Patient portals gave people access to their health information but also handed them the work of coordinating their own care, and the next generation of digital health should take that work back by reaching out to patients instead of waiting for them to log in.
5 Min Read
Digital health was supposed to make healthcare easier. Instead, patients became responsible for checking results, remembering medications, completing forms, monitoring symptoms, scheduling appointments, and deciding when something is worth reporting.
Ask people about their patient portal and you get two answers at once.
The first is gratitude. Test results arrive in days, not weeks. Visit notes are there to reread. A message to the care team no longer means a phone tree and a callback window.
The second is fatigue. When The Wall Street Journal asked readers about their portals, the frustrations were familiar: a separate login for every health system, more information than anyone explains, the same intake forms filled in again and again. Underneath it all ran one feeling. The paperwork didn't disappear. It moved to the patient.
Both answers are true. And together they point to something healthcare rarely says out loud.
Read the discharge instructions again
Think about what happens when someone leaves the hospital. They're handed a set of instructions, and each one quietly assigns them a task.
What healthcare says | What the patient now has to do |
|---|---|
"Take these medications." | Remember them, on schedule, for weeks |
"Monitor these symptoms." | Decide which ones matter |
"Call us if anything changes." | Judge what counts as a change |
"Complete this questionnaire." | Remember to log in, and remember the password |
"Schedule your follow-up." | Find the number, find the slot, book it |
"Tell us how you've been since we last saw you." | Reconstruct three months from memory |
None of these instructions is unreasonable on its own. Stacked together, they describe a job: tracking, triaging, scheduling, reporting. It's care coordination, done by the person least equipped to do it, often while recovering, often alone.
We've turned the patient into an unpaid care coordinator. And we've given them a portal to do it in.
We digitized the responsibility instead of removing it
For more than fifteen years, healthcare has been going digital. Records moved online. Portals launched. Forms became PDFs, then web forms, then app screens.
But look at what actually changed. The clipboard became a login. The phone call became a notification. The paper questionnaire became a link that expires in seven days. Each step made information easier for the organization to receive. Almost none made the work easier for the patient to do.
The result is a strange kind of progress. A patient seeing four specialists may now manage four portals, four passwords and four inboxes. Researchers studying single sign-on for portals noted years ago that a separate login at every institution quickly becomes cumbersome for patients. They also found something telling: patients mostly used portals reactively, when a message pushed them there, not on their own initiative.
That last finding matters more than it looks. It suggests the portal was never the thing patients engaged with. The prompt was.
The engagement problem might be a design problem
The industry knows something isn't working. Experian Health's State of Patient Access 2026 survey of 1,000+ patients and 200+ revenue cycle leaders found access improvements have stalled: 18% of patients say access got better, and the same 18% say it got worse. Among providers' top access challenges is getting patients to use digital tools at all.
The usual reading is that patients aren't engaged enough. They don't log in, don't finish forms, don't report symptoms on time. So organizations add reminders, gamify dashboards and launch adoption campaigns.
There's another reading. Maybe engagement is low not because patients don't care, but because we designed engagement around what's convenient for healthcare organizations rather than what's easy for patients.
Deloitte's 2026 research on consumer trust in health care points the same way. Across 42,500+ consumer responses, trust explained 52% of perceived value. Its four drivers are humanity, transparency, capability and reliability. Deloitte notes that trust falters when systems put internal processes ahead of patients' lived realities, and when digital front doors are fragmented or handoffs and follow-ups fail.
A portal that waits for a recovering patient to remember a password scores poorly on all four.
Give patients less to do
The next generation of digital health shouldn't give patients another tool to use. It should give them less to do.
Today, a routine check-in asks the patient to run the whole sequence:
Download the app
Create an account
Remember the password
Open the dashboard
Find the right form
Enter symptoms in someone else's categories
Hope someone reads it
Now flip it. The patient doesn't start anything. Their phone rings.
"Hi Sarah, it's Cali. How have you been feeling since your procedure?"
Sarah talks the way people talk. Cali asks the follow-up questions a nurse would ask, turns the conversation into structured information, and gets it to the care team that needs it. Anything worrying is flagged; the rest is documented.
The technology does the work: starting the interaction, asking the questions, structuring the answers, routing them. Sarah's only job is to be a patient.
This is the difference between engagement as a demand and engagement as a service. One asks patients to come to the system. The other brings the system to them, in the most familiar interface there is: a conversation.
Where the job is heaviest
The hidden job shows up wherever care happens between visits, which is to say, most of the time.
After discharge. The first days home are when warning signs appear and when patients are least able to judge them. A proactive call replaces "call us if anything changes" with someone actually asking.
Home health. Patients and family caregivers juggle visit schedules, medication changes and symptom logs. Checking in by phone keeps the care team current without adding another app to the kitchen counter.
Chronic care. Living with heart failure, COPD or diabetes means reporting on yourself for years. A regular conversation captures what's changed now, instead of a fuzzy summary at the next appointment.
Clinical trials. Participants are asked to complete diaries, questionnaires and check-ins on a strict schedule. Every missed entry is a data gap. Making the study come to the participant protects both their experience and the data.
The settings differ. The pattern doesn't. Wherever we ask patients to remember, decide, log in and report, we can ask them a question instead.
Stop asking patients to manage the technology
Portals gave patients access, and that was worth doing. But access was never the finish line. The measure of digital health isn't how much information patients can reach. It's how little work they have to do to get good care.
Healthcare gave patients a portal. Then it gave them a job. The next step is to take the job back.
Sources
Patient portal reader responses, The Wall Street Journal
Patient access in 2026: Cost and complexity reshape the patient journey, Experian Health, May 6, 2026
Trust drives consumer value and adoption in life sciences and health care, Deloitte Insights, June 17, 2026
Accessing Patient Electronic Health Record Portals Safely Using Social Credentials, JMIR Formative Research, 2022
