Table 1.
Summary of the findings on health outcomes and adherence.
| First author, year | Country | Health information technology | Study design | Sample size | Main findings |
| Ancker, 2019 [34] | United States | Blood glucose flow sheet (EpicCare and Weill Cornell Connect portal) | Observational, hypothesis testing | 53 patients | Pregnant: average BMI dropped while average blood pressure increased significantly more in the 9 months among uploaders than nonuploaders. Chronic disease patients: after 9 months, uploaders had significantly larger reductions in HbA1c and BMI than nonuploaders. One subset of uploaders had low well-controlled HbA1c values before and during PGHDa upload. Another uploader subset began to upload when their HbA1c levels were elevated and experienced a decrease in HbA1c levels followed by a plateau. |
| Fiks, 2015 [60] | United States | MyAsthma (clinical interface in MyChart) | RCTb | 60 families of children | No significant differences in baseline control, quality of life, or parent activation between the two study arms (P>.2 for all comparisons). Frequency of asthma flares improved in the intervention group over time by 2.0 points on a 25-point scale (P=.02). Families in the intervention group had a marginally significant improvement in symptoms during periods without flares. A nonstatistically significant improvement in quality of life in terms of daytime symptoms and functional limitations was observed in the intervention group. There were no significant changes in parent activation. |
| Fiks, 2016 [32] | United States | MyAsthma | Descriptive, mixed methods | 237 families | Portal users with uncontrolled asthma had significantly more medication changes after using the portal relative to the year earlier (increase of 14%). |
| Huang, 2019 [45] | United States | MyPennMedicine (branded version of Epic MyChart) | Observational, hypothesis testing | 10,000 patients | Patients’ preventive health behaviors were significantly associated with portal use. The proportions of annual flu vaccination, blood pressure checks, and lipid level screening were substantially higher in portal users compared with nonusers (ORc=1.58, 1.13, and 1.50, respectively; P<.001). The average composite prevention score was significantly higher among portal users compared with nonusers (mean difference=0.22; P<.001). The proportion of colorectal cancer screening between users and nonusers was statistically significant (P<.001, OR very close to 1). No clinically meaningful difference between patient portal users and nonusers in chronic health outcomes. |
| Jhamb, 2015 [46] | United States | Free patient portal tethered to an ambulatory EHRd | Observational, hypothesis testing | 1098 patients | In the fully adjusted model (controlling for hyperlipidemia, nephrolithiasis, history of kidney transplant, CCIe, proteinuria, eGFRf, number of nephrology and outpatient visits, and university affiliated PCPg), the association was not significant (OR 1.11, 95% CI 0.99-1.24). |
| Kipping, 2016 [35] | Canada | Ontario Shores HealthCheck Patient Portal | Observational, hypothesis testing | 91 patients | The overall Mental Health Recovery Measure score increased from 70.4 (SD 23.6) at baseline to 81.7 (SD 25.1) at follow-up (P=.01). Of the eight domains, seven increased from baseline to follow-up (overcoming stuckness, self-empowerment, basic functioning, overall well-being, new potentials, spirituality, and advocacy/enrichment; all P<.05. No change for learning and self-redefinition). |
| Lau, 2014 [36] | Canada | BCDiabetes.ca | Observational, hypothesis testing | 1957 patients | Overall, 28 of 50 users had a follow-up HbA1c ≤7%, whereas 22 of 50 did not (56% success rate). Only 16 of 50 nonusers achieved a follow-up HbA1c ≤7%, while 34 of 50 did not (32% success rate). Users were significantly more likely to control their HbA1c levels successfully than nonusers (McNemar test, P=.03). The HbA1c level at the last follow-up was significantly lower for users compared to nonusers (P=.02). |
| Manard, 2016 [37] | United States | Online patient portal | Observational, hypothesis testing | 1571 patients | After adjusting for age, users were more likely to achieve BPh control (HRi 1.24, 95% CI 1.06-1.45). After adjustment for sociodemographics, portal use was no longer associated with BP control (HR 0.98, 95% CI 0.83-1.16). |
| Quanbeck, 2018 [54] | United States | Seva | Interventional, other than RCT | 268 patients | Significant reductions in the numbers of risky drinking days, which declined by 44% ([0.7-1.25]/1.25) from baseline to 6 months, and illicit drug-use days, which declined by 34% ([2.14-3.22]/3.22). Two of the three abstinence outcomes showed significant improvements (any illicit drug use and/or any drink or drug). Significant effects were found for two of the three quality of life scores (overall quality of life and mental health). |
| Riippa, 2015 [55] | Finland | Patient portal by The Finnish Medical Society, Duodecim | Interventional, other than RCT | 876 patients | Minor differences in patient-reported physical and mental health changes that changed the sign from the matched (physical health mean=1.2, 95% CI −3.3 to 5.7; mental health mean=0.8, 95% CI −3.6 to 5.2) to the unmatched sample (physical health mean=−0.4, 95% CI −4.7 to 3.9; mental health mean=−0.4, 95% CI −4.8 to 4.0). Patient activation improved more in the intervention group, but it was not statistically significant. There was no marked short-term impact on health status based on the SF-36v2 measure. |
| Van der Vaart, 2014 [57] | Netherlands | Medisch Spectrum Twente | Interventional, other than RCT | 360 patients | Overall, 56% of the respondents had a score of 7 (out of 8) on medication adherence. |
aPGHD: patient-generated health data.
bRCT: randomized controlled trial.
cOR: odds ratio.
dEHR: electronic health record.
eCCI: Charlson Comorbidity Index.
feGFR: estimated glomerular filtration rate.
gPCP: primary care practice.
hBP: blood pressure.
iHR: hazard ratio.