Too Many Don’ts and Not Enough Do’s? A Survey of Hospitals About Their Portal Instructions for Patients

  • Joy L. LeeEmail author
  • Claire E. Williams
  • Sean Baird
  • Marianne S. Matthias
  • Michael Weiner
Original Research



Patient portals present the opportunity to expand patients’ access to their clinicians and health information. Yet patients and clinicians have expressed the need for more guidance on portal and secure messaging procedures to avoid misuse. Little information is currently available concerning whether and how expectations of portal and messaging usage are communicated to patients.


To identify the information made available to patients about patient portal use, and to assess ease in accessing such information.


A national survey of publicly available portal information from hospital websites. The study team followed up with phone calls to each hospital to request any additional patient-directed materials (e.g., pamphlets) not located in the web search.


A random sample of 200 acute-care hospitals, 50 from each of four US Census regions, selected from the US Centers for Medicare & Medicaid Hospital Compare dataset.

Main Measures

Availability of patient portals, secure messaging, and related functionality; the content and ease of access to patient-directed information about portals.

Key Results

Of the hospitals sampled, 177 (89%) had a patient portal; 116 (66%) of these included secure messaging functionality. Most portals with secure messaging (N = 65, 58%) did not describe appropriate patient messaging conduct. Although many included disclaimers that the service is not for emergencies, 23 hospitals only included this within the fine prints of their “Terms and Conditions” section. Content analysis of additional patient-directed materials revealed a focus on logistical content, features of the portals, and parameters of use. Of the three categories, logistical content (e.g., creating an account) was the most thorough.


Although most of the sampled hospitals had patient portals, many fail to educate patients fully and set expectations for secure messaging. To improve patient engagement and minimize harm, hospitals and clinicians need to provide more information and set clearer guidelines for patients.


patient portals electronic health record patient provider communication informatics 



We would like to express our gratitude to Rachel Gruber for her comments and copyediting that greatly improved the manuscript.

Funding Information

This project was funded in part by the Indiana Clinical and Translational Sciences Institute, by grant numbers UL1TR001108 and UL1TR002529 from the National Institutes of Health, National Center for Advancing Translational Sciences, Clinical and Translational Sciences Award.

Compliance with Ethical Standards

This study was declared not human subjects research and exempt from review by the Indiana University Institutional Review Board.

Conflict of Interest

The authors declare that they do not have a conflict of interest.


Dr. Weiner is the Chief of Health Services Research and Development at the Richard L. Roudebush Veterans Affairs Medical Center in Indianapolis, IN. The views expressed in this article are those of the authors and do not necessarily represent the views of the U.S. Department of Veterans Affairs.


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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  1. 1.Division of General Internal Medicine and Geriatrics, Department of MedicineIndiana University School of MedicineIndianapolisUSA
  2. 2.Regenstrief Institute, Inc.IndianapolisUSA
  3. 3.Department of Communication StudiesIndiana University-Purdue UniversityIndianapolisUSA
  4. 4.Center for Health Information and Communication, U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service CIN 13-416Richard L. Roudebush VA Medical CenterIndianapolisUSA

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