The Limits of Digital Health for Primary Care Patients and Clinicians: Communication, Information Exchange, and Portal Use.

Patient portals have the potential to both improve and harm patient-clinician partnerships by reshaping how health information is exchanged and how patients and providers communicate. Patients (n = 20) and primary care clinicians (n = 11) purposively sampled from clinics serving diverse New Jersey communities were interviewed. Patients distinguished two portal functions - linear information exchange and bidirectional communication - but did so in different ways. Patients who valued portals oriented to portals as complementary to in-clinic interactions, finding portals to support information exchange but inadequately support their needs for relational communication. They viewed portals as having limited functionality that is beneficial alongside in-clinic visits. A subset of patients identifying as Black/African American and over 40 years of age and who did not value portals adopted a substitution orientation. They perceived in-person communication with their clinicians to be especially effective and described portals as unnecessary, imagining them to only be necessary when in-person visits are ineffective. Clinicians approached portals from a hybrid orientation, adopting both complementary and substitution orientations depending on how information and communication tasks via portals were perceived to redefine their workload. Unlike patients, clinicians sometimes conflated the functions of information exchange and communication. Neither patients nor clinicians perceived portals to effectively support bidirectional communication. We reflect on the need to develop and implement technological systems that complement bidirectional patient-clinician communication, rather than replace it with the linear exchange of health information to better serve the needs of patients with diverse backgrounds.