From strategy to execution - A research on the embedding of patient portals in Dutch hospitals

The interest towards digital information exchange has increased over the years. Healthcare professionals have expressed optimism towards the positive role the patient portal could have on the process of healthcare. The self-management of patients has been emphasized and patients have indicated that they want to use the patient portal. Still, the use of the patient portal by Dutch patients has been low and hospitals have been trying to integrate and adopt it. Research and empirical evidence into the development and implementation of patient portals in hospitals has been limited. This study investigates how hospitals’ patient portals can be embedded in local care processes and stimulated in their use. The purpose of this research is to provide insight in the context of the patient portal and how adoption can be stimulated among patients and healthcare professionals. To achieve this, multiple hospitals’ patient portals have been assessed and evaluated. The main research question central to this study is: How does hospital governance and strategy contribute to the embedding of patient portals in care processes and the stimulation of use by staff and patients? The research has combined an in-depth study of one academic hospital with an in-width study of 12 hospitals. For all cases, an analysis of documents and interviews has taken place to assess elements of governance and strategy. Respondents ranged from patients, healthcare professionals to staff members. The patient portal is supplied as a customizable by-product of the Electronic Health Record (EHR). As the portal is integrated with the EHR, it is often unknown to healthcare professionals and requires support and knowledge. Patients and healthcare professionals perceive the technology’s value very different and its desirability is thus contested. The role of the healthcare professional, specifically the doctor, is critical in assuring the use of the portal by patients. Professionals’ expectations are dependent on patients’ health status, expectations, and departmental adoption of the patient portal. Limited resources, accompanied with low priority in the hospitals, has assured that the patient portal has not been fully integrated internally yet, even though Dutch hospitals are innovative organizations. Implementation requires integration into hospital processes, monitoring and reflection. Hospitals have focused on different aspects of implementation and consequently, elements of the portal. Involving all stakeholders, enabling feedback, could ensure that the development and implementation of the portal is supported. The priority given to the patient portal is essential, by allocating resources and support, for further development and implementation. The complexities of the portal should be addressed. By means of strategy practices could the internal configuration enable the portal’s embedding and adoption.