Patients with chronic conditions, or more fundamentally the sickest and most expensive-to-care for patients using the healthcare system, should be big users of digital portals.

That’s because patients with diabetes, cancer, heart disease and other chronic medical conditions, have the most need to go online and share health and wellness data and notes about how they are feeling with their doctors. In turn, digital portals also offer physicians, nurses and other providers a secure online communications platform to monitor really sick patients once they are home and out of the hospital.

But chronic care patients are infrequent users of digital portals and frequently find them hard to use, says new research from the Sinclair School of Nursing at the University of Missouri. Researchers examined the electronic health records of 500 chronic care patients.

The research found that patients who could benefit the most from the convenience of online patient portals connected to their electronic medical records often don’t use them even after signing up for them. The study found that nearly all of the patients have signed up to use a digital healthcare portal, but about 35% of those registered didn’t go online. “We were troubled to see that so many patients never used the portal,” says Kimberly Powell, a post-doctoral fellow in aging, informatics and quality research. “We only looked at registered users, and registering for the portal is a two-step process that suggests a degree of commitment—the fact that many people who took the time to register never logged in to the portal indicates there is still work to be done.”

Other statistics also point to low use of portals by chronically ill patients, Powell says. For example, only 30% of patients used the secure messaging system to exchange messages with their doctor and fewer than 2% used the portal to upload health updates and metrics such as weight, blood pressure and related vital signs back to their provider.

Today, most health systems have a digital portal tied to an electronic health records system and more than 90% of the nation’s nearly 6,000 hospitals now have an EHR, says the U.S. Department of Health and Human Services. But portals, especially for chronic care patients, can be clunky and hard to use. To date, providers—because of financial incentives from the federal government —also have been more focused on signing users up for their hospital or health system’s portal rather than making it easier to use, Powell says.

“In follow-up interviews, numerous patients told us these portals were difficult to use and it wasn’t an age issue,” Powell says. “I had one 65-year-old patient tell me ‘I use lots of apps and this one (to access a digital portal) should be as easy to use any other I use.’”

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