In the Marine Corps, we had a saying about equipment: if the operator can't figure it out under stress, the equipment failed, not the operator. That principle applies directly to patient portals.
The federal government has spent over $25 billion incentivizing electronic health record adoption through the HITECH Act [1]. A major pillar of that investment was patient portals, the idea that giving patients direct access to their medical records would improve outcomes, reduce costs, and close communication gaps between visits. And to be fair, there has been progress. According to the Office of the Assistant Secretary for Technology Policy (ASTP/ONC), 77% of individuals nationwide were offered online access to their health information in 2024, and 65% accessed their records at least once, more than double the pre-pandemic rate of 15% in 2019 [2].
But access and effectiveness are not the same thing. The portals that patients actually use, and the ones that sit idle eating server costs, are separated by a set of engineering decisions made long before a single patient logs in.
The Failure Rate Nobody Talks About
Healthcare IT projects fail at rates that would be unacceptable in any other industry. Research published in Procedia Computer Science found that healthcare technology projects fail at a rate of up to 70% when failure is defined as a project delay, substantial cost overrun, failure to meet an intended goal, or complete abandonment [3]. For patient portals specifically, the Fox Group, a healthcare consulting firm, estimates that more than 50% of EHR systems either fail or fail to be properly utilized [3].
A 2017 systematic review and meta-analysis published in the Journal of Medical Internet Research found an average patient portal adoption rate of just 52%, with the researchers concluding that little is known about how to actually increase adoption [4]. The 2024 HINTS data shows improvement to 65%, but that still means roughly one in three patients offered a portal chooses not to use it [2].
The question is not whether portals can work. It is why so many do not.
Usability Is Not a Nice-to-Have
The most consistent finding across portal research is that usability determines adoption more than any other factor. The Agency for Healthcare Research and Quality (AHRQ) funded a multi-year study across three healthcare organizations in New York City and found that common barriers to adoption include poor usability and portal designs that focus on facilitating organizational goals rather than patients' goals [5].
This distinction matters. Most portal development teams build features that satisfy compliance requirements, things like the ability to view lab results, download health records, and message providers, because those features check boxes on Meaningful Use attestation forms. But building features and building usable features are two different disciplines.
A 2024 HIMSS survey found that 48% of clinicians reported that EHR systems slowed their tasks due to poor workflow fit [6]. If clinicians struggle with these tools, patients with far less training and context face an even steeper challenge. Burying lab results behind three navigation layers, presenting medical terminology without explanation, and requiring desktop-only access in 2026 are all design decisions that suppress adoption regardless of how compliant the system is.
The portals that succeed treat usability testing with real patients as a non-negotiable part of the development cycle, not a phase that gets cut when budgets tighten.
Mobile-First Is No Longer Optional
The ASTP/ONC data shows a notable trend: caregiver and proxy access to patient portals more than doubled from 24% in 2020 to 51% in 2024 [2]. This means patients' family members are increasingly managing health information on behalf of others, often from their phones, in waiting rooms, parking lots, and between shifts at work.
If your patient portal requires a desktop browser for core functionality, you have already lost a significant portion of your user base. Organizations with mobile-optimized tools consistently see higher engagement [7]. Responsive design is the minimum. A truly effective patient portal should be built mobile-first, with touch-friendly interfaces, simplified navigation, and offline-capable features for areas with unreliable connectivity.
This is especially critical for underserved populations. Research has well-documented the digital divide in portal adoption, where disparities in income, education, and internet access create unequal adoption rates [8]. Lightweight, mobile-optimized portals partially close that gap by meeting patients where they already are, on their phones.
Health Literacy Determines Whether Data Becomes Information
Offering patients access to their records accomplishes nothing if they cannot understand what they are reading. Health literacy is an integral key to improving patient portal adoption [7]. A patient who sees "eGFR 58 mL/min" without context does not have useful information. They have anxiety.
Some health IT developers have begun leveraging natural language processing (NLP) to make portal information more accessible, translating clinical terminology into plain language automatically [7]. This is the right direction. But even without NLP, there are engineering choices that improve comprehension: displaying reference ranges alongside lab values, providing brief explanations for common tests, flagging results that need attention versus those that are routine, and using visual indicators rather than raw numbers where appropriate.
Stanford University research found that 74% of clinicians noted increased work hours after EHR implementation, with 71% attributing burnout to EHRs [3]. If clinicians are overwhelmed by the data presentation, designing patient-facing views that simply mirror the clinical interface is a failure of imagination, not a feature.
What Good Portals Do Differently
The portals with strong adoption share characteristics that go beyond feature checklists. They prioritize appointment scheduling, secure messaging, and lab results, which are the three features patients use most frequently [9]. They surface what matters and hide what does not. They send proactive notifications rather than waiting for patients to remember to log in. They support caregiver delegation without requiring patients to share credentials. And they treat security as invisible infrastructure rather than a barrier that adds friction to every interaction.
Good portals also integrate with the broader care experience. When a patient messages their provider and receives a response within the portal, when test results appear the same day they are finalized, when appointment reminders arrive by text rather than a letter mailed three weeks in advance, the portal becomes part of the patient's care rather than a separate system they have to manage.
The AHRQ research found that effective portals require ongoing iteration based on how patients actually use the system, not just what was specified in the requirements document [5]. Post-launch monitoring, usage analytics, and regular feedback loops with real patients are what separate working portals from expensive digital placeholders.
Build for the Patient, Not the Attestation Form
The federal investment in health IT was meant to improve care, not just digitize paperwork. But too many patient portals are built to meet compliance thresholds rather than to serve the people who need them most. When 70% of healthcare IT projects fail to meet their goals [3], the problem is not the technology. It is the engineering discipline behind it.
At Kortex Digital Labs, we build patient-facing platforms the way the Marine Corps builds mission-critical systems: start with the end user, test under realistic conditions, and never confuse checking a box with accomplishing the mission. A portal that patients avoid is not a portal. It is a liability.
Kortex Digital Labs builds patient portals and healthcare platforms designed for real-world adoption. Start a project to discuss your requirements.
References
[1] U.S. Department of Health and Human Services, "Adoption of Electronic Health Records and Barriers," PMC, 2016, doi: 10.5811/westjem.2016.7.30710. [Online]. Available: https://pmc.ncbi.nlm.nih.gov/articles/PMC5089148/
[2] Office of the Assistant Secretary for Technology Policy / Office of the National Coordinator for Health IT, "Individuals' Access and Use of Patient Portals and Smartphone Health Apps, 2024," ASTP/ONC Health IT Data Brief, Oct. 2025. [Online]. Available: https://healthit.gov/data/data-briefs/individuals-access-and-use-patient-portals-and-smartphone-health-apps-2024/
[3] EHR in Practice, "10 EHR Failure Statistics: Why You Need to Get It Right First Time," 2024. [Online]. Available: https://www.ehrinpractice.com/ehr-failure-statistics.html
[4] P. Fraccaro, M. Vigo, P. Balatsoukas et al., "Patient Portal Adoption Rates: A Systematic Literature Review and Meta-Analysis," Journal of Medical Internet Research, 2018, doi: 10.2196/portal. [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/29295056/
[5] Agency for Healthcare Research and Quality, "Improving Healthcare Quality with User-Centric Patient Portals," Digital Healthcare Research, AHRQ. [Online]. Available: https://digital.ahrq.gov/ahrq-funded-projects/improving-healthcare-quality-user-centric-patient-portals
[6] HIMSS, "2024 HIMSS Healthcare Cybersecurity Survey," Healthcare Information and Management Systems Society, 2024.
[7] S. Mastrogiacomo, "What Are the Top Barriers to Patient Portal Adoption, Use?" TechTarget Patient Engagement HIT, 2024. [Online]. Available: https://www.techtarget.com/patientengagement/news/366585215/What-Are-the-Top-Barriers-to-Patient-Portal-Adoption-Use
[8] A. Nishii, C. Campos-Castillo, and D. Anthony, "Disparities in patient portal access by US adults before and during the COVID-19 pandemic," JAMIA Open, 2022.
[9] A. Fox, "More patients accessed their medical records online in 2024," Healthcare IT News, Jul. 2025. [Online]. Available: https://www.healthcareitnews.com/news/more-patients-accessed-their-medical-records-online-2024