Want to Improve Patient Engagement? Ditch the App, Other Barriers

Patient Engagement

June 14, 2023
Happy interaction between doctor and patient inside of clinic.

Despite increased patient portal use in recent years, limitations impede adult adoption. Staff-to-patient texting resolves barriers to higher engagement.


  • Top portal challenges are downloading required apps, poor user experience, low health literacy, limited two-way interactive services, and overburdened IT staff.
  • Increasing patient engagement with proactive, conversational chatbot interactions can help providers survive in a digitally competitive healthcare landscape.
  • Organizations that deploy best practices for successful digitally enabled patient engagement tend to move beyond the portal, effectively improving their provider-patient relationships and achieving higher adoption rates.  

Patient portals, which have become increasingly popular in recent years, are secure websites through which patients access personal health information. Patients can  

  • review their health data,  
  • securely message their providers, and
  • complete administrative tasks such as self-scheduling visits and bill pay from any location using a computer or smartphone.  

But even with the convenience and ease of these tools, most adults are not using portal services.

A 2021 Brief from the Office of the National Coordinator for Health IT (ONC) found that only four in 10 individuals (38%) nationwide reported accessing their portal at least once in 2020. This significant finding is consistent with the following top barriers limiting the adoption and use of protected online health record sites:

1. Forced to download an app. A 2021 survey of smartphone users in the U.S. conducted by Heady revealed that a shocking 78% of consumers abandoned a transaction that they would have been interested in because they were required to download an app they didn’t want on their smartphone. This app statistic, combined with the low portal rates of use reported by the ONC, presents healthcare organizations with significant opportunities to create strategies that better educate, engage and influence patient and consumer behavior.

A 2021 survey of smartphone users in the U.S. conducted by Heady revealed that a shocking 78% of consumers abandoned a transaction that they would have been interested in because they were required to download an app they didn’t want on their smartphone.

A picture containing text, screenshot, font, diagramDescription automatically generated

Fig. 1. The downside of requiring users to download a required app.


2. Poor user experience. Patients are unlikely to use patient portals that are not simple and easy to use. A portal’s navigation difficulty aligns with the fact that the vendors designed the technology to meet regulatory requirements, most notably the 21st Century Cures Act in 2016, leaving patient usability and engagement as a second priority.  

Additionally, patients who are less tech-savvy need more support and education in navigating portal technology. Consider two all-too-common use cases:  

  • A provider issues a text message and link alerting the patient of a health update available via the portal. The patient clicks on the link, which takes them to the main portal page instead of the site where the new information is located. This roundabout workflow can discourage and limit patient engagement and portal adoption, decreasing its effectiveness.  

  • In another instance, some portals allow patients to securely message their provider; however, the U.S. fee-for-service billing model prompts providers to increasingly consider charging a fee to respond to a patient message.

3. Restricted or no interactive services. Though some portals support patient self-care options such as scheduling appointments, renewing medication refills, and viewing lab results, many lack support for two-way interaction desired by patients, such as virtual visits. Patients may be able to text their provider; however, provider responsiveness varies, including potentially charged fees for a physician or clinical staff member to respond.

4. Low health literacy. Patient health literacy is an integral part of improving patient portal adoption. Many portals provide generic educational materials with the intent that patient users have personal health literacy, defined as the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. The National Assessment of Adult Literacy (NAAL), the only large-scale health literacy survey, reported that overall, 36% of surveyed adult participants had basic or below basic health literacy skills; this finding represented more than a third of the U.S. population. NAAL’s health literacy definitions reinforce the inability of this population to read and apply generic materials to themselves, such as comprehend why a person with no symptoms of disease should be tested for a disease or how often a person should have a specific medical test.  

NAAL’s health literacy definitions reinforce the inability of this population to read and apply generic materials to themselves...

5. Overburdened IT departments. Most patient portals require time and commitment to monitor and maintain online tools. These responsibilities usually fall to the healthcare organization’s IT employees, who are already inundated with managing the enterprise or practice’s electronic health record (EHR) system. Like the EHR, the portal requires continuous customizing and optimizing to meet patients’ growing needs; routing patient messages appropriately to providers or clinical team members; and ensuring that patients have real-time support and resources for password resets, access concerns, and other usage issues.  

Today’s consumer has adopted digital engagement in many aspects of their work and personal life. With telehealth use increasing dramatically, they have come to expect convenience with seamless transactions and online personalized engagement as part of clinical care. Patients now have more digital healthcare options than ever before and will choose to look elsewhere if they encounter consistently poor experiences.  

young black woman with glasses holding her iphone

Best Practices for Digital Engagement to Move Beyond the Patient Portal

Considering the willingness and expectations of patients and consumers to use digital health solutions, now is the ideal time for healthcare organizations to invest in or expand personalized and convenient engagement beyond the patient portal.  

The following are best practices for successful digitally enabled patient engagement. Healthcare organizations employing these strategies tend to move beyond the portal to improve provider-patient relationship interactions and achieve higher engagement rates.  

Infographic describing the best practices for digital engagement that are covered below.f


1. Ditch the app. Given a patient’s reluctance to download apps and the challenge of remembering passwords, consider adopting an app-less approach. If you want your patients to respond, send an SMS text with a link to secure, app-less communication. Removing the barrier of downloading an app and having to remember a password further reduces barriers to completing the interaction.

2. Design for health literacy. Ensure all provided communication is written at the fifth-grade level for wider reading comprehension. Use a conversational, informal tone in your word choice, sentence structure, and other elements in writings, videos, and practice forms to relay key practice, health messages, and care directions. Make it easy for the patient to understand what they need to do when they need to take immediate action.

3. Personalize patient communication. Effective communication is key to engaging patients. That said, instead of providing just standard education materials, use a chatbot to personalize the message to the patient’s exact situation. For instance, send a conversational chatbot detailing education on the value of well-health exams along with informing the patient that it is time to schedule their own well-health exam. Making the process easy to self-schedule goes a long way toward keeping the patient on track ─ and helping them to remember their annual exam now and in the future. With a digital platform, staff time is minimal for customization and maintenance.

4. Personalize timing. Access challenges increasingly create significant delays from the point when the patient makes an appointment to when the visit or procedure happens. Understandably, the patient may forget about the appointment and verbal instructions and lose the paper instructions.

One alternative is to use chatbots to:

  • Confirm the appointment
  • Remind the patient of the appointment several days before it is scheduled
  • Provide information and instructions to prepare the patient for the visit

Operational and revenue benefits reaped from deploying chatbots to assist with administrative activities are significant. Healthcare organizations can significantly reduce patient no-show rates, saving hundreds to thousands of dollars annually.  


5. Maximize convenience. Providing convenient access to care is essential to achieve patient loyalty. Providers can offer flexible scheduling, telehealth options, and secure texting that empower patients to proactively engage in self-care. Proactively delivering educational material and enabling the patient to complete intake forms before their visit translates into more in-person visit time, increasing patient and care team satisfaction.

6. Following up with patients and providing ongoing support between scheduled visits also helps maintain positive patient engagement. Providers who provide clear instructions for follow-up care, monitor a patient’s progress, and offer support and resources as needed enjoy mutually beneficial relationships with their patient community.

Two women checking into a busy clinic with a receptionist. h

Take discharge instructions. In the hustle and bustle on the day of discharge, patients are given large volumes of verbal and written treatment instructions and sent home with a pile of paperwork. Poorly prepared patients who do not understand the importance of following their treatment plan could exacerbate their condition and end up back in the hospital.

Review the top three best practices for reducing preventable readmissions that require the patient to:

  • Fill and take medications as prescribed
  • Schedule a follow-up appointment and attend  
  • Understand symptoms that require re-engaging with the health team

While this may sound simple, readmission rates across the county suggest otherwise. Staffing shortages preclude many organizations from calling their discharged patients multiple times in the weeks after they have gone home. So, what is the result of minimal patient outreach? Hospital readmissions. What is the alternative? Design and implement condition-specific chatbots to proactively reach out to each patient, reinforce instructions, and screen for those following through compared to patients who require immediate intervention.

Ready to upscale your organization’s engagement with staff-to-patient texting and other digital alternatives? Contact us today to learn how our solutions can be tailored quickly to fit your organization’s needs.

The Author
Krishna Kurapati

Krishna Kurapati is the Founder and CEO of QliqSOFT. He has more than two decades of technology entrepreneurship experience. Kurapati started QliqSOFT with the strong desire to solve clinical collaboration and workflow challenges using artificial intelligence (AI)-powered digital technologies across the U.S. healthcare system.

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