Enrollment is the first step to engagement. In signing up for the portal, becoming familiar with it, and committing to using it, patients take an active step in managing their health and care. But patients can be slow or reluctant to enroll in their EHR patient portals — and many never enroll at all.

Patients report not enrolling because they:

• Don’t remember discussing it with their clinicians
• Lack information or motivation — for example, they don’t have signup instructions or they feel too busy
• Question the value of digital communication — for example, they think it won’t be useful or they prefer phone over email
• Need computer help — for example, they don’t have computer access or skills ⁹

This reluctance may seem overwhelming or out of your control, but there’s a lot that clinicians and practices can do to overcome these barriers and boost registration.

In this chapter, we’ll identify best practices for getting patients enrolled in — and on board with — patient portals. You can then tailor this approach to fit your practice. For instance, clinicians in small practices who have lifelong relationships with their patients can use the portal as a tool to deepen their communication. Large health systems might train patient greeters to become portal enrollment staff. One thing is certain: whether you’re a practice of 1 or 1,000, you can achieve high portal adoption. ¹⁰

The amount of time and effort it takes to register for a patient portal can affect whether your patients successfully enroll or give up halfway through.

Make the process easier on them and you by choosing a portal with a quick, secure signup process. Ideally, the patient has to enter only a few pieces of information — and the portal confirms the patient’s identity on the back end.

To facilitate enrollment, automatically enroll your patients in a portal account, instead of waiting for patients to sign up themselves. Keep enrollment numbers up by encouraging new patients to stay registered and offering tips for patients with limited computer access or skills.

You can also increase the number of patients who enroll and use the portal by integrating portal use into patients’ care plans. For example, encourage patients to use the portal to make follow-up appointments, stay on top of recommended screenings, or request refills. Some portals even enable clinicians to create task lists for patients that include activities related to taking medications, eating a healthy diet, and staying physically active. By taking this approach, you can set the expectation that using the patient portal is part of following their recommendations — just like getting regular physical activity or taking medicine as prescribed.

Treat patients’ office visits as a prime opportunity for portal registration.

Patients are more likely to register in the office, where they can get support from practice staff and engage in a personal conversation about benefits of the portal. If patients are asked to sign up once they’ve returned home, they may forget, have competing priorities, or struggle to navigate the technology on their own.

Make in-office registration the default by building it into your care delivery workflow and offering several registration touch points during a visit. For example, at check-in and check-out the receptionist, medical assistant, or nurse can teach patients about the portal and offer to sign them up on the spot using a kiosk, tablet, or registrar computer.

Use positive, encouraging language — with both staff and patients — and leverage every educational opportunity.

Get staff buy-in

Strong leadership and staff buy-in to the patient portal can set the stage for effective marketing and lead to higher enrollment.

Tips for Practice Administrators ¹⁵

Practice leaders can take several steps to create an environment that encourages portal adoption.

• Provide opportunities for practice staff to discuss portal adoption, so that you can address fears and identify solutions
• Encourage staff to set up their own patient portal accounts, so that they can better understand the tool and its potential value to patients
• Offer staff incentives for portal adoption — for example, via practice-wide contests
• Promote the portal internally as a critical offering to patients, so that all staff view portal use as an opportunity for high-quality customer service
• Explain that it’s important for all clinicians to adopt the portal so that the practice can market consistently to all patients and avoid sending mixed messages
• Foster enthusiasm for the portal among staff, so that they can relay that enthusiasm to patients

Tell patients how they can benefit.

Ensure that all members of the care team can relay the benefits of the portal and show patients how to do basic tasks like view lab results, send messages, pay bills, and request or schedule an appointment. See Chapter 2 of this playbook for more information on portal benefits.

Give clinicians and staff talking points so that everyone reinforces the same key messages.

Consider jumping on board with the Blue Button Initiative, a public-private partnership to provide consumers with easy access to their health records in a format they can use. ¹⁷ The Blue Button symbol indicates to patients that they can download a personal medical summary that includes medications, conditions, and more. You can customize the Blue Button symbol to your practice.

Take advantage of every touchpoint. ²²

Take every opportunity to promote patient portal enrollment. Over the course of a visit, a patient may talk to several practice staff including a receptionist, nurse, and doctor. Treat each conversation with a patient as an opportunity to explain the portal’s value and highlight the simple steps patients can take to activate their account.

You can also add portal enrollment steps to paperwork, such as after-visit summaries. Make the instructions actionable and easy for patients to understand — choose clear, direct language and use illustrations, bullets, and numbering where possible. Encourage them to take immediate action.

Adding clear action steps to your after-visit summaries — with images in an appealing layout — may inspire patients to enroll in online portals. It’s an affordable, scalable way to encourage patient participation.

Remember that marketing opportunities exist outside of a visit, too — like when patients call the office.

Tips for Practice Staff

Practice staff can take steps to make the most of each patient touch point.

• Teach patients about the portal while they’re waiting to see their doctors
• In the waiting room, have posters, brochures, and videos that highlight portal features. Ask your EHR vendor what materials they offer — many have developed portal marketing materials so that you don’t have to
• Give patients instructions for logging into the portal on a smartphone while they wait
• Set up a pre-recorded hold message or a message that plays at the end of a call that reminds patients to register
• Show patients the simple portal enrollment steps listed on their after-visit summary and encourage them to sign up

Make patient portal communication the norm.

Move away from traditional methods of patient communication, like phone and mail. Frame the patient portal as the best way to reach clinicians and see important medical information.