Disruptive Digital Innovation in Healthcare Delivery: The Case for Patient Portals and Online Clinical Consultations

  • Changmi JungEmail author
  • Rema Padman


Health care is the largest service sector in many economies worldwide, but it lags behind other industries in the use of efficient and innovative approaches to both patient care and service organization. Thus, innovative, disruptive models of healthcare delivery that leverage current information, communication,and decision technology platforms in novel ways have the potential to change the practice of healthcare delivery and management. To satisfy the growing demand for medical care, several new models are currently being developed and piloted, such as online medical consultations, which do not rely on face-to-face visits as the sole model of care delivery. Alongside, the current patient-centered care imperative has also resulted in the use of portal technologies, among others, to inform, engage, and empower the patient in shared decision making. In this chapter, we briefly introduce different types of digital service innovations in health care and provide some details about these current streams of care delivery innovations, particularly in the primary care setting given its broad influence on overall healthcare services. Furthermore, we focus on the potential of online care delivery that includes web portal services for patients and online medical consultations beyond simple email communications between patients and physicians. We conclude with a brief discussion of the implications of these models for the future of healthcare delivery in the digital age.


eHealth Patient portal Online medical consultation eVisit Disruptive service innovation 


  1. Adamson SC, Bachman JW (2010) Pilot study of providing online care in a primary care setting. Mayo Clin Proc 85(8):704–710CrossRefGoogle Scholar
  2. Agarwal R, Selen W (2011) Multi-dimensional nature of service innovation: operationalisation of the elevated service offering construct in collaborative service organisations. Int J Oper Prod Manag 31(11):1164–1192CrossRefGoogle Scholar
  3. Agarwal R, Selen W (2009) Dynamic capability building in service value networks for achieving service innovation. Decis Sci 40(3):431–475CrossRefGoogle Scholar
  4. Alder KG (2006) Web portals in primary care: an evaluation of patient readiness and willingness to pay for online services. J Med Internet Res 8(4):e26CrossRefGoogle Scholar
  5. Andreassen HK, Bujnowska-Fedak MM, Chrnonaki CE, Dumitru RC, Pudule I, Santana S, Voss H, Wynn R (2007) European citizens’ use of E-health services: a study of seven countries. BMC Public Health 7(53):1–7Google Scholar
  6. Audet AM, Doty MM, Peugh J, Shamasdin J, Zapert K, Schoenbaum S (2004) Information technologies: when will they make it into physician’s black bags? Med Gen Med 6(2):65Google Scholar
  7. Baker L, Wagner TH, Singer S, Bundorf MK (2003) Use of the internet and e-mail for health care information. JAMA 289(18):2400–2406CrossRefGoogle Scholar
  8. Barras R (1986) Towards a theory of innovation in services. Res Policy 15:161–173CrossRefGoogle Scholar
  9. Berry LL, Shankar V, Parish JT, Cadwallader S, Dotzel T (2006) Creating new markets through service innovation. MIT Sloan Management Review, Jan 2006Google Scholar
  10. Bitner MJ, Brown SW, Goul M, Urban S (2008) Services science journey: foundations, progress, and challenges. In: Hefley B, Murphy W (eds) Service science, management and engineering education for the 21st century. Springer, US, pp 224–237Google Scholar
  11. Boehm E, Dorsey M, Chu W, Zinser R (2010) Which US consumers are healthcare eVisit early adopters? Forrester Research, June 2010Google Scholar
  12. Bower DJ (2003) Innovation in healthcare delivery. Service innovation: organizational responses to technological opportunities and market imperatives. Imperial College Press, London, pp 211–230CrossRefGoogle Scholar
  13. Browning R, Camargo R, Camargo T, Memon B, Salyers G, Spencer Brent (2012) American well: a viral solution. Theses, dissertations and capstones paper 421Google Scholar
  14. Cai H, Yeh J, Su H (2008) Relooking at service science and services innovation. SOCA 2(1):1–14CrossRefGoogle Scholar
  15. Carrell D, Ralston J (2006) Variation in adoption rates of a patient web portal with a shared medical record by age, gender and morbidity level. In: Proceedings of AMIA 2006 symposium, p 871–876Google Scholar
  16. Christensen CM (2009) The innovator’s prescription. McGraw Hill, New YorkGoogle Scholar
  17. Cummings E, Chau S, Turner P (2009) Assessing a patient-centered e-health approach to chronic disease self-management. In: Wilson EV (ed) Patient-centered e-health. IGI Global, Hershey, pp 168–185CrossRefGoogle Scholar
  18. Davis FD (1989) Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Q 13(3):319–340CrossRefGoogle Scholar
  19. den Hertog P (2000) Knowledge-intensive business services as co-producers of innovation. Int J Innov Manag 4:491–528CrossRefGoogle Scholar
  20. England L, Steward D, Walker S (2000) Information technology adoption in health care: when organizations and technology collide. Aust Health Rev 23(3):176–185CrossRefGoogle Scholar
  21. Eysenbach G (2001) What is e-health? J Med Internet Res 3(2):e20CrossRefGoogle Scholar
  22. Fishbein M, Ajzen I (1975) Belief, attitude, intention and behavior: an introduction to theory and research. Addison-Wesley, ReadingGoogle Scholar
  23. Goldzweig CL, Orshansky G, Paige NM, Towfigh AA, Haggstrom DA, Miake-Lye I, Beroes JM, Shekelle PG (2013) Electronic patient portals: evidence on health outcomes, satisfaction, efficiency, and attitudes: a systematic review. Ann Intern Med 159(10):677–687CrossRefGoogle Scholar
  24. Grigsby B, Brega AG, Bennett RE, Devore PA, Paulich MJ, Talkington SG, Floersch NR, Barton PL, Neal S, Araya TM, Loger JL, Krohn N, Grigsby J (2007) The slow pace of interactive video telemedicine adoption: the perspective of telemedicine program administrators on physician participation. Telemed J E Health 13(6):645–656Google Scholar
  25. Harle C, Downs J, Padman R (2011) Effectiveness of personalized and interactive health risk calculators: a randomized trial. Med Decis Making 32(4):594–605CrossRefGoogle Scholar
  26. Harle C, Neill D, Padman R (2012) Development and evaluation of an information visualization system for chronic disease risk assessment. IEEE Intell Syst 27(6):81–85Google Scholar
  27. Interactive Harris (2002) Patient/physician online communication: many patients want it, would pay for it, and it would influence their choice of doctors and health plans. Health Care News 2(8):1–4Google Scholar
  28. Hesse BW, Nelson DE, Kreps GL, Croyle RT, Arora NK, Rimer BK, Viswanath K (2005) Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first health information national trends survey. Arch Intern Med 165(22):2618CrossRefGoogle Scholar
  29. Hoffman DL, Kalsbeek WD, Novak TP (1996) Internet and web use in the U.S. Commun ACM 39(12):36–46Google Scholar
  30. Hsu J, Huang J, Kinsman J, Fireman B, Miller R, Selby J, Ortiz E (2005) Use of e-health services between 1999 and 2002: a growing digital divide. JAMIA 12(2):164–171Google Scholar
  31. Hwang J, Christensen CM (2008) Disruptive innovation in health care delivery: a framework for business-model innovation. Health Aff 27(5):1329–1335CrossRefGoogle Scholar
  32. Jung C, Padman R, Paone S, Shevchik G (2011) Who are portal users versus early adopters? a preliminary analysis. In: Proceedings of AMIA Annual Symposium , p 1070–1079Google Scholar
  33. Jung C, Padman R, Argote L (2013) Impact of individual and organizational usage experience with structured eVisits on service efficiency: a preliminary analysis. In: Proceedings of the 8th INFORMS workshop on data mining and health informatics (DM-HI 2013)Google Scholar
  34. Katz SJ, Moyer CA (2004) The emerging role of online communication between patients and their providers. JGIM 19(9):978–983CrossRefGoogle Scholar
  35. Kittler AF, Carlson GL, Harris C, Lippincott M, Pizziferri L, Volk LA (2004) Primary care physician attitudes towards using a secure web-based portal designed to facilitate electronic communication with patients. Inform Prim Care 12(3):129–138Google Scholar
  36. Klein R (2007) An empirical examination of patient-physician portal acceptance. Eur J Inf Syst 16(6):751–760CrossRefGoogle Scholar
  37. Leong SL, Gingrich D, Lewis PR, Mauger DT, George JH (2005) Enhancing doctor-patient communication using email: a pilot study. J Am Board Fam Pract 18(3):180–188CrossRefGoogle Scholar
  38. Liederman EM, Morefield CS (2003) Web messaging: a new tool for patient-physician communication. JAMIA 10(3):260–270Google Scholar
  39. Lim S, Kim S, Kim J, Kwon M, Min S, Yoo S, Kang S, Kim H, Jung H, Park K, Ryu J, Shin H, Jang H (2011) A survey on ubiquitous healthcare service demand among diabetic patients. Diab Metab J 35(1):50–57CrossRefGoogle Scholar
  40. Maglio PP, Spohrer J (2008) Fundamentals of service science. J Acad Market Sci 36(1):18–20CrossRefGoogle Scholar
  41. Margolinus D, Bodenheimer B (2010) Transforming primary care: from past practice to the practice of the future. Health Aff 29(5):779–784CrossRefGoogle Scholar
  42. Menachemi N, Burke DE, Ayers DJ (2004) Factors affecting the adoption of telemedicine: a multiple adopter perspective. J Med Syst 28(6):617–632CrossRefGoogle Scholar
  43. Miles I (2005) Innovation in services. In: Fagerberg J, Mowery DC, Nelson RR (eds) The oxford handbook of innovation. Oxford University Press, New York, pp 433–458Google Scholar
  44. Miles I (2008) Patterns of innovation in service industries. IBM Syst J 47(1):115–128CrossRefGoogle Scholar
  45. Minetaki K, Akematsu Y, Tsuji M (2011) Effect of e-health on medical expenditures of outpatients with lifestyle-related diseases. Telemed e-Health 17(8):591–595CrossRefGoogle Scholar
  46. MyChart by Epic Systems—link: Accessed 20 Nov 2013)
  47. My HealthVet by Veterans Affairs—link: Accessed 20 Nov 2013)
  48. Nazi KM, Hogan TP, Wagner TH, McInnes K, Smith BM, Haggstrom D, Chumbler NR, Gifford AL, Charters KG, Saleem JJ (2010) Embracing a health services research perspective on personal health records: lessons learned from the va my healthevet system. J Gen Intern Med 25(1):62–67CrossRefGoogle Scholar
  49. Padman R, Shevchik G, Paone S, Cervenak J, Dolezal C (2010) eVisit: a pilot study of a new kind of healthcare delivery. In: Medinfo 2010. Stud Health Technol Inform 160:262–266Google Scholar
  50. Rittenhouse DR, Shortell SM (2009) The patient-centered medical home: will it stand the test of health reform? JAMA 301(19):2038–2040CrossRefGoogle Scholar
  51. Rosenthal TC (2008) The medical home: growing evidence to support a new approach to primary care. J Am Board Fam Med 21(5):427–440CrossRefGoogle Scholar
  52. Rogers E (2003) Diffusion of innovations, 5th edn. The Free Press, New YorkGoogle Scholar
  53. Sands DZ (2004) Help for physicians contemplating use of e-mail with patients. JAMIA 11(4):268–269Google Scholar
  54. Sarkar U, Karter AJ, Liu JY, Alder NE, Nguyen R, Lopez A, Schillinger D (2010) The literacy divide: health literacy and the use of an internet-based patient portal in an integrated health system: results from the diabetes study of Northern California (DISTANCE). J Health Commun 15(S2):183–196CrossRefGoogle Scholar
  55. Schumpeter JA (1934) The theory of economic development: an inquiry into profits, capital, credit, interest, and the business cycle. Harvard University Press, CambridgeGoogle Scholar
  56. Smith R (1997) The future of healthcare systems. BMJ 314(7093):1495–1496CrossRefGoogle Scholar
  57. Sosa-Iudicissa M, Wootton R, Ferrer-Roca O (1998) History of telemedicine. In: Sosa-Iudicissa M, Ferrer-Roca O (eds) Handbook of telemedicine. IOS Press, M. Amsterdam, p 1–17Google Scholar
  58. Stange KC, Nutting PA, Miller WL, Jaen CR, Crabtree BF, Flocke SA, Gill JM (2010) Defining and measuring the patient-centered medical home. JGIM 25(6):601–612CrossRefGoogle Scholar
  59. Strunk BC, Cunningham PJ (2002) Treading water: Americans’ access to needed medical care, 1997–2001. Center for Studying Health System Change, Washington DCGoogle Scholar
  60. Tang PC, Black W, Young CY (2006) Proposed criteria for reimbursing eVisits: content analysis of secure patient messages in a personal health record system. In: Proceedings of AMIA annual symposium, p 764–768Google Scholar
  61. Taylor H, Leitman R (2002) The future use of the Internet in 4 countries in relation to prescriptions, physician communication and health information. Harris Interactive Inc., RochesterGoogle Scholar
  62. Vargo SL, Lusch SF (2008) Service-dominant logic: continuing the evolution. J Acad Mark Sci 36(1):1–10CrossRefGoogle Scholar
  63. Viswanath K, Kreuter MW (2007) Health disparities, communication inequalities, and e-health: a commentary. Am J Prev Med 32(5 Suppl):S131–S133CrossRefGoogle Scholar
  64. Wald HS, Dube CE, Anthony DC (2007) Untangling the web; the impact of internet use on health care and the physician-patient relationship. Patient Educ Couns 68(3):218–224CrossRefGoogle Scholar
  65. Wang X, Bao G, Jia X (2010) A brief study on the research of service science theory. In: Proceedings of international conference on IEEE, p 248–252Google Scholar
  66. Wakefield DS, Kruse RL, Wakefield BJ, Koopman RJ, Keplinger LE, Canfield SM, Mehr DR (2012) Consistency of patient preferences about a secure internet-based patient communication portal. Am J Med Qual 27(6):494–502Google Scholar
  67. Weingart SN, Rind D, Tofias Z, Sands DZ (2006) Who uses the patient internet portal? the patientSite experience. JAMIA 13(1):91–95Google Scholar
  68. White CB, Moyer CA, Stern DT, Katz SJ (2004) A content analysis of e-mail communication between patients and their providers: patients get the message. JAMIA 11(4):260–267Google Scholar
  69. Whitten P, Buis L, Love B (2007) Physician-patient e-visit programs: implementation and appropriateness. Dis Manag Health Outcomes 15(4):207–214CrossRefGoogle Scholar
  70. Wilson EV (2003) Asynchronous healthcare communication. Commun ACM 46(6):79–84CrossRefGoogle Scholar
  71. Wilson EV, Lankton NK (2004) Modeling patients’ acceptance of provider-delivered e-health. JAMIA 11(4):241–248Google Scholar
  72. Xue M, Hitt LM, Harker PT (2007) Customer efficiency, channel usage, and firm performance in retail banking. Manufact Serv Oper Manag 9(4):535–558CrossRefGoogle Scholar
  73. Zanaboni P, Wootton R (2012) Adoption of telemedicine: from pilot stage to routine delivery. BMC Med Inform Decis Mak 12(1):1–9CrossRefGoogle Scholar
  74. Zhou YY, Garrido T, Chin HL, Wiesenthal AM, Liang LL (2007) Patient access to an electronic health record with secure messaging: impact on primary care utilization. Am J Manag Care 13(7):418–424Google Scholar

Copyright information

© Springer-Verlag London 2015

Authors and Affiliations

  1. 1.Carey Business SchoolJohns Hopkins UniversityBaltimoreUSA
  2. 2.H. John Heinz III CollegeCarnegie Mellon UniversityPittsburghUSA

Personalised recommendations