Optimizing Patient Portals to Support Engagement and Prevent Burnout

Laura M. Cascella, MA, CPHRM

Patient portals are part of the digital enhancements in healthcare designed to streamline the exchange of information and task efficiency. Well-implemented portals offer a convenient way for patients to view their health information, follow up on their test results and care plans, schedule appointments, contact their providers with questions, request forms and paperwork, and more. By facilitating these interactions, portals also can engage patients in their care and improve their overall healthcare experience.

Unfortunately, this convenience for patients often translates into undue burden for healthcare providers. The volume of messages, misuse of the portal, and inadequate administrative processes can leave providers feeling inundated and unable to keep up without spending excessive time managing portal communications. In turn, this contributes to the ongoing and detrimental problem of burnout in healthcare.¹

Although patient satisfaction is a priority, maintaining the well-being of the healthcare workforce is equally important. Fortunately, patient portals do not have to be a win–lose scenario. Both patients and providers can benefit from this technology with prudent planning and implementation. Developing comprehensive policies regarding portal use is the first step in a strategic approach. Policies should clearly describe:

• The purpose of the portal (e.g., to facilitate communication, build stronger provider–patient relationships, improve information sharing, and give patients greater flexibility)
• Appropriate users (e.g., only individuals who are current and established patients at the healthcare organization)
• Appropriate uses of the portal (e.g., nonemergent requests and actions, such as requesting a medication refill, scheduling an appointment, updating contact information and medication lists, accessing health notes and patient education, and sending healthcare providers nonurgent messages)
• Inappropriate uses of the portal (e.g., seeking critical or emergency care, requesting diagnostic or medical consultation, asking for new medications, sending lengthy messages, and arguing with or harassing staff)
• Expected timeframes for responding to messages (e.g., 48 hours or 72 hours, not including weekends and holidays)
• Information regarding privacy and security, including how the organization safeguards patient data during transmission and storage (as well as patients’ responsibilities for ensuring data security)
• Potential consequences for violating portal policies (e.g., loss of portal access)²

New patients should receive the patient portal policies before or during their initial visit. Staff also should share these policies with existing patients who opt in to portal usage. Patients (or their guardians/proxies) should authorize their consent to use the portal and agree to the terms of use when they register to gain access to the system.

Devising solutions to handle the volume and types of portal communications is another crucial step that will help prevent stress and frustration among patients and providers. Just as healthcare practices should have telephone triage policies that guide staff in responding to or escalating questions and concerns, they should follow a similar model for triaging portal messages. Enabling message categories within the portal allows patients to clearly indicate the nature of their message and helps ensure a smooth triage process. Examples of message categories include “request a refill,” “make an appointment,” and “ask a question.”

The American Medical Association (AMA) recommends creating “pools” for different types of messages to help route them to delegated individuals who manage each pool (e.g., an administrative staff member, medical assistant, or nurse). From there, the manager of each pool can determine whether they should answer the message directly or escalate it to another person who is better suited to handle the request. Using this team-based approach can ensure messages receive a timely response and don’t overwhelm practitioners with tasks that other staff members can complete.³

Other important strategies that healthcare organizations can explore to help manage their portals, improve efficiency, and prevent misuse include the following:

• Have support staff compile the information needed to thoroughly respond to patient questions/requests prior to escalating messages to practitioners. For example, staff may need to obtain additional or clarifying information from a patient who is seeking medical advice, or they may need to pull previous lab or imaging results for comparison with new results.
• Standardize responses and processes for certain types of common requests (e.g., prior authorizations, routine lab work, and disability paperwork) to help save time and improve efficiency.
• Identify situations that providers cannot manage through the portal because they require patients to schedule an in-person or telehealth appointment (e.g., switching medications, changes in condition, new symptoms, and chronic ailments that require periodic evaluation). Proactive identification of these situations can ensure a consistent approach and messaging across the organization.
• Encourage patients to write brief messages, and limit the amount of text that they can enter in the messaging function. Additionally, organizations may want to disable the messaging function for patients who have not seen a provider within a certain timeframe (e.g., a year) and do not have an upcoming appointment. Work with your technology vendor to determine the capabilities of your portal.
• Allow adequate time for patients to ask questions, voice concerns, and get clarification during their appointments. Doing so can help minimize follow-up messages from patients after appointments.
• Communicate honestly and diplomatically with patients who send too many messages or misuse the portal. Reinforce the portal policies and terms of use and explain their rationale. If the behavior continues, let patients know that they will lose access to the portal or staff will no longer respond to messages.
• Collect data on the most frequent types of messages and then work to identify system or workflow changes that might help reduce the quantity of those messages. For example, sending automatic notifications to patients following appointments to remind them to review their visit notes may help cut back on messages requesting clarification of treatment plans.
• Research potential technology solutions — such as artificial intelligence (AI) applications — that your organization can incorporate into its portal to help with standardized processes and messaging. (Note: AI is not foolproof, so organizations should carefully screen AI vendors and ensure that providers and staff members are aware of their responsibilities to monitor AI applications and content for accuracy.)
• Develop coverage plans for provider absences to ensure messages do not pile up, patients receive timely feedback, and important information does not fall through the cracks.⁴

Much like other technologies in healthcare, patient portals sometimes represent a contradiction. On one hand, portals may improve patient experience and satisfaction. Conversely, they may contribute to provider dissatisfaction and burnout, which can cascade into various negative outcomes. With strategic planning and implementation, healthcare organizations can ensure that portals benefit both patients and providers. Developing policies, establishing boundaries, devising workflows, and communicating well with patients can ensure the efficient and productive use of portals.

To learn more about best practices for patient portals, see AMA’s STEPS Forward^®: Patient Portal Optimization module and the American Health Information Management Association’s Patient Portal Toolkit.

Endnotes

¹ Physician Retraining & Reentry. (2025, June 12). Physician burnout by inbox: Digital demands fuel primary care crisis. Retrieved from https://prrprogram.com/physician-burnout-by-inbox-digital-demands-fuel-primary-care-crisis/

² Jin, J., Hopkins, K., Lozovatsky, M., & Rice, J. (2024, August 20). AMA STEPS Forward^®: Patient portal optimization. American Medical Association. Retrieved from https://edhub.ama-assn.org/steps-forward/module/2822815; MedPro Group. (2025 [last updated]). Guideline: Communicating effectively with patients to improve quality and safety. Retrieved from www.medpro.com/documents/10502/2837997/Guideline_Communicating+With+Patients.pdf

³ Jin, et al., AMA STEPS Forward^®: Patient portal optimization.

⁴ Jin, et al., AMA STEPS Forward^®: Patient portal optimization; Baltaro, L., Henderson, W., & Goldstein, K. M. (2022). Patient electronic messaging: 12 tips to save time. Family Practice Management, 29(6), 5–9. Retrieved from www.aafp.org/pubs/fpm/issues/2022/1100/electronic-messaging-tips.html; Peterson, J. L., & Houser, S. H. (2024). Unlocking patient portals: Health information professionals navigating challenges and shaping the future. Perspectives in Health Information Management, 21(1), 1e; American Health Information Management Association. (2016). Patient portal toolkit. Retrieved from www.ahima.org/media/52oljtaa/patient-portal-toolkit_axs.pdf

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