Health Literacy and the Patient Portal: Start Assessing Your Community and Facility

I got a new phone a week ago, and I feel pretty special because it’s one of the “new flip phones”.  Of course, that also makes me laugh because I owned one of the original flip phones way back when.  My phone had developed a battery issue and it needed to be replaced; I had one requirement when I was looking – size.  I text, read emails, play a few games and make an occasional phone call – yes, the least often thing I do with my phone is a phone call.     

As a healthcare technologist, I look at my new phone that does so much but that I use for so little, I pause to wonder: How technology literate am I? How healthcare literate am I? 

Low healthcare literacy coupled with technology may be hindering healthcare decisions 

Healthcare literacy is a topic that has become a passion of mine. The more I read and understand the issue, the more I want to impact a patient’s ability to understand the health information they interact with. A patient’s healthcare literacy can influence their ability to make critical decisions about the care they choose or more importantly life changes that will impact their health. 

The American Academy of Family Physicians (AAFP) says, “More than one-third of U.S. adults, an estimated 80 million persons, have limited health literacy, making it more difficult for them to read, understand, and apply health information (e.g., wording on medication bottles, food labels, appointment slips, discharge instructions, informed consent documents, medical forms, insurance applications, medical bills, and health education materials).”  The research also shows that literacy is not based upon an individual’s education level, but is compounded by factors that inhibit the ability to understand and make informed decisions based on the healthcare information being communicated. When you add technology such as the patient portal to the healthcare industry, you are requiring another set of skills and the need for technology literacy in order for individuals to make healthcare decisions.  

Included in the low healthcare literacy statistic are those of us who work in healthcare and who also find ourselves in the shoes of patients, consumers, and non-traditional caregivers. When testing or configuring EHR features, I often emulate the role of physicians and nurses, but when faced with understanding my own health needs or interrupting the health needs of my family members and friends, I am not as literate as I believed. I consider myself an expert at designing complex workflows and dictionary builds within a particular EMR but remembering which provider’s patient portal to login to and how to send a message or request an appointment sends me into a tail spin.   

As a society, how do we become more healthcare literate and savvy?   

Helping our culture become more healthcare literate will take time, attention, and collaboration. According to the American Academy of Family Physicians (AAFP), 75% of patient education materials are written at a high school/college reading level when the average U.S. adult only reads at an 8th grade level. Factor in language, cultural barriers, and technology, and the reading level drops to a 4th or 5th grade level.  

The article went on to say that many physicians overlooked or incorrectly assumed that patients were comprehending health information and patient education materials, but the fact is that they retain only half of the information communicated to them in the office. In addition, 40% of patients with low healthcare literacy admit feeling shame, and many report not telling their spouse or children about their difficulty understanding health information. 

Patient engagement hinges on health literacy   

The pandemic has changed patient engagement forever, and true patient engagement depends on health literacy. Disengaged patients are three times more likely to have unmet medical needs. While this is not a new problem, the good news is there are several agencies who offer healthcare literacy toolkits: 

• Centers for Disease Control 
• National Library of Medicine 
• Agency for Healthcare Research and Quality 
• National Council for Mental Wellbeing  

Where can you start as a healthcare provider?   

First, you need to determine how healthcare literate is your community and your facility. Second, look to your patient portals and other technologies to support patient engagement in a stronger way.  

CereCore provides patient portal support for hospitals and health systems. During the height of the pandemic, they saw a 500-600% increase in patients using patient portals for scheduling visits. The support team helped bridge the technology gap and provided education for patients on how to login to their portal, how to find test results and view information, and how to connect to their provider. Patient portals are important tools to help improve healthcare literacy, too, because they put the power of patient information in the hands of the patient.  

On the other side of the equation is research showing 27.6 million US households without internet access and over 1.4 million using dial-up internet. The most connected states are Utah, Colorado, and California while the least connected states are Mississippi, Arkansas, and Alabama.

Therefore, the solution is a multi-layered approach, and below are two simple assessments to help you baseline the healthcare literacy of each. Then, you can begin to develop a strategy for your facility and to collaborate with other healthcare providers in your community.