Patient portals vs. email: Comparing security, costs and implementation

Patient portals were designed to provide patients with 24/7 access to their health information, appointment scheduling, prescription refills, and direct communication with healthcare providers. 

However, the promise of digital patient portals has not translated into universal success. According to The Impact of Digital Patient Portals on Health Outcomes, System Efficiency, and Patient Attitudes: Updated Systematic Literature Review,  "patient portal messaging has led to an increased clinician workload, particularly in primary care settings, where optimization efforts are most needed". Additionally, technical inefficiencies plague portal systems, as studies demonstrate that "secure messaging tasks were inefficient as related to clinical document sharing (it took almost 5 minutes for providers to only attach and send a clinical document)" 

Furthermore, the implementation and adoption of patient portals present challenges that healthcare organizations must navigate. According to the Updated Systematic Literature Review, "Despite this widespread availability, adoption remains a challenge. The same source highlights that 'in a national cross-sectional survey, more than 50% of survey participants were not portal users'". The NIH in Understanding the Risks and Benefits of a Patient Portal Configured for HIV Care: Patient and Healthcare Professional Perspectives outlines that the risks accompanied by patient portals include:

• Stress or Uncertainty: Patients worried about complicated features, outdated data, and difficulty interpreting information.
• Contribution to the Digital Divide: Concerns that access to patient portals might be limited by technology disparities (e.g., lack of smartphones or internet).

These challenges show the complexity of portal implementation and the need for patient education and support systems. The digital divide particularly affects vulnerable populations, including elderly patients, those with limited English proficiency, and individuals from lower socioeconomic backgrounds who may lack reliable internet access or modern devices.

The Updated Systematic Literature Review has identified barriers to portal adoption, finding that "some of the main issues were related to perceived or preconceived security concerns, limited knowledge, satisfaction with current care, paying for the service, disinterest in managing one's own disease, personal/time constraints and not thinking about accessing the portal".

Interestingly, concerns about digital technology adoption extend beyond healthcare into other sectors requiring sensitive information sharing. According to the article Two-Fifths of Americans Want to Ban Biometric Use published in Infosecurity Magazine, "A majority of Americans have grave concerns about providing biometric information online and two-fifths (39%) argue the technology should be banned." This broader context of digital privacy concerns may contribute to patient hesitancy in adopting digital health platforms.

Email communication in healthcare

In contrast to the complexity of patient portals, email communication offers a familiar and accessible alternative for patient-provider communication. Most patients already possess basic email skills, reducing the learning curve and potentially improving adoption rates across diverse demographic groups.

Standard email systems can be prone to potential risks like interception, phishing, and unauthorized access, which are concerns when dealing with sensitive patient information.

However, encrypted email solutions like Paubox offer a secure alternative to standard email systems. Paubox integrates into existing email workflows, ensuring that both providers and patients can send and receive HIPAA compliant messages without the need for additional software or training.

The simplicity of email communication cannot be overstated. Patients can access their emails from any device with internet connectivity, including smartphones, tablets, and computers, without needing to remember additional login credentials or navigate complex portal interfaces. This accessibility makes email particularly valuable for routine communications, appointment reminders, and non-urgent medical inquiries.

Implementation costs

Portal implementation cost

The implementation of patient portals involves costs, including software acquisition, staff training, and ongoing technical support. According to the HIMSS Greater Kansas City Chapter, in an article titled Patient Portal Enrollment and Engagement Rounds on Inpatient Units, "Having dedicated staff prevented additional responsibility on unit staff to educate and support the enrollment of admitted patients." This shows that integrating patient portals into the healthcare system would need additional staff.

The same sources noted that "Over 50% of survey respondents said that the portal was never discussed with them, or they were unsure if it was ever discussed with them." This suggests that beyond financial considerations, successful portal implementation requires proactive communication strategies. Moreover, policy changes, billing models, and additional infrastructure will be necessary to manage the growing message volume effectively.

The initial investment for patient portals typically ranges depending on the size of the healthcare organization and the complexity of the chosen system. Additional costs include:

• Ongoing maintenance
• Software updates
• Cybersecurity measures
• Dedicated IT support staff
  
  

Email system costs

According to a study from BMC Health Services Research, the cost of providing email communication for 1,000 consultations annually was approximately $19,930, with costs decreasing as the volume of consultations increases. The low cost can be attributed to the minimal overhead involved when using existing email systems, especially when administrative tasks are automated. With email-based services, there are no significant start-up costs beyond the necessary infrastructure, making it an accessible option for healthcare organisations seeking to reach patients remotely.

The same study notes that, "studies of email-based telemedicine have shown that some roles – namely administrative and supervisory – are more automation-friendly than clinical roles. Purpose-written email systems – through automation – can reduce or eliminate these roles," thus reducing costs.

The scalability of email systems also presents a cost advantage. As patient volumes increase, email systems can handle the additional load without proportional increases in infrastructure costs, making them particularly attractive for growing healthcare practices or organizations with fluctuating patient populations.

Read also: 6 major benefits of using healthcare email in your practice

Security and compliance considerations

Healthcare organizations must prioritize security and regulatory compliance when selecting communication platforms. Both patient portals and email systems must meet HIPAA requirements to protect patient privacy and avoid costly violations.

Patient portals typically offer security features, including:

• Multi-factor authentication
• Role-based access controls
• Audit trails that track all user activities
• Automatic session timeouts
• Encrypted data storage

These systems are designed specifically for healthcare environments and often include advanced security measures.

However, security concerns in digital communications are not limited to healthcare. The broader technology landscape faces challenges with identity verification systems. As reported in the Infosecurity Magazine article, "deepfakes now comprise 24% of fraudulent attempts to pass motion-based biometrics checks, which are used by banks and other service providers to authenticate users." This emerging threat landscape affects all sectors relying on digital identity verification, including healthcare platforms that may incorporate biometric authentication features.

Email systems, while traditionally less secure, have evolved with the introduction of specialized healthcare email platforms. Modern encrypted email solutions provide encryption, ensuring that sensitive patient information remains protected during transmission and storage. The key advantage of email is that security measures are often transparent to users, requiring minimal training or behavior changes.

Read also: What is the role of HIPAA compliant email services in protecting patient privacy?

Patient demographics and adoption patterns

Understanding patient demographics plays a role in determining the most effective communication strategy for healthcare organizations. Different age groups, socioeconomic backgrounds, and technological comfort levels significantly influence the success of either patient portals or email communication systems.

Elderly patients, who often represent a portion of healthcare consumers, frequently struggle with complex portal interfaces but may be more comfortable with simple email communication. Conversely, younger patients may prefer the features of patient portals but also appreciate the immediacy and familiarity of email for quick communications.

The socioeconomic digital divide also affects communication platform success. Patients with limited financial resources may rely on public computers or basic smartphones that cannot adequately support sophisticated portal applications but can handle email communication effectively. Healthcare organizations serving diverse communities must consider these factors when implementing communication strategies.

Consumer attitudes toward digital technology adoption reveal interesting paradoxes that healthcare organizations should consider. Research published in the Infosecurity Magazine found that:

• 87% were asked to provide a biometric identifier to verify their identity online in the past year
• 63% had 'serious concerns' about doing so
• Despite these concerns, 91% did so anyway
• Two-thirds agreed that biometrics can reduce identity crimes

This pattern of reluctant adoption despite security concerns may mirror patient behavior with healthcare communication platforms.

Training and support considerations

Staff training and ongoing support represent an important factor in the success of either communication platform. Patient portals typically require training for both healthcare staff and patients, covering:

• Basic system usage
• Troubleshooting
• Privacy settings
• Integration with existing workflows

Email communication systems generally require less training due to the widespread familiarity with email interfaces. However, staff must still understand:

• HIPAA compliance requirements
• Appropriate use policies
• Security best practices specific to healthcare communication

The ongoing support requirements also differ between the two platforms. Patient portals often require:

• Dedicated technical support staff
• Help desk services for patient assistance
• Account management support
• Password reset services
• Navigation problem resolution

Email systems typically require less intensive support, though organizations must still provide guidance on secure communication practices and system usage policies.

Learn more: HIPAA compliant email

FAQs

Can patient portals integrate with wearable health devices or apps like Apple Health or Fitbit?

Some patient portals support integration with health tracking apps, but compatibility depends on the system’s capabilities and vendor support.

Are there any legal liabilities for clinicians who miss patient messages on a portal or email system?

Yes, failure to respond to messages in a timely manner could expose providers to legal risks depending on the nature of the communication.

How do language barriers affect the usability of patient portals versus email?

Patient portals may lack multilingual support, whereas email can be translated more easily with integrated tools.

Do patient portals or email systems support accessibility features for visually impaired patients?

Many portals and email platforms can work with screen readers, but usability varies widely depending on design.

How do rural healthcare providers manage portal access for patients with unreliable internet?

They may opt for hybrid models or prioritize email and phone communication where broadband is limited.