Barriers and Facilitators for the Implementation of an Online Portal in Hospital Mental Health Care: Implementation Study

Abstract Background In recent years, digital patient portals have become an increasingly common feature of care in various medical fields. Despite growing scientific evidence of their effectiveness and the benefits they offer to patients and caregivers, their implementation, especially in hospital mental health settings, lags behind expectations. Objective The study aimed to identify the barriers and facilitators to implementing a patient portal in a public mental health hospital setting in Germany. Moreover, it aimed to develop recommendations for implementing a patient portal. Methods Three psychiatric clinics in the early stages of implementing an online portal for patients participated in this implementation study. We assessed objective usage data (log data from the patient portal) and performed qualitative interviews with professionals and questionnaire surveys with both patients and professionals. We combined the results to develop generic recommendations for the implementation of patient portals in a mental hospital setting using a 2-stage Delphi method with a group of professionals and patients. Results Portal log data from 71 patients indicated variation in the use of the portal functions. On average, users logged in 9.5 (SD 14.9) times (median 4, IQR 2-7 times). The variability in the number of logins per patient, ranging from 1 to 72, indicated a high variance in the frequency of use. On average, the portal was used for 47 (SD 59) days (median 27, IQR 2-62 days). Questionnaire data from 27 patients showed satisfaction with the portal and elucidated perceived barriers to usage. Qualitative interview data from 15 professionals revealed patient-related, professional-related, organizational, structural, and technical facilitators and barriers to the implementation process. We developed 10 actionable recommendations for the implementation of digital patient portals in psychiatric hospitals, which were rated by an expert group on different dimensions. Conclusions To our knowledge, this is the first implementation study in a German mental health hospital setting that provides experience-based recommendations for advancing the implementation of digital patient portals in hospital mental health care. The next steps will include the analysis of a larger number of users and functions, which will help to specify recommendations for different target groups and settings.