Email vs. Patient portals: Why most patients prefer the inbox

According to the latest Health Information National Trends Survey, HINTS 7, 77% were offered online access to their health information in 2024. While this number suggests growing adoption, it hides a deeper truth: most patients rarely log into patient portals. Instead, they continue to rely on a tool that predates digital health systems: email.

Email remains the most familiar and widely used communication method in healthcare, even as institutions invest heavily in developing patient portals. These portals were designed to give patients secure, centralized access to their records and providers. But real-world data and two decades of experience tell a different story—patients prefer the convenience and simplicity of email.

The study “Patient Portals: Who uses them? What features do they use? And do they reduce hospital readmissions?” captures this reality vividly: “Although portal messaging systems were designed to replace email, many patients continue to prefer traditional email communication with their providers.”

Despite the promise of portals, patient behavior remains consistent. The study’s findings show that email’s accessibility and familiarity continue to drive engagement far more effectively than any new platform. For healthcare organizations seeking to improve patient communication, this insight carries powerful implications.

The reality behind low patient portal adoption

Despite widespread implementation of patient portals by healthcare systems, actual access and meaningful use remain disappointingly low. According to the study Barriers to Patient Portal Access and Use: Evidence from the Health Information National Trends Survey, although 76.9% of respondents reported their provider maintained an electronic medical record system, only 47.2% said they were offered access to these records, and just 29.3% accessed their own medical records in the past year.

As the authors note: “Rates of PPs [patient portals] access and use are low… under a half reported that they were offered access … only a third reported accessing their own medical data.”

Key barriers proven by the study include:

Access doesn’t equal offer or usage

Many patients had providers with electronic records, but fewer were offered portal access, and fewer still used them. Having the technology in place doesn’t guarantee patient uptake.

Most patients who were offered portals did not enroll, and those who did, rarely logged in. 

Socio-economic and structural factors matter

The study found that individuals without a regular doctor (AOR 0.4, CI 0.3–0.5), without health insurance (AOR 0.4, CI 0.2–0.7), or with lower educational attainment (high school or vocational/some college vs. college/post-graduate) were significantly less likely to access their online records. 

Further, the authors note that “Identified disparities in PPs access and use, driven primarily by patients’ educational attainment and whether they have a regular doctor…” 

Limited confidence and incentivisation

Only 27.2% of respondents reported being confident their electronic records were safe. Without strong patient confidence in security and clear encouragement from providers, adoption stalls.

Once access is achieved, use remains uneven

The study reveals that even among those who accessed the portal, use of key functionalities (messaging, appointment scheduling, and health monitoring) was inconsistent, particularly among older and socio-economically disadvantaged groups.

Why this matters

For healthcare organizations aiming to engage patients digitally, these findings show a fundamental reality: having a portal is not enough. The portal remains underutilized if patients aren’t offered access, don’t trust the system, or lack incentives and support to use it. In turn, the promise of better engagement, lower no-show rates, or improved adherence is undermined.

As the authors caution, “Without purposeful planning and integration, reliance on patient portals alone for engaging patients … could inadvertently serve to exacerbate existing … disparities.” 

For providers focused on HIPAA compliant patient communication, this insight is important: if portals aren’t being used by large segments of your audience, relying solely on the portal channel may exclude many patients. This is where email, when securely enabled, becomes a more widely accessible channel.

Read also: Why patient portals aren’t the right solution for HIPAA compliance

Email as the communication equalizer

Email bridges the digital divide for many patients, especially those in rural or underserved areas. The study “Patient Portals: Who uses them? What features do they use? And do they reduce hospital readmissions?” demonstrates that “email enables communication with patients who lack access to sophisticated devices or broadband.” Portals often require high-speed internet, recent browsers, and multiple authentication steps that can discourage engagement.

Email, by contrast, works almost everywhere. It’s compatible with basic smartphones, accessible in low-bandwidth settings, and familiar across generations.

The study Contextual Factors That Impact the Implementation of Patient Portals With a Focus on Older People in Acute Care Hospitals: Scoping Review found that older adults are far less likely to use patient portals, even when offered assistance, but frequently check their email. Email’s simplicity allows for inclusivity in a way that portal systems have yet to achieve.

The authors Patient Portals: Who uses them? What features do they use? And do they reduce hospital readmissions?, “The introduction of portals has not displaced email communication, particularly among populations less comfortable with technology.” This persistence demonstrates that effective communication is not about introducing new tools, it’s about optimizing the ones people already trust.

Why email wins: usability and trust

In healthcare, trust and usability drive engagement more than any feature list. The study’s two-decade overview reveals that even when portal systems were improved and rebranded, “patients did not view them as a natural extension of care.” In contrast, email’s ubiquity and human familiarity built confidence.

Another line from the paper states: “Despite institutional preference for portals, patient satisfaction and response rates remained higher for email communication.”

This finding proves what many healthcare administrators have quietly recognized, forcing patients into new systems rarely works. The digital tools that endure are those that adapt to patient behavior, not the other way around.

When email is both secure and compliant, it becomes the best of both worlds: convenient for patients and safe for organizations.

Email and the continuity of care

Continuity of care depends on timely, clear, and consistent communication. The study found that “email played a key role in maintaining continuity, particularly for chronic disease management.” Patients with long-term conditions used email to clarify instructions, request refills, and follow up between visits, activities that improved adherence and satisfaction.

By contrast, portals often created communication gaps. Notifications went unnoticed, or messages remained unread because patients forgot passwords or didn’t understand navigation menus.

As the authors wrote, “The asynchronous nature of email allows for communication that respects the time constraints of both patients and clinicians.”

This characteristic, flexible but direct, makes email an ideal medium for managing ongoing relationships between care teams and patients.

Reinforcing patient communication with HIPAA compliant email

Paubox recognizes what this study makes explicit: the future of patient communication isn’t about reinventing technology; it’s about securing what already works. Email remains the foundation of digital interaction, and when it’s secured by default, it becomes a powerful enabler of patient engagement.

Traditional security approaches burden users with portals or password-protected attachments. Paubox’s HIPAA compliant email flips that model. It protects sensitive data seamlessly in the background, preserving the user experience patients prefer.

With Paubox Email Suite, healthcare organizations can:

• Send encrypted emails directly to patients’ inboxes: no portals or logins required
• Ensure every message is automatically HIPAA compliant
• Streamline workflows while maintaining documentation and audit trails
• Increase patient engagement rates by communicating through familiar channels

When patients trust how information is delivered, they engage more, respond faster, and remain connected to their care teams.

See also: Why choose Paubox for HIPAA compliant email

FAQS

Is email communication with patients HIPAA compliant?

Yes, if it’s properly secured. Traditional email isn’t inherently HIPAA compliant because it lacks encryption and audit controls. However, HIPAA compliant email solutions like Paubox encrypt messages end-to-end and integrate directly with existing email platforms, allowing providers to communicate safely without requiring patients to log into a portal.

Why is email more inclusive than patient portals?

Email is universal—most adults already use it daily. Portals, however, require account creation, password management, and familiarity with new interfaces. For older adults, patients with limited health literacy, or those without consistent internet access, portals can become a barrier. Email reduces this friction, improving accessibility and engagement.

How does HIPAA compliant email improve patient satisfaction?

Because it’s simple and immediate. Patients can read updates, test results, or reminders directly in their inbox without logging into a separate system. Research consistently shows that ease of access and communication speed drive higher patient satisfaction and trust.