013). They introduced their patient portal in 2010 and now have over
240,000 patients enrolled. With only about 12,000 patients using the portal, they are struggling to
meet the 5%. Eric Manley, product manager of global solutions at the Mayo Clinic says “simply
making services available doesn’t cut it. Unless you are engaging patients, you won’t meet MU
requirements. [Messaging and other mechanisms] need to be a part of your practice” (Wilkins,
2011). Kaiser Permanente, an early adopter with an aggressive patient portal implementation and
marketing plan, has 53.3% of their 218,456 patients enrolled in their Northwest locations
(Kushinka, 2013).
Before patients can use a patient portal, they must enroll or be enrolled automatically by the
provider. Some challenges to enrollment and use include:
 Patient motivation

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 Staff education
 Competing initiatives
 Physician buy-in
 Security concerns
 Demographics and socioeconomic status
 The EHR implementation process
The physician can play a key role in encouraging patients to engage in the portal. Initial
pushback from physicians may stem from a fear of more work or a fear that patients won’t
understand what they see. In Delbanco et al.’s 2012 study, physicians feared this practice would
add more work to their daily routine—in reality it had little impact on their workflow. Providers
may also want to keep some information private and for that, a “sensitive note” function can be
developed (Butcher, 2014).
Passive marketing can become active marketing simply by taking the time to explain what
the patient portal does and how easy it is to enroll and use. Many of the above barriers can be
attributed to a lack of staff education and fear of change.
Competing initiatives in the organization can make it difficult for staff to remember what
they are supposed to promote. Periodic reminders are essential to reinforce the patient portal
initiative to staff. The EHR implementation process is a big transition for most organizations.
Typically the initial focus is on ensuring that each person is trained on their daily workflow.
Promoting the patient portal may not be a focus at this time; however it would be wise to include
a tutorial in the initial EHR training. A big bang approach (rolling out all EHR applications at
once) may be better than a gradual roll-out. This way, staff does not have to constantly change
their workflow to fit new initiatives.

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Demographics. Patients over 65 have the lowest rate of enrollment and use (Goel et al.,
2011a); yet they are the demographic with the most clinical questions. That said, age may not be
the biggest barrier to adoption. There is evidence that this demographic is interested in the portal
and will adopt it with ease if properly coached (Butcher, 2014). Older adults may just need a
little more information, explanation, and hands-on assistance with enrollment. It should not be
assumed that older patients do not have e-mail or are not interested in the patient portal. Younger
patients have the highest rate of adoption and will generally enroll themselves without added
persuasion (Goel et al., 2011a).
Socioeconomic Status. There is a discrepancy in enrollment with low-income and ethnically
diverse populations. If not addressed, the digital divide may become the healthcare divide among
these groups (Winters et al., 2013). Winters et al. surveyed 654 patients in safety-net practices in
the New York area and found that the greatest impediment to adoption was not a lack of interest
or patient portal education, but a lack of resources (2013). Most respondents did not have easy
access to a computer or felt that the process of enrolling would be too hard. They were interested
in the patient portal to view test results, make appointments, and refill prescriptions, but
surprisingly only 1% were interested in e-mailing their physician. Furthermore, Goel et al.
(2011a) found large gaps in enrollment with these groups, but not in use. Ethnic patients used the
portal with the same frequency as the white patients.
Enrollment Process. Even if all other barriers are addressed, the enrollment process may
create a huge roadblock. The most effective way to get the patient enrolled is to do it in the
office. This can be accomplished by:
 Placing computer terminals in the waiting rooms
 Enrolling patients at the front desk, exam rooms, or over the phone

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 Electing a patient portal enrollment advisor(s)
Computer terminals can be placed in waiting rooms. Rather than spending their time
reading a magazine, patients may be apt to explore the enrollment process. They may be more
comfortable knowing that staff is there to answer questions. Staff can enroll patients at the front
desk, though this is often difficult with busy offices and frazzled patients. Perhaps a more
effective and calm environment would be in the exam room—accomplished by weaving the
process into the clinical staff’s workflow. He or she can enroll the patient and show them how to
quickly send a secure message, a process that Memorial Care Health System in Southern
California has implemented. This process may at first seem a burden, but the few minutes it takes
can mean hours saved later. Texas Neurology in Dallas spends five to ten minutes on this process
and now has 80% enrollment (Butcher, 2014).
The physician can be the strongest presence to entice the patient to enroll, as patients
often heed the recommendations of their physicians. Staff can also enroll patients while on the
phone, a task which may not be currently mandated. A patient portal representative can be
assigned to a high-traffic area. This person can be mobile—armed with a desk, laptop, printer,
phone, and marketing collateral. This initiative was implemented successfully at Shasta
Community Health Center in Redding, California (Kushinka, 2013).
Additional strategies to increase enrollment include:
 Collection of all e-mails
 Bulk enrollment
 Opt-out vs. opt-in strategy
The first step of enrollment is obtaining the patient’s e-mail. Front office staff should be
instructed to ask patients for it. Gena Cook, a practice marketing specialist, agrees:

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This seems obvious but this is your number one success factor. Don’t assume that
your patients don’t have an email address. Ask every patient for their email as
they schedule an appointment. Capture that information in your practice
management system. Your patients will automatically be invited to join your
portal (Cook, 2013).
Obtaining e-mail addresses for the patient’s medical record is beneficial for more than just
marketing purposes. It serves as an additional way to contact the patient. Managers can reinforce
the importance of this as something that is on par with the mandatory MU core data elements.
Even if the patient doesn’t want to enroll in the portal at the time, having their e-mail in the
system creates the opportunity to send an invitation later. Organizations can try bulk enrollment
by e-mailing an invitation to their patients who are not enrolled. Of course the patient may never
see it, but it’s not a lot of effort on the organization’s part for a potentially large reward.
An opting-in strategy is not the only approach (i.e. when patients actively choose to
enroll in the portal). An opt-out strategy is more aggressive and may be more effective.
Cleveland Clinic has been doing this since 2012. Every patient receives an activation code which
never terminates; they can choose to enroll when they are ready. This may be more effective than
sending a one-time e-mail that may be forgotten. Posk says that the “clinical staff reinforce the
importance” when giving the patient the activation code (Butcher, 2014). It may increase
enrollment, but follow up will be needed to ensure that patients engage.
Promoting the Patient Portal
A patient from West County Health Center’s Patient Advisory Group offered a simple tip
for patient engagement: “If you want a patient to use the portal, help them answer the question:
‘Why am I using this?’ Relate to the patient in ways that feel more personal and in ways that

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help them to feel like engaging in the portal” (Kushinka, 2013, pp, 3). Just as the old advertising
mantra goes, the patients must know what’s in it for them. They have to be sold on it. There are
many ways to accomplish this, all the while remembering to tailor the delivery to the patient’s
needs. Many offices have a heavy patient load and slow callback time. That in itself gives the
patient a great reason to sign up for the portal.
Front office staff, medical assistants, nurses, and physicians should all be trained how to
present the patient portal in a meaningful way. Organizations should:
 Identify champions
 Standardize training
 Have staff use the patient portal themselves
 Hold department enrollment contests
Physicians and staff must convince patients that the portal is personal and will strengthen their
relationship with their physician. Champions will “lead by example” and their efforts will
influence other staff (ONC, 2012). Marketing the patient portal should be a high priority in the
staff’s mind. If a patient isn’t enrolled in the portal, staff should ask them if they’ve heard about
it.
Training should be standardized throughout the organization by showing a training video,
role-playing, lecturing, one-on-one coaching, or distributing printed material to staff. Patients
First, a healthcare organization with 21 sites in Missouri, thought to let the staff use the patient
portal first, as most employees were patients in the health system (ONC, 2012). Competition
often yields high returns. Monthly contests between departments should be considered to
motivate staff.
There are several promotional tools that can be utilized for patients:

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 A video in the exam room or waiting room
 Staff buttons
 Posters and fliers
 Phone message greeting
 Promotional gifts
Mayo Clinic studied 12,050 office visits at their internal medicine clinics. The patients saw a
marketing video prior to their appointment, received paper literature, or only received passive
marketing. Patient portal registrations were 11.7% higher with the video compared to 7.1%
higher with the paper literature only (North et al., 2011). Staff can wear buttons with “Ask me
about our patient portal” on them. Posters and fliers can be placed in high-traffic areas or mailed
to patients. A recording on the office’s phone system could say something like “Tired of being
on the phone? Get online and connect with your physician now!” Small items such as a
keychain, magnet, pen, stress ball, flash drive, or mouse pad with the patient portal URL could
be given to patients.
This is an exciting time in healthcare. Providers should view the patient portal as an
opportunity to engage patients rather than a burden on their practice. This paradigm shift has and
will continue to transform the lives of patients and dramatically alter the standard workflow of
medical offices. With a little planning, organizations can meet MU requirements, streamline
workflows, engage patients, and, most importantly, improve patient outcomes.
With only about half of medical offices possessing a patient portal, the prevalence and
successful promotion of one in an organization will define it in the marketplace. Organizations
would be wise to consider lessons learned from early adopters. Synergy in the organization will
help it be proactive in meeting challenges head-on. This will be easier if a cohesive training

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program is distributed throughout the organization. The importance of this paradigm shift in
healthcare must not be underestimated. Just like cell phones replaced land lines, e-mails replaced
postal mail, and the EHR replaced paper records, the patient portal will soon become the industry
standard.

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Chapter 3: Project Description
With MU incentives, process improvement, and improved health outcomes dependent on
the patient portal, organizations must be proactive and embrace the transformation. To assist in
this endeavor, the website “Patient Portal Basics” (2015) has been developed with the objective
of serving as a one-stop resource for patient portal initiatives. Tools and recommendations have
been curated from the ONC, CMS, American Health Information Management Association
(AHIMA), California Healthcare Foundation (CHCF), and Health Information and Management
Systems Society (HIMSS). Case studies from healthcare organizations such as Kaiser, Cleveland
Clinic, Mayo Clinic, and the VA are also provided. The overall goal of this project is to provide
tools that organizations can use to develop their own patient portal initiative. The website is built
to cater to a broad audience. Each organization is different; the website does not provide one
single solution, but rather provides guidance so that organizations can develop a project plan
unique to their environment. Then they may choose to develop an internal training module to be
dispersed to medical offices. See Appendices A-I for website screenshots.

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Chapter 4: Project Methodology
Website Content Acquisition
Extensive research on patient portal methodologies was conducted to produce suitable
content for the website. Over twenty-seven peer-reviewed articles were reviewed. Open-source
tips and tools were embedded into the website. Open-source diagrams were used to demonstrate
EHR workflow and process design. Permission was attained to use all copyrighted materials
where appropriate. Examples of patient portal enrollment kiosks and marketing materials were
used with permission from Compex Two (2015), a technology consulting company in Silverton,
Oregon. Links to patient portal survey examples for staff and patients are included, as well as
useful videos for patient portal engagement.
Website Design
The final product was designed using GoDaddy web hosting (2015) (see Appendix A-H).
Wireframes were created using Gliffy software (2015) (see Appendix I). Wireframes are rough
sketches commonly used in website design to serve as a blueprint for the website’s layout.

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Chapter 5: Project Product
The website “Patient Portal Basics” (2015) has background information, a detailed definition,
and features that many patient portals possess. The benefits for organizations and patients are
defined, including MU incentives ROI, streamlined workflow, decreased office phone calls,
private messaging, timely care, and engaged patients. Links to success stories from the VA,
Kaiser, Cleveland Clinic, and Mayo Clinic are provided, as well as case studies on disparities in
enrollment and use and socioeconomic factors. Articles on personal medical device technology
and improved medication adherence are also provided.
The “Toolbox” section of the website has useable tools for providers on how to assess, plan,
and implement the patient portal initiative. The “Assess” page has tips on assessing an
organization’s readiness for change and creating a culture receptive to change through effective
change management. This can be done by observing the organization’s current state and
identifying challenges. Analyzing the patient experience in and out of the office will help,
including staff response to patient portal messages. The page also includes links to staff and
patient EHR satisfaction surveys. Planning the patient portal initiative is essential. The “Plan”
page has tips for success: identify champions, have staff use the patient portal, offer technical
support, hold department contests, and use promotional tools. Examples of promotional tools
include a video in the exam room, staff buttons, posters and fliers, phone message greetings,
promotional gifts, and social media. Links to articles are also presented as evidence of these
tools’ effectiveness.
The “Implementation and Evaluation” page brings it all together, with tips on how to
standardize training and streamline the enrollment process. Training tactics include the
development of an interactive training module, constant reinforcement of the initiative, and role-

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playing common scenarios. The enrollment process can be simplified by adding computer
terminals to waiting rooms and having staff available for troubleshooting. Patients should be able
to be enrolled at every point of contact—at the front desk, in exam rooms, or over the phone.
Electing patient portal enrollment advisors, collecting e-mails for bulk enrollment, and utilizing
an opt-out versus opt-in strategy are also offered. Implementation tips from the National
Learning Consortium (NLC) and AHIMA can be found on this page. Finally, the website has
links to the ONC, AHIMA, HIMSS, CMS, KLAS, and CHF (see Appendices A-H for website
screenshots).

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References
Butcher, Lola (2014). The patient portal to the future. Retrieved from
http://www.hfma.org/Content.aspx?id=22676
Centers for Medicare and Medicaid Services (2014a). Eligible professional MU Stage
1 spec sheets. Retrieved from http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html
Centers for Medicare and Medicaid Services (2014b). Stage 2 EP spec sheets (2014). Retrieved
from http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Stage_2.html
Centers for Medicare and Medicaid Services (2015). Medicare and Medicaid EHR incentive
program basics. Retrieved from http://www.cms.gov/Regulations-and-
Guidance/Legislation/EHRIncentivePrograms/Basics.html
Compex Two (2015). Patient portal promotion tools. Retrieved from
http://compex2.com/patient-portal/
Cook, Gena (2013). 10 tips to marketing your patient portal to your patients. Retrieved from
http://navigatingcancerblog.dreamhosters.com/2013/05/20/10-tips-to-marketing-your-patient-
portal-to-your-patients/
Delbanco, T., Walker, J., Bell, S. K., Darer, J. D., Elmore, J. G., Farag, N., & Leveille, S. G.
(2012). Inviting patients to read their doctors' notes: A quasi-experimental study and a look
ahead. Annals of Internal Medicine, 157(7), 461-470. doi: 10.7326/0003-4819-157-7-
201210020-00002
Dooling, J. A. (2012). It's about the patient: Engagement through personal health records and
patient portals. Journal of Health Care Compliance, 14(2), 33-34. Retrieved from

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http://www.aspenpublishers.com/Product.asp?catalog_name=Aspen&product_id=SS152
08303
Gliffy (2015). Retrieved from https://www.gliffy.com/
GoDaddy (2015). Retreived from https://www.godaddy.com/
Goel, M., Brown, T., Williams, A., Hasnain-Wynia, R., Thompson, J., & Baker, D. (2011a).
Disparities in enrollment and use of an electronic patient portal. Journal of General
Internal Medicine, 26(10), 1112-1116. doi:10.1007/s11606-011-1728-3
Haun, J., Lind, J., Shimada, S., Martin, T., Gosline, R., Antinori, N., & Simon, S. (2014).
Evaluating user experiences of the secure messaging tool on the Veterans Affairs' patient
portal system. Journal of Medical Internet Research, 16(3), e75. doi:10.2196/jmir.2976
KLAS Research (2012). Patient portals: Provides choose path of least resistance. Retrieved from
http://www.klasresearch.com/news/pressroom/2013/PatientPortals
Kushinka, S. (2013, April). Patient portals in the safety net phase 2: Implementation. California
Healthcare Foundation. Retrieved from http://www.chcf.org/patient-portals/implementation
North, F., Hanna, B., Crane, S., Smith, S., Tulledge-Scheitel, S., & Stroebel, R. (2011). Patient
portal doldrums: Does an exam room promotional video during an office visit increase
patient portal registrations and portal use? Journal of the American Medical Informatics
Association, 18, i24-i27. doi: 10.1136/amiajnl-2011-000381
Office of the National Coordinator for Health Information Technology (2015). Office-based
health care professional participation in the CMS EHR incentive programs. Retrieved from
http://dashboard.healthit.gov/quickstats/pages/FIG-Health-Care-Professionals-EHR-
Incentive-Programs.php
Office of the National Coordinator for Health Information Technology (2014). What is a patient

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portal? Retrieved from: www.healthit.gov/providers-professionals/faqs/what-patient-
portal
Office of the National Coordinator for Health Information Technology (2012). Viewing patients
as partners: Patient portal implementation and adoption. Retrieved from
http://healthit.gov/providers-professionals/patients-first-health-care-case-study
Wilkens, S. (2013). If you build a patient portal, why won’t they come? KevinMD. Retrieved
from http://www.kevinmd.com/blog/2013/04/build-patient-portal.html
Sanders, M., Winters, P., Fortuna, R., Mendoza, M., Berliant, M., Clark, L., & Fiscella, K.
(2013). Internet access and patient portal readiness among patients in a group of inner-city
safety-net practices. Journal of Ambulatory Care Management, 36(3), 251-259.
doi:10.1097/JAC.0b013e31829702f9
The Patient Portal (2015). Retrieved from http://www.patientportalbasics.com/

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Appendix A: Homepage
http://www.patientportalbasics.com/

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Appendix B: About – The Patient Portal

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Appendix C: About – Benefits

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Appendix D: Toolbox – Assess

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Appendix E: Toolbox – Plan

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Appendix F: Toolbox – Implement and Evaluate

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Appendix G: Outside Resources

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Appendix H: Contact

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Appendix I: Wireframes

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