How to Increase Patient Portal Adoption in Your Practice
Practical ways to increase patient portal adoption: why patients skip it, how to enroll at check-in, keep them logging in, and track what's working.
How to Increase Patient Portal Adoption in Your Practice
The fastest way to increase patient portal adoption is to stop treating the portal as something patients will find on their own. Enroll them in the building, have a real person recommend it, give them a reason to log in (lab results, refills, scheduling), and answer what they send. Do those four things and most of the rest is polish.
We talk to pharmacy owners and clinic administrators all the time who paid for a portal, flipped it on, and then watched a few hundred accounts sit untouched. The phone keeps ringing. Staff keep re-keying the same questions. Sound familiar? The portal isn’t the problem. The rollout is.
TL;DR
- Patients skip portals mostly out of habit and unclear value, not hostility. In one U.S. survey of nonadopters, 64% preferred in-person communication and nearly 49% saw no need.
- Enroll at check-in or check-out with staff help. Federal guidance says patients are more likely to adopt when providers recommend and support the portal.
- Give patients a reason to return: results, refills, scheduling, messages answered fast.
- Measure registrations, feature use, response times, phone call volume and no-shows, and review them monthly.
- Loyalty and retention programs work best when the portal is already part of the care routine.
Table of Contents
- Why patients don’t sign up (or stop using it)
- Enroll patients before they leave the building
- Give patients a reason to come back
- Make it work for patients who struggle with access
- Patient portal engagement strategies that last
- What to measure
- Patient retention programs and loyalty programs
- Perspective
- Put the system in place
- FAQ
- Sources
Why patients don’t sign up (or stop using it)
Before you fix anything, know what you’re up against. A 2020 national U.S. survey of 2,828 nonadopters found these main barriers:
| Barrier among nonadopters | Share |
|---|---|
| Prefer in-person communication | 64.00% |
| See no need | 48.97% |
| Uncomfortable or inexperienced with computers | 25.99% |
| Privacy concerns | 21.00% |
| Trouble logging on | 18.99% |
| Too many portals | 9.02% |
No portal available and no internet access each came in at 22.98%.
A systematic review in JMIR adds practice-side problems: unintuitive interfaces, reading levels that are too high, thin patient education, hard enrollment, unclear costs, and providers who aren’t sure who is responsible for answering messages.
Read that list again. Almost everything on it is something your front desk, your workflow or your website can change. You can’t make a patient prefer email over a chat in the exam room. You can make signup take two minutes and make the first login worth it.
Enroll patients before they leave the building
The ONC Patient Engagement Playbook is blunt about the mechanics: make signup simple and secure, and build in-office registration into check-in and check-out, using a kiosk, a tablet or a staff computer. Then give patients clear after-visit instructions and help with smartphone login.
Here’s a workflow that fits a busy independent clinic or pharmacy counter:
- At check-in: Ask for the patient’s mobile number and email, and send the portal invite while they’re still sitting there.
- In the waiting room: Put up a poster or loop a short video showing what the portal does. The same Playbook lists waiting-room posters, brochures, videos, phone hold messages and after-visit summaries as promotion channels.
- In the room: The provider says one sentence: “You’ll see your results in the portal, and you can message us there.”
- At check-out: A staff member helps the patient log in once, on their own phone, and set the password. Done is better than “you’ll get an email.”
- After the visit: Put the login steps and a direct link in the after-visit summary.
That third step matters more than it looks. ONC’s own account of one portal rollout says that provider engagement was the single most important factor in motivating registration and use: asking patients to register, communicating results, and responding to messages.
Give the whole team a script
The ONC guidance recommends whole-staff promotion, provider talking points and staff-assisted registration. In practice, that means the receptionist, the tech and the pharmacist all say roughly the same thing, in plain language. Write it down. Rehearse it at a huddle. Tell staff what’s in it for them: fewer phone calls about results and refill status.
Give patients a reason to come back
An account nobody opens twice isn’t adoption. It’s a sign-up list.
The ONC says a portal has to be engaging, user-friendly and used by the care team in actual encounters. Merely making it available isn’t enough. So what pulls people back?
The Health Federation portal toolkit points to the same short list:
- Lab and immunization results posted promptly
- Timely responses to requests
- Access to the care team
- Educational content and health campaigns
- Online scheduling
The data back up the pattern. In a 2019 JMIR acute-care study, 59.01% of 2,974 sampled patients agreed to use the portal, and the most-used features were lab results, care-team information and medication lists.
Tie portal tasks to the care plan
The Playbook suggests building portal tasks into the care plan: follow-up appointments, recommended screenings, prescription refills, medication adherence, diet and physical activity. For a pharmacy, refill requests and adherence reminders are the obvious entry point. For a clinic, it’s “book your follow-up here” and “your results will be posted here.”
Online scheduling in particular is a strong hook. If you want to see what an EHR-connected version looks like, our write-up on EHR-first online scheduling walks through it.
Close the loop
Patients keep using tools when they see someone noticed. ONC’s practical guide on patient-generated data says positive feedback loops, like acknowledging that data was reviewed and sending reminders, can sustain engagement. Translate that: a message sent on Monday gets a reply by Tuesday. A result gets a short note, not silence. Our guide to secure messaging for clinics covers how to set response expectations so nobody on your team is guessing who answers what.
Make it work for patients who struggle with access
The barrier list above includes low digital comfort, no internet and language gaps. A one-size-fits-all rollout leaves those patients behind.
The JMIR review recommends staff and patient support, simpler interfaces and language, tailored outreach, and keeping print resources. The toolkit adds multiple enrollment options, targeted outreach to patient groups, and staff or volunteers who help patients sign up.
A few concrete moves:
- Offer enrollment in person, by text link and by phone, so no one is forced down one path.
- Keep a printed one-page “how to log in” sheet at the counter, in the languages your patients speak.
- Target outreach. A 2022 study of groups with low portal use isn’t something we’ll lean on here, so check your own data: which age groups, languages or plans have the lowest activation? Start there.
- Set up caregiver or proxy access. The Playbook recommends unique secure logins, defined access levels and staff workflows so a daughter can help manage a parent’s care without sharing a password.
Privacy worries, which 21% of nonadopters cited, deserve a straight answer too. Tell patients, in one sentence, that the portal is login-protected and that your site and tools are built to HIPAA standards. Then make sure that’s true.
Patient portal engagement strategies that last
Activation is the first hurdle. Habit is the second. These are the engagement moves we’d put in place in the first 90 days:
- Automated nudges. A text after the visit: “Your results are in the portal.” A reminder before a screening is due. A refill alert.
- A friendly first-use sequence. Welcome message, a short “here’s what you can do” tip, and a follow-up a week later for anyone who never logged in.
- Consistent branding. Patients trust a portal that looks like your practice. We cover that in why branded portals drive engagement.
- A clean, fast website path. If the login button is buried, adoption stalls. See our notes on website optimization for healthcare.
- Regular new reasons. A flu-shot campaign, a seasonal reminder, a new service. The toolkit lists health campaigns as a legitimate reason to log in.
For a broader view, our evidence-based patient engagement playbook goes beyond the portal.
What to measure
If you don’t track it, you’ll argue about it. The toolkit recommends watching registrations and portal access, use of features like refills and messages, self-scheduling no-shows, phone calls and response times.
A simple monthly scorecard:
| Metric | Why it matters |
|---|---|
| New registrations as a share of visits | Shows whether front-desk enrollment is happening |
| Active users (logged in during the last 90 days) | Separates real adoption from dormant accounts |
| Feature use: results, refills, messages, scheduling | Tells you what’s pulling patients in |
| Average response time to messages and requests | Predicts whether patients keep using it |
| Phone call volume on routine questions | Shows whether the portal is relieving the phones |
| No-show rate for self-scheduled visits | Ties the portal to revenue |
The toolkit also suggests soliciting patient and staff feedback and reviewing utilization as part of quality improvement. Ask staff which patients get stuck at login. They know.
Patient retention programs and loyalty programs
Why does portal adoption keep coming up next to retention? Because the portal is a standing line to the patient between visits.
The evidence is encouraging but should be read carefully. A 2022 Vanderbilt observational study of 4,237 people living with HIV found portal access was independently associated with retention in care (adjusted prevalence ratio 1.13) and viral suppression (1.18). That’s an association, not proof of cause, and it concerns one patient population. An older ONC case study at Howard University Hospital’s diabetes center reported that portal appointment reminders lowered no-show rates, with text reminders working well because 98% of patients had mobile phones. A Kaiser Permanente qualitative study found portal access could strengthen satisfaction and organizational connection, depending on implementation conditions.
If you want to measure retention yourself, borrow the Vanderbilt definition: at least two kept appointments or lab measurements at least three months apart within 12 months. Adapt it to your specialty. A pharmacy might use refill continuity instead.
What about loyalty programs?
Points and perks are common in consumer retail, and some practices try them. In healthcare, anything of value offered to patients can raise legal questions, especially for Medicare and Medicaid patients under federal anti-kickback and beneficiary inducement rules. Run any reward idea past a healthcare attorney or your compliance advisor before launch.
The safer, usually more effective loyalty move is service-based: faster refills, easy scheduling, quick replies, reminders that save patients a trip. Those are exactly what a well-used portal delivers.
Perspective
We built KLYR Media for independent pharmacies and clinics because generic agencies don’t understand your day. They don’t know that the phone is what breaks first, or that a portal nobody uses is just another bill.
Our view: portal adoption is a marketing, workflow and website problem at the same time. Patients need to hear about the portal before the visit, get enrolled during it, and get nudged after it. That’s why we pair HIPAA-compliant web design with automated follow-up, so the login button is easy to find and the reminder arrives without a staff member typing it.
Compliance isn’t a layer you add at the end. We design our systems with it from day one, so you can ask patients to trust the portal and mean it.
Opinly
Put the system in place
If your team is stretched, you don’t have to build the follow-up machinery by hand. Our Retention Automation Service is designed to handle patient reminders and follow-up messages, so portal invitations, refill nudges and recall messages go out on their own. Pair it with a HIPAA-compliant website that puts portal login front and center.
Want to talk through your current portal setup? Start at klyrmedia.com and tell us where adoption is stuck.
FAQ
What is a good patient portal adoption rate?
There’s no single benchmark that fits every practice, because patient mix, specialty and portal features differ. A more useful target is your own trend: registrations as a share of visits, and active users over the last 90 days. Set a baseline this month and improve it each quarter.
Does staff really make that much difference?
Yes. Federal ONC guidance says patients are more likely to adopt portals when providers recommend and support their use. A one-sentence recommendation from the provider plus hands-on login help at check-out is the simplest version.
How do I get older or less tech-comfortable patients to sign up?
Offer enrollment in person with a staff member helping, keep printed instructions available, and set up proxy access for family caregivers. The JMIR review recommends staff support, simpler language and keeping print resources for this reason.
Should we offer rewards for signing up?
Be careful. Incentives to patients can trigger federal anti-kickback and beneficiary inducement concerns, particularly with Medicare and Medicaid. Talk to a healthcare attorney first, and favor service-based benefits like faster refills and easy scheduling.
Sources
- Patient Portal Barriers and Group Differences (JMIR, 2020)
- Barriers, Facilitators, and Solutions to Optimal Patient Portal and Personal Health Record Use (JMIR, 2018)
- Patient Engagement Playbook, Chapter 2 (ONC)
- Patient Engagement Playbook, Chapter 5 (ONC)
- How to Optimize Patient Portals for Patient Engagement (ONC, 2013)
- How to Optimize Patient Portals and Meet Meaningful Use Requirements (ONC)
- How to Use a Patient Portal (ONC Blog)
- Patient-Generated Health Data practical guide (ONC)
- Acute Care Patient Portal Intervention (JMIR, 2019)
- Patient Portal Toolkit (Health Federation, 2021)
- Electronic Patient Portal Use and HIV Care Outcomes (JMIR Medical Informatics, 2022)
- Howard University Hospital Diabetes Treatment Center Case Study (ONC)
- Organizational dynamics enabling patient portal impacts (BMC Health Services Research, 2015)
