EHR Patient Portals in 2026: Features, Vendors, and What Patients Actually Want
Side-by-side portal comparisons, adoption benchmarks by age group, ROI data, and the regulatory requirements shaping patient access in 2026.
Key Takeaways
| Portal adoption | 65% of patients accessed their portal in 2024 -- but only 34% are frequent users (6+ logins/year). |
| No-show impact | Portal users had 21 million fewer no-shows in 2024 across 1.6 billion visits (Epic Research). |
| Mobile-first | 57% of patients access portals via smartphone app, surpassing web browsers for the first time. |
| KLAS leader | Epic MyChart scored 90.2 in the 2025 Best in KLAS Patient Portals category, with 150M+ users. |
| Penalties are real | Information blocking fines up to $1M/violation; Medicare payment reductions for non-compliant providers. |
The 2026 Patient Portal Landscape
The patient portal market grew from $6.45 billion in 2025 to an estimated $8.02 billion in 2026, with a projected CAGR of 24.26% through 2032. But market size tells one story. Actual patient behavior tells another.
While 99% of hospitals now offer electronic record access and 90% of organizations have portal infrastructure, only about one-third of patients use their portal regularly. The gap between "available" and "actually used" is where the real opportunity lives.
| Access Method | 2020 | 2022 | 2024 | Trend |
|---|---|---|---|---|
| Smartphone App | 38% | 51% | 57% | +19 pts |
| Web Browser Only | 60% | 48% | 42% | -18 pts |
| Overall Portal Access Rate | 38% | 57% | 65% | +27 pts |
Source: ASTP/ONC Health IT Data Brief No. 77 (July 2025), based on HINTS survey data.
The shift to mobile is definitive. If your portal requires pinch-to-zoom on a phone, you are losing patients at the adoption stage. The crossover from web to mobile happened in 2022-2023 and the gap is widening every year.
Portal Adoption by Demographics
| Age Group | Adoption Rate | Most Used Features | Preferred Access |
|---|---|---|---|
| 18-29 | 61% | Scheduling, messaging, Rx refills | Mobile app (78%) |
| 30-49 | 72% | Lab results, messaging, bill pay | Mobile app (65%) |
| 50-64 | 68% | Lab results, clinical notes, Rx refills | Split mobile/web |
| 65-74 | 52% | Lab results, medication lists | Web browser (62%) |
| 75+ | 34% | Lab results (often via proxy) | Web browser / proxy |
Sources: ASTP/ONC Data Brief (2024), JMIR cross-sectional analysis (2025), Epic MyChart institutional studies.
The bimodal peak is notable: usage spikes in the 30s (tech-savvy parents managing family health) and again in the 50-64 range (higher healthcare utilization). The steepest drop-off is after 75.
Equity gap: Portal use is significantly lower among Black patients, non-English speakers, patients without college education, and those in rural areas. A JAMA study of 250,000+ adults with chronic conditions found portal engagement was lowest among older, non-English-speaking, and Black patients. Practices serving these populations need multilingual portals, in-person digital literacy support, and proxy access options.
| Patient Population | Portal Use Rate | Gap vs. Average |
|---|---|---|
| English-speaking, college-educated | 74% | +9 pts |
| Spanish-speaking | 28% | -37 pts |
| Non-metropolitan / rural | 41% | -24 pts |
| Adults 65+ with chronic conditions | 42% | -23 pts |
| Patients with recent cancer diagnosis | 76% | +11 pts |
Sources: JAMA Network Open (2024), ASTP/ONC Data Brief (2024), institutional MyChart studies.
Vendor Portal Feature Comparison
Not all portals are equal. This matrix compares the five most common EHR portals across the features patients and practices care about most.
| Feature | Epic MyChart | athenahealth | eClinicalWorks | DrChrono | Elation |
|---|---|---|---|---|---|
| Secure Messaging | Full | Full | Full | Full | Full |
| Online Self-Scheduling | Full | Full | Full | Full | Request only |
| Lab Results Access | Full | Full | Full | Full | Full |
| Rx Refill Requests | Full | Full | Full | Full | Full |
| Integrated Telehealth | Full | Full | Full | Full | Third-party |
| Online Bill Pay | Full | Full | Full | Full | No |
| Clinical Notes (Open Notes) | Full | Full | Full | Full | Full |
| Cross-System Record Sharing | Full | Partial | Partial | No | No |
| Proxy Access (Family) | Full | Full | Full | Limited | Limited |
| Native Mobile App | 4.8 stars | 4.7 stars | 4.2 stars | 4.0 stars | 3.8 stars |
| AI Features (2026) | Live | Beta | Planned | No | No |
| Apple Health / SMART on FHIR | Full | Full | Partial | Partial | Partial |
Based on 2025 Best in KLAS data, vendor documentation, and our analysis. Ratings reflect standard configurations; specific implementations may vary.
Best for health systems and large groups. Broadest feature set, strongest cross-system sharing, and the first major portal with live AI features.
Best for independent and mid-size practices. Strong RCM integration, AI-driven reminders, and automated care gap alerts.
Best for large groups and FQHCs. Full-featured healow app with telehealth, scheduling, health tracker integration, and wearable device sync.
Best for small and solo practices. Simple onboarding, e-check-in, and basic portal features. Limited cross-system sharing and proxy access.
For a complete vendor evaluation framework, see our EHR selection process guide. For more on vendor options by specialty and size, see our top EHR vendors comparison.
Patient Satisfaction Benchmarks
Satisfaction varies dramatically by portal quality. These benchmarks help you gauge where your portal stands relative to the industry.
| Metric | Industry Avg | Top Quartile | Bottom Quartile |
|---|---|---|---|
| Portal enrollment rate | 65% | 82%+ | 38% |
| Monthly active users (of enrolled) | 34% | 55%+ | 15% |
| Patient satisfaction with portal (1-5) | 3.6 | 4.3+ | 2.8 |
| Secure message response time | 33 hrs | < 8 hrs | 72+ hrs |
| Mobile app store rating | 3.8 stars | 4.5+ stars | 2.5 stars |
| Online scheduling availability | 58% | 90%+ | 20% |
| "Would recommend portal" rate | 62% | 84%+ | 35% |
Sources: KLAS Research (2025), ASTP/ONC (2024), MGMA Stat Polls (2025), JMIR portal engagement studies.
The biggest differentiator between top and bottom quartile is not technology -- it is response time. Practices that respond to portal messages within 8 hours see satisfaction scores 1.5 points higher than those taking 72+ hours. A fast reply teaches patients the portal works.
Portal ROI: The Numbers That Matter
Epic Research's landmark 2025 study analyzed 1.6 billion outpatient visits and quantified the no-show reduction alone. Here is the full ROI picture.
| Metric | Before Portal | After Portal | Improvement |
|---|---|---|---|
| No-show rate | 7.9% | 6.2% | -21.5% |
| Inbound phone calls | Baseline | Reduced | -20% to -30% |
| Patient retention rate | Baseline | Improved | +60% |
| Admin costs | Baseline | Reduced | -15% to -25% |
| Days in A/R (patient balances) | 45-60 days | 30-40 days | -25% to -33% |
| 3-Year ROI (engagement platform) | -- | 6:1 to 15:1 | 532-1,479% (Yr 1-3) |
Sources: Epic Research (July 2025), SovDoc ROI analysis (2025), MGMA benchmarking data.
What 21 million fewer no-shows means in dollars: At 1,700 fewer no-shows per 100,000 visits and an average visit revenue of $175, that is roughly $297,500 in recovered revenue per 100,000 visits. For a 10-provider practice seeing 40,000 visits/year, that translates to approximately $119,000 in annual recovered revenue from no-show reduction alone.
The biggest ROI driver is not a single feature -- it is sustained engagement. Practices that auto-enroll patients, release lab results through the portal, and respond to messages within the same business day capture the full stack of ROI: fewer no-shows, fewer calls, faster collections, and higher retention.
Regulatory Requirements for Patient Portals (2026)
Compliance is not optional. Multiple federal rules now create a matrix of requirements that make functional patient portals a practical necessity.
| Feature / Requirement | Regulatory Status | Patient Impact | Implementation Effort |
|---|---|---|---|
| Electronic access to all EHI | Required | High | Medium |
| Open Notes (clinical notes access) | Required | High | Low |
| USCDI v3 data elements | Required (Jan 2026) | High | High |
| FHIR API for patient access | Required | Medium | High |
| No-fee access to records | Required | High | Low |
| Secure messaging | MIPS incentivized | High | Low |
| Patient education materials | MIPS incentivized | Medium | Low |
| Online self-scheduling | Nice-to-have | High | Medium |
| Integrated telehealth | Nice-to-have | High | Medium |
| AI plain-language explanations | Nice-to-have | High | High |
| Multilingual portal content | Nice-to-have | High | Medium |
Regulatory status based on 21st Century Cures Act, ONC Information Blocking Rule, HTI-1/HTI-2 final rules, and MIPS 2026 QPP requirements.
Enforcement is active. In September 2025, HHS announced nationwide information blocking enforcement -- the most aggressive action since the Cures Act became law. Penalties include up to $1 million per violation for health IT developers, Medicare payment reductions for hospitals and clinicians, and exclusion from the Medicare Shared Savings Program for ACOs. This is no longer theoretical risk.
The practical takeaway: every "Required" row in the table above must be fully functional in your portal today. The "MIPS incentivized" rows directly affect your Medicare payment adjustment. And the "Nice-to-have" features are rapidly becoming patient expectations -- especially online scheduling and telehealth.
For more on interoperability requirements, see our EHR interoperability guide.
Portal Engagement Strategies That Work
90% of organizations offer a portal. Only one-third of patients use it regularly. These strategies close the gap, ranked by expected impact.
| Strategy | Expected Impact | Cost | Timeline |
|---|---|---|---|
| Provider encouragement during visit 89% of encouraged patients access portal | Very High | Free | Immediate |
| Auto-enroll at check-in Eliminates "I didn't know how to sign up" barrier | Very High | Free | 1-2 weeks |
| Portal-first lab results Patients register to get results faster | High | Free | 1-2 weeks |
| Automated text reminders (3-7-14 day) 98% text open rate vs. 20% for email | High | $50-200/mo | 2-4 weeks |
| Enable online self-scheduling Drives repeat portal visits; 70% lower no-shows | High | Varies | 4-8 weeks |
| Designate a "portal champion" staff member In-person help for patients with low digital literacy | Medium | Staff time | Immediate |
| Multilingual portal content Addresses 37-point gap for non-English speakers | Medium | Varies | 1-3 months |
| Personalized health dashboards Graph trends in BP, A1c, weight over time | Medium | $$-$$$ | 3-6 months |
| AI chatbot for routine inquiries Handles 65% of routine questions automatically | Medium | $$$ | 3-6 months |
Start with the free strategies. Provider encouragement and auto-enrollment are the two highest-impact levers and they cost nothing. A practice that implements those two alone typically sees adoption climb from 30% to 55-65% within 6 months.
Once baseline adoption is strong, invest in self-scheduling and automated reminders. These features drive repeat engagement and have the largest operational ROI through no-show reduction and phone call deflection.
AI-Powered Portal Features in 2026
| AI Feature | Vendor | Status | What It Does |
|---|---|---|---|
| AI message draft assist | Epic MyChart | Live | Drafts responses to patient messages for clinician review |
| Plain-language record chat | Oracle Health | GA 2026 | Patients ask questions about diagnoses, labs, treatments in plain language |
| Health record Q&A | OpenAI (ChatGPT Health) | Live | Links portal data + Apple Health; answers grounded in actual patient records |
| AI care gap alerts | athenahealth | Live | Surfaces overdue screenings and vaccination reminders proactively |
| Automated symptom triage chatbot | Multiple vendors | Emerging | Handles routine inquiries, escalates complex questions to clinical staff |
| Multilingual AI translation | Multiple vendors | Emerging | Real-time translation of portal content and messages |
| Voice-enabled portal interaction | Pilot programs | Pilot | Speak to navigate portal, dictate messages, hear results read aloud |
Only 19% of medical practices currently use AI chatbots or virtual assistants for patient communication (MGMA, April 2025). But the global healthcare chatbot market is growing at 21.5% CAGR and reaching roughly $544 million by 2030. Early movers are seeing significant message triage benefits.
Proceed with caution: An AMA survey found 76% of physicians worry chatbots cannot meet all patient needs, 72% cite lack of emotional understanding, and 74% are concerned about inaccurate self-diagnosis. AI features should supplement clinical guidance, not replace it. Audit AI-generated portal content for accuracy and ensure patients understand the distinction.
What Patients Actually Want From Their Portal
| Rank | Feature | % Who Want It | % Who Have It | Gap |
|---|---|---|---|---|
| 1 | Lab results without delay | 94% | 88% | 6 pts |
| 2 | Online appointment scheduling | 89% | 58% | 31 pts |
| 3 | Secure messaging with provider | 86% | 92% | Surplus |
| 4 | Prescription refill requests | 82% | 78% | 4 pts |
| 5 | Cost estimates before visit | 78% | 32% | 46 pts |
| 6 | One portal for all providers | 76% | 7% | 69 pts |
| 7 | Bill pay from mobile | 74% | 65% | 9 pts |
| 8 | Plain-language explanations of results | 71% | 12% | 59 pts |
Sources: ASTP/ONC HINTS data (2024), MGMA patient surveys (2025), Accenture Digital Health Consumer Survey (2025).
The three largest gaps tell the story of where the industry needs to go. Patients overwhelmingly want consolidated access across providers (76% want it, 7% have it), upfront cost estimates (78% want, 32% have), and AI-powered plain-language explanations (71% want, 12% have).
Online scheduling is the most actionable gap for practices. 89% of patients want it, but only 58% of portals offer real-time self-scheduling (not just "request an appointment" forms). Practices that enable true self-scheduling see both higher portal engagement and 70% lower no-show rates for online-booked appointments.
The fragmentation problem is the biggest unmet need. 59% of patients have multiple portals, yet fewer than 7% use an aggregator like Apple Health to consolidate them. Encourage patients to link accounts to Apple Health or CommonHealth, and push your vendor for SMART on FHIR app support. Epic's Care Everywhere already enables cross-system MyChart record sharing -- if you are on Epic, make sure it is turned on.
Frequently Asked Questions
What patient portal features do patients use most?
The most-used features are viewing lab results and test reports (90% of portal users), secure messaging with providers (76%), prescription refill requests (64%), appointment scheduling (58%), and bill pay (47%). Lab results are the single strongest driver of portal adoption. Secure messaging delivers the most operational value for practices, reducing inbound phone volume by 20-30%.
What is the average patient portal adoption rate in 2026?
Nationally, 65% of patients offered a portal accessed it in 2024, up from 38% in 2020. The critical distinction is between enrollment and active use: while 90% of organizations offer portals, only 30-34% of patients log in six or more times per year. Top-performing practices achieve 80%+ enrollment by integrating portal sign-up into check-in and having providers personally recommend use.
How much do patient portals reduce no-shows?
Epic Research analyzed 1.6 billion outpatient visits in 2024 and found portal users had a 6.2% no-show rate vs. 7.9% for non-users -- a 21.5% relative reduction totaling 21 million fewer missed appointments. The greatest impact was among patients aged 50-64. At $175 average visit revenue, that translates to roughly $119,000 in annual recovered revenue for a 10-provider practice.
Are patient portals required by federal law?
No single law mandates portals, but the 21st Century Cures Act requires electronic patient access to all health information at no cost, and the Information Blocking Rule (penalties enforceable since 2024) prohibits restricting that access. MIPS Promoting Interoperability measures incentivize portal-based access and messaging. Together, these effectively require a functioning portal for any practice using certified EHR technology. Penalties include up to $1 million per violation for health IT developers and Medicare payment reductions for providers.
Which EHR has the best patient portal in 2026?
Epic MyChart leads with a 90.2 KLAS score and 150M+ users, offering the broadest feature set including cross-system record sharing, AI message drafts, and Apple Health integration. For independent and mid-size practices, athenahealth offers a strong cloud-native portal with automated care gap alerts. InteliChart (KLAS score 86.7) is the best EHR-agnostic option for practices wanting a portal upgrade without switching EHRs. See our top EHR vendors comparison for full details.
The Bottom Line
| Priority | Action | Impact |
|---|---|---|
| 1 | Have every provider recommend the portal during every visit | +30-35% adoption |
| 2 | Auto-enroll patients at check-in with staff-assisted mobile app download | +20-25% adoption |
| 3 | Enable true self-scheduling (not just appointment requests) | 70% fewer no-shows |
| 4 | Respond to portal messages within 8 hours (same business day) | +1.5 satisfaction pts |
| 5 | Verify USCDI v3 and information blocking compliance with your vendor | Avoids penalties |
The data is unambiguous: provider encouragement drives portal adoption more than any technology investment. A mediocre portal recommended by a trusted clinician will outperform the best portal that nobody mentions during the visit. Start there.
Then invest in mobile experience, online scheduling, and same-day message responses. With information blocking penalties now actively enforced and USCDI v3 expanding data access requirements, the cost of underinvesting in your portal strategy is rising every quarter.
Next Steps
- → Follow Our EHR Selection Process -- Includes portal evaluation criteria
- → Compare Top EHR Vendors -- Portal capabilities across platforms
- → EHR Interoperability Guide -- How FHIR and TEFCA affect your portal
- → Browse All EHR Vendors -- Detailed vendor profiles with portal ratings