Journal of General Internal Medicine

, Volume 26, Issue 10, pp 1112–1116 | Cite as

Disparities in Enrollment and Use of an Electronic Patient Portal

  • Mita Sanghavi Goel
  • Tiffany L. Brown
  • Adam Williams
  • Romana Hasnain-Wynia
  • Jason A. Thompson
  • David W. Baker
Original Research



With emphasis on the meaningful use of electronic health records, patient portals are likely to become increasingly important. Little is known about patient enrollment in, and use of, patient portals after explicit invitation from providers.


To examine enrollment in, and use of, an electronic patient portal by race/ethnicity, gender and age.


Observational, cross sectional study.


Patients with attending physicians seen at one urban, academic primary care practice between May 2008 and October 2009 who received electronic orders inviting their participation in an electronic patient portal.

Main Measures

(a) Enrollment in the patient portal, (b) Solicitation of provider advice among enrollees, (c) Requests for medication refills among enrollees.

Key Results

Overall, 69% of 7,088 patients enrolled in the patient portal. All minority patients were significantly less likely to enroll than whites: 55% blacks, 64% Latinos and 66% Asians compared with 74% whites (chi-square p < 0.05 for all pairwise comparisons). These disparities persisted in adjusted analyses, although differences for Asians were no longer significant. In addition, the oldest patients were less likely to enroll than the youngest (adjusted OR 0.79, 95% CI 0.65–0.97). Although there were no racial/ethnic disparities in use of the patient portal among enrollees, we found differences by age and gender. The youngest patients were significantly less likely to solicit provider advice or request medication refills than any other age group in unadjusted and adjusted analyses. Similarly, male patients were less likely to solicit provider advice than women in all analyses.


Large racial/ethnic disparities were seen in enrollment in our patient portal. Among enrollees, use of the portal was similar by race/ethnicity, but not by age or gender. Future efforts to expand use of the patient portal need to address potential mechanisms for these disparities to ensure this technology is accessible to diverse patient populations.

Key Words

race/ethnicity disparities Electronic Health Record patient portal 



This research was supported entirely by internal funds.

Initial results for this research were presented at that Midwest Society of General Internal Medicine Conference in Chicago, September 2010.

Conflicts of Interest

None disclosed.


  1. 1.
    Health IT Policy Committee. Electronic health records and meaningful use. Accessed April 13, 2011.
  2. 2.
    Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness: the chronic care model, Part 2. JAMA. 2002;288(15):1909–1914.PubMedCrossRefGoogle Scholar
  3. 3.
    Roblin DW, Houston TK 2nd, Allison JJ, Joski PJ, Becker ER. Disparities in use of a personal health record in a managed care organization. J Am Med Inform Assoc. 2009;16(5):683–689.PubMedCrossRefGoogle Scholar
  4. 4.
    Hsu J, Huang J, Kinsman J, et al. Use of e-Health services between 1999 and 2002: a growing digital divide. J Am Med Inform Assoc. 2005;12(2):164–171.PubMedCrossRefGoogle Scholar
  5. 5.
    Sarkar U, Karter AJ, Liu JY, et al. The literacy divide: health literacy and the use of an internet-based patient portal in an integrated health system-results from the diabetes study of northern California (DISTANCE). J Health Commun. 2010;15(Suppl 2):183–196.PubMedCrossRefGoogle Scholar
  6. 6.
    Weingart SN, Rind D, Tofias Z, Sands DZ. Who uses the patient internet portal? The PatientSite experience. J Am Med Inform Assoc. 2006;13(1):91–95.PubMedCrossRefGoogle Scholar
  7. 7.
    Mossberger K, Tolbert C.Digital Excellence in Chicago: A city wide view of technology use. Chicago2009Google Scholar
  8. 8.
    Bertakis KD. The influence of gender on the doctor-patient interaction. Patient Educ Couns. 2009;76(3):356–360.PubMedCrossRefGoogle Scholar
  9. 9.
    Owens GM. Gender differences in health care expenditures, resource utilization, and quality of care. J Manag Care Pharm. 2008;14(3 Suppl):2–6.PubMedGoogle Scholar
  10. 10.
    Fremont AM, Bierman A, Wickstrom SL, et al. Use of geocoding in managed care settings to identify quality disparities. Health Aff (Millwood). 2005;24(2):516–526.CrossRefGoogle Scholar
  11. 11.
    Geronimus AT, Bound J, Neidert L. On the validity of using census geocode characteristics to proxy individual socioeconomic characteristics. J Am Stat Assoc. 1996;91(434):8.CrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Mita Sanghavi Goel
    • 1
  • Tiffany L. Brown
    • 1
  • Adam Williams
    • 1
  • Romana Hasnain-Wynia
    • 2
  • Jason A. Thompson
    • 1
  • David W. Baker
    • 1
  1. 1.Division of General Internal Medicine, Feinberg School of MedicineNorthwestern UniversityChicagoUSA
  2. 2.Center for Healthcare Equity, Institute for Healthcare Studies, Feinberg School of MedicineNorthwestern UniversityChicagoUSA

Personalised recommendations