Otte-Trojel et al. BMC Health Services Research (2015) 15:559 DOI 10.1186/s12913-015-1208-2 RESEARCH ARTICLE Open Access The organizational dynamics enabling patient portal impacts upon organizational performance and patient health: a qualitative study of Kaiser Permanente Terese Otte-Trojel1,4*, Thomas G. Rundall2, Antoinette de Bont1, Joris van de Klundert1 and Mary E. Reed3.