Patients With Lower Health Literacy May Find Electronic Health Care Portals Challenging

Dr. Courtney Lyles Ph.D. Assistant Professor UCSF School of Interview with:
Dr. Courtney Lyles Ph.D.
Assistant Professor
UCSF School of Medicine

Medical Research: What is the background for this study? What are the main findings?

Dr. Lyles: In our commentary (, we describe the Meaningful Use program sponsored by the federal government to incentivize healthcare systems to implement electronic health records (EHRs).  This Meaningful Use program also includes financial incentives for healthcare systems who can get substantial proportions of their patient population to access their electronic health records – that is, by logging into an online patient portal website to view medical information like lab results or immunization lists or to perform a healthcare task like requesting a medication refill or messaging their provider.  Because there are billions of dollars at stake in this program for EHR implementation, there is a lot of attention on this issue right now.  Many thought leaders are discussing how we can transform healthcare by digitizing medical information and connecting with patients in their everyday life outside of office or hospital visits.  Portals are key to a lot of changes we might make in healthcare delivery in an attempt to increase convenience and satisfaction for patients.  Perhaps most importantly, these online portal websites are also one of the first health technologies that will be relatively uniformly distributed across healthcare settings, from private doctor’s offices to public clinics/hospitals serving vulnerable patient populations.

However, our main message is that we in the medical and healthcare fields should be paying more attention to how patients are able to understand and use the information provided through portal websites.  There is a lot of evidence that patients who have lower education/income, are from racial/ethnic minority groups, or have limited health literacy are significantly less likely to use the existing portal websites.  There is also evidence that portal websites are not extremely usable or accessible, which is an additional barrier for those with communication barriers like lower literacy or limited English proficiency.  Therefore, we don’t want widespread EHR implementation to result in only the most well-resourced individuals gaining the potential benefits of portal access.

Medical Research: What should clinicians and patients take away from your report?

Dr. Lyles: Hopefully clinicians and patients can read our paper and think about the utility of the existing portal websites in their setting, and come up with recommendations for better design and functionality.  Delivering health data to patients is a goal that most providers and patients agree is critical to delivering truly patient-centered care.  But providing data that is not always easily accessed, understood, or acted upon is not ideal.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Lyles: We put forth several recommendations in the paper for next steps.  From a research perspective, we believe it is critical to produce generalizable health communication knowledge about the best ways to display and communication complex health information for patients with a spectrum of literacy, numeracy, and English language skills.  Making information clearer will benefit not only those with communication challenges, but for all patients looking to best comprehend and actively manage their healthcare treatment decisions.


Connecting the Dots: Health Information Technology Expansion and Health Disparities

Courtney Lyles , Dean Schillinger, Urmimala Sarkar

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Dr. Courtney Lyles Ph.D. (2015). Patients With Lower Health Literacy May Find Electronic Health Care Portals Challenging 

Last Updated on July 17, 2015 by Marie Benz MD FAAD