A Portal Is Not a Patient Strategy
Healthcare has invested heavily in patient portals, and for good reason. Modern patient portals can give patients secure digital access to appointments, test results, medications, messages, educational information and other elements of their health record. They have become an important part of modern healthcare infrastructure.
But there is an important distinction we sometimes overlook:
Having a patient portal is not the same as having a patient strategy
A portal is a destination. A patient strategy is how you get people there — who gets there, who doesn't, and what happens before, during and after they arrive. Increasingly, the evidence suggests those distinctions matter.
The Registration Paradox
Consider what happens when a patient arrives at a hospital. At registration, the organization establishes something extremely important:
Who is this person? Demographics are confirmed; identity is established; and a medical record is located or created. The patient enters a controlled healthcare workflow. In many cases, a patient identification wristband is printed and attached to the patient.
At that moment, the health system has completed one of the most important identity events in the entire care journey. Yet remarkably, the patient's digital journey can remain disconnected from it.
The patient may be told about the portal
They may receive printed instructions
They may get an email later
They may be asked to create an account when they get home
And sometimes they simply never do
We establish the patient's identity when they enter the healthcare system — and then ask them to establish another digital relationship with us later.
Offered Does Not Mean Connected
U.S. national data demonstrate the difference. According to 2024 data from the Office of the National Coordinator for Health Information Technology, more than three-quarters of individuals reported being offered online access to their medical records by a healthcare provider or insurer. But 65% reported both being offered access and actually accessingtheir online medical record or patient portal. That represents enormous progress. The figure has more than doubled from 25% in 2014. But another finding may be even more important.
Among people who had been offered portal access, 87% of those who said their healthcare provider encouraged them to use it accessed their portal during the year.
Among those who were not encouraged? 57%.
A 30-percentage-point difference. The technology didn't change.
The human interaction did
That should tell us something important about digital patient engagement. Building the digital front door matters. Helping patients through it matters too.
Canada: The Gap Between Digital Interest and Digital Reality
The latest Canadian evidence makes this distinction even clearer.
In July 2026, the Canadian Institute for Health Information released national data examining how Canadians access and use digital health information.
Patient interest is not the problem: 89% of Canadians are interested in accessing their personal health information electronically and using digital tools to manage their care.
But access and actual use tell a very different story.
In 2025:
69% of Canadians reported access to at least one type of electronic health information
Only 13% of Canadian adults reported online access to all three core components measured by CIHI: laboratory and imaging results, immunization records, and medication history and renewals
31% — approximately 10 million Canadian adults — reported having no electronic access to any of their health information
Only 32% reported using technology to understand and manage their health
Consider that gap:
89% interested.
32% actively using digital tools to manage their health.
That suggests patient willingness is not necessarily the problem.
The pathway may be
The 69% access figure requires context. Having electronic access to one piece of health information is very different from having a connected view of your healthcare journey.
Laboratory results were the most commonly available information, accessible to 52% of Canadians. Access dropped to 27% for medication history, 25% for immunization records and 21% for imaging reports.
CIHI makes an important point: putting information online is only the first step. For Canadians to use it effectively, information also needs to be easy to find, understandable, relevant and ideally provide a more complete view of their care.
That is remarkably close to the distinction between a portal and a patient strategy.
A login provides access. A connected, understandable and usable healthcare journey creates engagement.
In Ontario, Access Does Not Guarantee Use
Recent Ontario research adds another dimension. A 2026 study surveyed 970 patients and caregivers about their experiences with patient portals in primary care. Only 57% of patients and 62% of caregivers surveyed reported having access to a patient portal.
But what happened after access became available may be even more important. Among people with portal access, not using any portal features was significantly more common among older adults, unemployed respondents and people who spoke a language other than English at home.
Among respondents aged 65 and older who had portal access, 14% reported using no portal features, compared with just 1% among people under 65.
Among respondents who spoke a non-English language at home, 9% used no portal features, compared with 1% among English-speaking respondents. Those differences should concern us, because they expose a weakness in how we sometimes measure digital transformation.
Providing access is not the same as achieving accessibility
A hospital can technically make the same portal available to every patient while creating very different experiences depending on age, language, digital literacy, socioeconomic circumstances, disability, access to technology or availability of family support.
As more of the healthcare journey becomes digital, that distinction becomes increasingly important.
The Digital Front Door Is Not Equally Easy to Open
This is where patient engagement becomes a health-equity issue. Digital healthcare has enormous potential to improve access.
Patients can see results without travelling
They can manage appointments without waiting on the telephone
They can communicate asynchronously with care teams
They can access information when and where they need it
But research consistently shows that portal adoption is not evenly distributed.
A recent systematic review and meta-analysis examining the digital divide in hospital patient portals found that people under 65 were significantly more likely to use portals and that higher education was associated with a 37% greater likelihood of portal use.
Another national U.S. analysis found that although patient portal access and utilization increased substantially between 2019 and 2022, those improvements were not equally distributed. Disparities persisted or increased among people with lower household incomes, people without college degrees and adults over 65.
The paradox is difficult to ignore.
The patients who may need the greatest help navigating healthcare can face some of the greatest friction accessing the digital tools designed to help them navigate it.
A portal therefore cannot simply be available – It needs to be accessible. Those are very different standards.
Language Begins Before Login
Language makes this issue even more important. A patient may technically have access to exactly the same portal as everyone else and still experience a very different digital healthcare journey.
Research in a large U.S. safety-net health system found that patients with limited English proficiency were less likely to use active portal functions even after registering for access.
A 2026 study involving nearly 40,000 patients at a large children's health system went further. Parents or guardians whose preferred language was Spanish were less likely than English-preferring families to:
be offered portal access
activate the portal
subsequently use it
The researchers found that the activation workflows themselves were not equally effective across language groups. That distinction matters because accessibility doesn't begin at the portal login screen.
Accessibility begins before login
How was the patient invited?
Was the process explained?
In what language?
Could someone help?
Did the patient understand why activation mattered?
Could a family member or caregiver participate?
Did we assume that sending an email or activation code completed the job?
Those are workflow questions. A poorly designed workflows can inadvertently create health inequity even when the underlying technology is technically available to everyone.
We Should Be Careful About Digitizing Inequality
There is an understandable drive toward digital-first healthcare, done well, digital access can remove barriers. However, a digital-first strategy that assumes every patient can independently navigate enrollment, authentication, language, technology and health information creates another risk:
We can digitize existing inequality.
The answer isn't to slow digital transformation. It is to design digital transformation around the people most likely to encounter friction.
That means considering:
Digital literacy
Language
Age
Disability and accessibility
Access to technology
Family and caregiver participation
And perhaps most importantly:
Human assistance at the moment of onboarding.
The Best Time to Connect a Patient May Be When They Are Already Connected
Healthcare frequently tries to establish the digital relationship after the physical encounter, perhaps we should reverse that thinking.
The patient is already present
Their identity has already been established
The organization knows why they are there
Staff are already interacting with them
The patient has an immediate reason to care about what happens next
That may be the strongest opportunity to begin the digital relationship.
Instead of:
“Here is information about our portal. Register when you get home.”
The experience could become:
“As you register, let's make sure you can access the digital tools you will need for the next stage of your care.”
That is a very different philosophy. It turns onboarding from an administrative afterthought into part of the care journey.
And remember that U.S. finding:
87% portal use among people encouraged by their healthcare provider
57% among those who weren't
The technology was already there.
The connection made the difference.
The Portal Should Not Have to Solve Onboarding
Patient portals are incredibly capable platforms and we should not expect the portal itself to solve every problem that occurs before someone successfully reaches it.
Think about an airport. The airline app may be excellent. But the airline doesn't simply build the app and assume every passenger will figure out how to navigate the entire journey.
There are check-in counters.
Kiosks
Boarding passes
Signs
Gate agents
Notifications
Baggage tags
Every element helps move the passenger through the journey. Healthcare needs the same thinking. The patient portal can be one of the most important destinations in the digital healthcare journey, but the health system still needs to design the pathways that get patients there.
And Not Every Patient Travels Alone
There is another reason the portal cannot represent the entire patient strategy.
Healthcare is frequently a shared experience.
A parent may manage care for a child
An adult child may help an aging parent
A spouse may coordinate appointments and medications
A trusted friend may provide transportation, translation or support
Major portal platforms recognize this reality and support forms of proxy or delegated access. That is important and patient behaviour reinforces the need.
U.S. national data show that proxy or caregiver access to online medical records more than doubled between 2020 and 2024, from 24% to 51%. But once again, the technology's capability and the patient's experience of discovering, understanding and activating that capability are different things.
A patient strategy needs to ask not only:
How do we connect the patient?
But also:
Who else does this patient rely upon to navigate their care, and how do we appropriately connect them?
A Portal Can Also Become Another Island
There is another challenge with equating a portal with a patient strategy.
Which portal?
A patient's healthcare journey rarely occurs inside a single organization.
They may see a family physician.
Visit a hospital.
Have imaging performed elsewhere.
Use a community laboratory.
See multiple specialists.
Fill prescriptions at a pharmacy.
Receive home or community care.
Yet the digital experience can still reflect the organizations delivering those services rather than the patient moving between them.
CIHI describes Canada's health information environment as fragmented, noting that even when information exists electronically, it often cannot move easily among providers, patients, care settings and jurisdictions.
That means a patient can have digital access — even multiple patient portals — without having a truly connected digital healthcare experience.
This is another reason the strategy cannot begin and end with the portal.
Patients don't experience healthcare as a collection of databases. They experience it as one journey – from Digital Access to Digital Continuity
Perhaps the bigger opportunity is to stop thinking about patient engagement as a collection of separate transactions.
Registration.
Portal activation.
Discharge.
Follow-up.
Education.
Family access.
Appointment reminders.
These may be different workflows inside the health system. To the patient, however, they are one journey. The identity established at the beginning of care could become the foundation for connecting that journey. That doesn't mean putting sensitive medical information on a wristband or QR code.
Quite the opposite. The physical identifier can act as a secure starting point for a controlled digital interaction. The intelligence belongs behind the identifier. A scan or digital interaction can launch the appropriate workflow based on context, permissions and identity. The wristband therefore becomes more than something the healthcare system uses to identify the patient.
It can potentially help the patient securely connect back to the healthcare system.
That is the transition from patient identification to patient engagement.
Stop Measuring the Door. Start Measuring the Journey.
Perhaps health systems should move beyond asking, how many patients have portal accounts? And start asking:
How many eligible patients were actually offered digital access?
How many completed onboarding?
Where did patients abandon the process?
How does activation differ by age, language, socioeconomic status or accessibility needs?
How quickly after registration did the patient establish digital access?
Did patients successfully return after their first login?
Were caregivers or family members connected where appropriate?
Did patients complete the actions required after discharge?
And importantly:
Who isn't getting through the digital front door?
Those measures tell a much richer story than simply counting portal registrations. They can also reveal whether digital transformation is reducing barriers — or unintentionally creating new ones.
The Portal Is Part of the Strategy
None of this diminishes the importance of patient portals, it reinforces it. Healthcare organizations have invested enormous resources in powerful digital platforms capable of connecting patients with their health information and care teams.
The question is whether we have invested enough thought in connecting patients to those platforms at the moment when the opportunity is greatest.
The portal is the destination
Identity can provide the trusted starting point
Onboarding creates the connection
Accessibility determines who can participate
Family and caregivers can extend it
And thoughtful workflow design can carry that connection throughout the patient's journey.
A portal is an important piece of technology.
A connected patient is the strategy.
About Medirex Systems Inc.
Medirex Systems Inc. (Medirex) is a Canadian-owned and operated business connecting patients to health information systems. Being an industry leader for over 50 years, Medirex has evolved to bridge the gap between patient identification and engagement by cultivating patient connections with ease, security, and no errors. Providing a positive patient identification experience for over 10 million Canadians, Medirex adopts technologies ensuring that the patient has a voice in their healthcare journey. Medirex aids in the adoption of digital health resources and data to improve the patient experience for your healthcare organization.
Media Contact:
Medirex Communications
Medirex Systems Inc.
+1.416.363.9313
info@medirex.com