Facilitators and Barriers to Implementing a Patient Portal at a Dental Hospital From the Implementers' Perspectives: Qualitative Study.

Abstract

Patient portals can improve care delivery and optimize health service efficiency, but they are not always adopted by patients and staff. To improve adoption of patient portals, existing research has focused on examining implementation processes from the perspectives of end users. However, to our knowledge, the views of the implementers, who have in-depth insight into interorganizational and intraorganizational factors impacting implementation, have not been previously explored. The aim of this study was to explore implementers' perspectives on the key facilitators and barriers to implementing a patient portal. This was a cross-sectional qualitative study conducted at a dental hospital in Sydney, New South Wales, Australia. Participants were implementers of a patient portal who were (1) administrative staff managers working at the dental hospital or (2) IT staff members who either worked within the district where the hospital is located or with the vendor. All implementers of the portal (N=13) took part in the interviews. Data were analyzed thematically and mapped to the Consolidated Framework for Implementation Research. Eighteen factors were reported to affect the implementation of the patient portal: 7 (39%) acted as facilitators, 8 (44%) acted as barriers, and 3 (17%) factors both facilitated and hindered implementation. Many of the facilitators were related to the implementation process, such as planning and project management, leadership support, stakeholder motivation, and co-design. Most of the barriers occurred at the interorganizational level, such as delayed training for new staff, unique workflow and clinic characteristics, challenges with timeline and budget, and lack of direct vendor access to end users. While participants saw potential benefits of the portal for patients and the health service, they had concerns about increased staff workload related to the portal implementation. From the intraorganizational perspective, the lack of direct vendor access to end users was identified as a key barrier to implementation. From both interorganizational and intraorganizational perspectives, challenges with integrating the portal into the electronic medical record were identified as a persistent barrier to portal implementation. In addition to factors directly impacting clinicians and patients, our study highlighted that numerous organizational factors at multiple levels within and across organizations impacted successful patient portal implementation and adoption. Portal implementations would benefit from interoperability with existing systems, adequate resourcing, regular policy review related to technological change, and strategies to improve interagency communication among portal implementers. Our study offers learnings to health service organizations, implementers, and policymakers who aim to implement new portals or optimize existing patient portals.