INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)

ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue IX September 2025

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How EHR Patient Portals Prevented 21 million Missed Appointments

and What This Means for Clinicians and Healthcare Systems - A

Commentary

Jalene Jacob, MD, MBA

Millennium Medical Network, Trinidad and Tobago

DOI: https://doi.org/10.51244/IJRSI.2025.120800239

Received: 24 Aug 2025; Accepted: 31 Aug 2025; Published: 01 October 2025

ABSTRACT

Data from Epic, a widely used electronic health record (EHR) system, revealed that patient portal use was

associated with approximately 21 million fewer missed appointments across the United States in 2024.

Converting these findings to rates, patients with activated portal accounts experienced roughly 1,700 fewer no-

shows per 100,000 scheduled visits compared to non-users. The greatest benefit was observed among middle-

aged patients. This commentary examines the implications of such findings for clinicians and health systems,

exploring possible mechanisms such as appointment reminders, rapid rescheduling, and direct communication

with care teams. While the evidence suggests that portals can improve adherence and support stronger doctor-

patient relationships, the findings derive from observational data and may reflect underlying patient

engagement differences. Equity considerations are critical, as portal adoption can exacerbate disparities for

populations with limited broadband access, device availability, or digital literacy. Recommendations are

provided for both practitioners and developers to enhance portal usability, integrate sign-up into every patient

touch point, link cancellations to automated rebooking systems, and monitor scheduling efficiency. By

translating these insights into practice, healthcare systems can maximize the operational and access benefits of

patient portals while ensuring inclusive adoption.

Key words: Patient Portals; Patient Compliance; Electronic Health Records; Telemedicine; Patient

Engagement; Healthcare Access; Health Literacy; Health Equity; Ambulatory Care; Practice Management;

Healthcare Utilization

INTRODUCTION

Maria was a busy 52-year-old juggling a demanding job, caring for her elderly mother, and managing her own

diabetes. She missed her last endocrinology appointment, not because she didn’t care, but because between

work deadlines and home responsibilities, the reminder card got buried under a stack of mail. At her next visit,

the clinic staff helped her sign up for the patient portal. A week before her follow-up, she received an email

reminder. Two days before, she got a text notification. The morning of the appointment, a push alert popped up

on her phone with directions to the clinic. She made it to the visit, on time, with her latest glucose readings

already uploaded through the portal.

Maria’s story isn’t unique, and the data now confirms what many of clinicians have seen in practice. A new

Epic research analysis looked at more than 1.6 billion outpatient face-to-face visits in 2024, and found that

patients with an active MyChart (Epic’s patient portal) account at scheduling were 21.5% less likely to miss

appointments.

The study compared no-show rates for patients with and without an established patient portal

account at the time the appointment was scheduled.

To emphasize, the difference adds up to more than 21

million fewer no-shows in a single year across the 1.26 billion scheduled visits among patient-portal users in

2024.

In practical terms, this equates to about 1,700 fewer no-shows per 100,000 scheduled visits among

patients with active portal accounts,

and even more compelling, the finding held true after adjusting for

demographic factors, social vulnerability, appointment lead time, insurance type, and prior visit history.

INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)

ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue IX September 2025

Page 2705

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The study found the largest improvement among middle-aged patients. For ages 50 to 64, portal users had a

6.2% no-show rate compared to 8.7% for non-users, a 2.5 percentage point reduction. Patients aged 35 to 49

showed a 7.8% vs. 9.9% rate (2.1-point decline), and those 18 to 34 had a 9.3% vs. 10.9% rate (1.6-point

decline). The numbers suggest that patient portal engagement is especially effective for older working age

adults.

Why this matters to Clinical Practices and Health Systems

In 2024, more than 1.6 billion outpatient visits took place across the United States, yet, millions of scheduled

appointments were never completed because patients simply did not show up.

In a healthcare environment

already strained by staffing shortages, tighter budgets, and growing patient demand, clinical slots cannot afford

to be wasted. No-shows don’t just inconvenience the clinics, but they also delay care for others and

disproportionately affect communities where access is already limited.

I. Operational Efficiency and Access

Reducing no-shows by over 21 million encounters in one year likely improved clinic throughput, improved

time management, and freed up valuable appointment slots where capacity is constrained.

Higher Return On Investment for Digital Patient Engagement

Evidence suggests that patient portal activation, already implemented in many systems, can meaningfully

improve patient adherence and even doctor-patient relationship.

This underscores the importance of enhancing

portal usability, sending timely reminders, and providing patient education.

Tailored Engagement by Age Demographics

The greatest benefit in no-show reduction was observed in middle-aged patients (those ages 50 to 64)

possibly

due to higher portal adoption and engagement among this group. Conversely, younger adults showed smaller

or less significant improvement,

signalling an opportunity for more age-targeted outreach strategies.

Robustness Across Demographics

The study’s sensitivity analysis supports the portal’s beneficial effect across a range of socio-demographic and

system variables. This suggests that it is a broadly applicable strategy to improve adherence.

Alignment with Health Equity Goals

While existing data provide some insight, a more granular analysis is essential to identify differential impacts

and tailor interventions to specific, often overlooked, subgroups, ultimately fostering more equitable

deployment of digital health tools.

Global Relevance and Adaptability

While the findings are based on data from the United States, the challenges of missed appointments and the

potential of digital health tools are universal. Healthcare systems worldwide, from high-income nations with

advanced digital infrastructures to developing countries with rapidly expanding mobile connectivity, face the

dual pressures of improving patient access and operational efficiency. The mechanisms through which patient

portals work such as automated reminders, simplified communication, and empowering patients with

information, are not unique to a single country. Therefore, these insights can be a valuable blueprint for global

health policymakers, clinicians, and health technology developers. Future research should explore the specific

impact of patient portals in diverse healthcare settings, considering differences in national health policies,

cultural attitudes toward technology, and varying levels of digital literacy to ensure these tools are adapted

effectively and equitably on a global scale.

INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)

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Points for Consideration

While encouraging, these results should not be over-interpreted. Portal users may already be more engaged, so

the portal may not be the sole factor driving better attendance. Moreover, the report only briefly addresses

equity, and as we know, digital tools can exacerbate disparities if certain populations lack access to health

technology tools or health literacy. Targeted strategies are essential to ensure portal benefits reach all patients.

I. Causation vs Correlation

While the study establishes a strong association between patient portal use and reduced no-show rates, it

acknowledges that portal users may be inherently more engaged in their healthcare. Future research should aim

to establish a more direct causal link, providing stronger evidence of the portal's direct impact on no-shows.

Such studies include Randomized Controlled Trials (RCTs) where patients are randomly assigned to a group

that receives standard care versus a group that receives standard care plus a mandatory, guided patient portal

activation and onboarding.

Feature Utilization and Behaviour Change

The analysis does not distinguish which portal features (e.g., scheduling, reminders, messaging) most influence

adherence. Evaluating feature-level engagement could guide investments. It could be beneficial to investigate

which specific features of patient portals are most effective in reducing no-shows. Is it the appointment

reminders via text, email or phone call? Is it the ability to directly message the care team? Or is it the ease of

rescheduling? A study could track feature-level utilization data to correlate specific actions (e.g., number of

reminders clicked and number of messages sent) with appointment adherence. This would help healthcare

systems prioritize the development and promotion of the most impactful features.

Equity and Access Gaps

The data suggest disparities by race, insurance, and other social determinants, though the report does not fully

explore them. For example, Black patients had a higher baseline no-show rate. Understanding how portal

activation affects this group is crucial for addressing equity gaps.

In addition, the article briefly mentions that digital tools can exacerbate disparities but does not fully explore

this. A deeper look is necessary to ensure patient portals are a tool for equity, not a source of further division. A

more granular analysis by race, ethnicity, and socioeconomic status to understand how patient portal activation

and use affect no-show rates among specific racial and ethnic groups, as well as those with different

socioeconomic statuses could yield meaningful insights for both developers and providers.

Other areas for meaningful exploration include digital literacy and technology access on vulnerable

populations. Research could explore how access to technology (e.g., smartphones, computers, reliable internet)

and digital literacy acts as barriers to patient portal adoption and use. A comparison of no-show rates in

communities with varying levels of broadband infrastructure could be done to quantify the impact on access.

Furthermore, the effectiveness of in-person assistance could also affect portal use. Evaluating the effectiveness

of different in-person strategies such as dedicated staff to assist with sign-up, on-site kiosks, and multilingual

instructions on portal adoption and subsequent no-show rates among vulnerable populations, could add a new

dimension to the study.

Operational and System-Level Impacts

The article suggests that reducing no-shows automatically improves access, but this assumption needs to be

tested at a systems level. While portals can lead to fewer no-shows, a cancelled slot is only valuable if it is

filled. Future research should examine the efficiency of automated rebooking systems and how quickly

cancelled slots are filled by other patients. This would provide a more complete picture of the portal's true

impact on clinic capacity and patient access. The impact of these system dynamics on staff workload could

also be an area for consideration.

INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)

ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue IX September 2025

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Strategies for practitioners and developers to further enhance the numbers

To translate the potential of patient portals into measurable improvements in attendance, practitioners and

developers can adopt approaches that optimize portal use, engagement, and accessibility. The following

methods outline actionable steps to further reduce missed appointments and maximize the impact of digital

health tools.

I. Integrate portal sign-up into every patient touch point

Make enrolment automatic during phone scheduling, front-desk check-in, or post-visit follow-up. Ensure staff

walk patients through the activation process rather than leaving it optional. A smooth, guided on boarding

experience increases adoption and engagement.

Don’t just tell patients why and how it helps - show them

Staff should walk patients through the portal features during the visit or registration process. Demonstrate

appointment reminders, quick rescheduling, direct messaging with the care team, access to lab results, and

educational resources. Show them how notifications work on their phone or email and let them try practice

tasks such as confirming an appointment. Patients are far more likely to engage with tools they can see in

action and understand first-hand.

Design engagement strategies for different age groups

Older adults may value reminders, access to lab results, and messaging with providers. Younger adults might

respond better to mobile-first notifications, push alerts, and integration with wearable devices. Tailoring

communication and training based on patient demographics improves both adoption and effectiveness.

Monitor and close equity gaps

Monitor portal adoption and no-show reductions across race, socioeconomic status, and geography. Offer

multilingual instructions, in-person assistance, and on-site kiosks or tablets for patients with limited device

access. Proactively addressing barriers ensures that portal benefits reach all populations equitably.

Pair portals with rapid rescheduling systems

Reducing no-shows is only part of the equation. A saved appointment slot only delivers value if it is promptly

filled. Integrating portal notifications with waitlists or automated rescheduling systems can ensure that

cancellations are quickly offered to other patients. Regular monitoring of appointment reallocation efficiency

would help maximize access, minimize wasted clinical capacity, and maintain smooth clinic operations.

Provide ongoing support and reinforcement

Encourage patients to revisit and explore the portal beyond their first use. Send tips, short tutorials, or highlight

features they may not have tried yet. Continuous engagement reinforces the portal as a useful tool, not just a

one-time enrolment task.

CONCLUSION

Patient portals alone won’t eliminate no-show problem, but they are one of the few interventions that improve

efficiency, access, and engagement without adding to clinician workload. The challenge isn’t whether they

work, it’s whether we are ready to make them work for everyone.

Investing in thoughtful, inclusive design and implementation of patient portals is a strategic tool for enhancing

patient engagement and operational resilience. The report suggests that implementing and promoting patient

portals can be a highly effective strategy for healthcare organizations to improve operational efficiency and

patient care.

The findings further support the idea that digital tools can enhance patient engagement and

INTERNATIONAL JOURNAL OF RESEARCH AND SCIENTIFIC INNOVATION (IJRSI)

ISSN No. 2321-2705 | DOI: 10.51244/IJRSI |Volume XII Issue IX September 2025

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communication, leading to better appointment adherence. Targeted promotion is key. Given the varying impact

across age groups, healthcare providers should tailor their patient portal promotion strategies to different

demographics, particularly focusing on the 50 to 64 age group where the impact on no-shows is most

pronounced,

including those in groups such as the 18 to 34 age group that showed the smallest difference.

Digital health solutions are a critical component of modern healthcare, and their benefits can be quantitatively

measured in terms of improved patient behaviour and operational outcomes.

Moreover, this study provides strong evidence that digital health interventions such as patient portals, can

significantly reduce the problem of missed appointments, benefiting both patients and healthcare systems.

Another study reiterated that patient portals generally have favourable effects on health outcomes, fostering

stronger doctor-patient relationships, increasing health awareness, and improving therapy adherence.

However, their impact on overall healthcare utilization and operational efficiency remains uncertain.

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shows-in-2024

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