Do Patients Actually Use Your Patient Portal?

Ask most practice owners how patients reach them and the portal comes up fast. We spent money on it, we push everyone to sign up, results and messages live there. So it feels like the hub. Then you look at the numbers and a different picture shows up: patients signed up, logged in once, checked a lab result, and never came back. The portal is on. It is just mostly empty.

That gap between having a portal and patients using a portal is where a lot of practices lose time and goodwill without noticing. So let us answer the honest question owners keep asking: do patients actually use your patient portal, and if most of them do not, what should you do instead?

Access went up. Real use did not follow.

Here is the part that surprises people. The problem is not that patients cannot get into a portal. Most can. According to federal data tracked by the Office of the National Coordinator for Health IT, about 77 percent of individuals were offered access to an online portal in 2024, and roughly 65 percent got in and viewed their record at least once. On paper that looks like a win.

Then look at how often they come back. The share of frequent users, meaning people who log in six or more times a year, sat at just 34 percent in 2024. It doubled from 15 percent back in 2019, which is real progress, but flip it around: about two thirds of portal users are not regular users. As TechTarget reported on the ONC figures, most people log in, check one thing, and go back to calling or texting for everything else.

Why patients skip the portal

It is not that patients hate their doctor or refuse technology. It is friction. Think about what a portal asks a patient to do for a thirty second task: find the right website or app, remember a username they made two years ago, reset a password because they forgot it, wait for the reset email, log in, then hunt for the button that does the thing they wanted. Every one of those steps is a place to give up.

Now compare that to a text. It arrives, they read it, they reply. No login, no app, no password. So when a patient needs to reschedule or ask a quick question, they do the easy thing. They call, or they wish they could just text you. This is the same friction problem we see with booking, which we dug into in whether patients prefer to book online or call. Every extra step between the patient and the goal costs you some of them.

What patients say they actually want

We do not have to guess here. In the State of Healthcare Patient Communication in 2026, a survey of 1,000 patients by Sinch, the ranking of preferred channels was clear:

• 90 percent prefer to receive healthcare communication by text.
• 59 percent are fine with email.
• 55 percent prefer the patient portal.
• 34 percent prefer a phone call.

Read that again. The portal, the thing many practices treat as the main channel, lands fourth in preference and behind plain text by 35 points. And the appetite for texting is not just passive: 97 percent of patients wanted appointment reminders by text, and 68 percent wanted two way texting so they could ask a question or reschedule without calling. The generational split is the warning shot. In the same survey, 42 percent of Gen Z patients said they would switch providers or pharmacies over a practice that would not text them, versus 20 percent of Baby Boomers. The patients you most want for the next twenty years are the least patient with a login screen.

The portal is a vault, not a front door

Here is our honest take. The portal is not the villain. For records, lab results, forms, and secure messaging, it does a real job and is often required. The mistake is treating it as your practice's front door, the place patients are supposed to go for everything. It was never built to be that, and the data shows patients quietly refuse to use it that way.

When you force booking, questions, and reminders behind a login, you are adding a wall in front of the exact moments that decide whether a patient stays or leaves. A patient who wants to move an appointment and hits a password reset does not finish the reset. They put the phone down, forget, and turn into a no show. A prospective patient who has to create an account just to ask if you take their insurance often just closes the tab. If your website gets visits but few of them turn into booked patients, this friction is one of the usual suspects, something we broke down in why a practice gets website traffic but no new patients.

What to do instead

You do not have to rip out the portal. You have to stop making it the only way in and meet patients on the channels they already use. In practice that looks like this:

• Send reminders and recalls by text, not a portal message. A portal notification a patient never opens is not a reminder. A text they read in minutes is. This is also how you cut no shows, and it pairs naturally with real replies, which we covered in why patients should be able to text your practice back.
• Let patients book without a login. Online booking should live on your website and take a couple of taps, no account required. Reserve the account for after they are a patient, not as the toll booth in front of becoming one.
• Answer questions where they ask them. If a patient texts or fills a form, respond in that channel fast. Speed is its own kind of marketing, and slow replies leak patients, which is the whole point of how fast you should respond to a new patient inquiry.
• Use the portal for what it is good at. Records, results, statements, and forms. When something is waiting there, text the patient a direct link so they go straight to it instead of hunting.

Where this fits, and where AI helps

The catch with meeting patients on text and phone is obvious: someone has to be there to answer. Your front desk is already stretched, and patients do not only reach out during business hours. That is exactly the gap a smart assistant fills. A good AI layer can answer the phone and reply to texts at any hour, handle the routine questions and reschedules, offer open appointment times, and only hand a real person the conversations that actually need one. You can hear how that plays out with our AI receptionist, which works calls and texts the same way.

This is how we think about the whole thing when we build a patient acquisition system for a practice. The portal stays for records. The front door is a fast website with real online booking, backed by texting and a receptionist that answers. The patient never has to remember a password to get to you, and you stop losing the ones who would not.

Our take

Portals are not going away, and you should keep yours. But if your plan for reaching patients is mostly the portal, you are betting on the one channel the data says patients use least. Nine in ten want text. Two thirds want to text back. A third of your portal users log in more than a handful of times a year. The practices that grow from here are not the ones with the fanciest portal. They are the ones that make it effortless for a busy person to book, ask, and confirm without ever logging in, and treat the portal as the vault it was always meant to be.