Electronic patient portals give patients access to information from their electronic health record and the ability to message their providers. These tools are becoming more widely used and are expected to promote patient engagement with health care.
To quantify portal usage and explore potential differences in adoption and use according to patients' socioeconomic and clinical characteristics in a network of federally qualified health centers serving New York City and neighboring counties.
Retrospective analysis of data from portal and electronic health records.
74,368 adult patients seen between April 2008 and April 2010.
Odds of receiving an access code to the portal, activating the account, and using the portal more than once
Over the 2 years of the study, 16% of patients (n = 11,903) received an access code. Of these, 60% (n = 7138) activated the account, and 49% (n = 5791) used the account two or more times. Patients with chronic conditions were more likely to receive an access code and to become repeat users. In addition, the odds of receiving an access code were significantly higher for whites, women, younger patients, English speakers, and the insured. The odds of repeat portal use, among those with activated accounts, increased with white race, English language, and private insurance or Medicaid compared to no insurance. Racial disparities were small but persisted in models that controlled for language, insurance, and health status.
We found good early rates of adoption and use of an electronic patient portal during the first 2 years of its deployment among a predominantly low-income population, especially among patients with chronic diseases. Disparities in access to and usage of the portal were evident but were smaller than those reported recently in other populations. Continued efforts will be needed to ensure that portals are usable for and used by disadvantaged groups so that all patients benefit equally from these technologies.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Kaelber DC, Jha AK, Johnston D, Middleton B, Bates DW. A research agenda for personal health records (PHRs). J Am Med Inform Assoc. 2008;15(6):729–36.
Kaelber DC, Shah S, Vincent A, Pan E, Hook JM, Johnston D, et al. The Value of Personal Health Records. Charlestown, MA: Center for Information Technology Leadership, Healthcare Information and Management System Society (HIMSS); 2008.
Nazi KM, Hogan TP, Wagner TH, McInnes DK, Smith BM, Haggstrom D, et al. Embracing a health services research perspective on personal health records: lessons learned from the VA My HealtheVet System. J Gen Intern Med. 2009;25(Suppl 1):62–7.
The Markle Foundation. Connecting for Health: A Public-Private Collaborative: The Markle Foundation; 2003.
Undem T. Consumers and health information technology: A national survey. Oakland, CA: California HealthCare Foundation; 2010.
Halamka JD, Mandl KD, Tang PC. Early experiences with personal health records. J Am Med Informat Assoc. 2008;15(1):1–7.
Centers for Medicare and Medicaid Services. Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Proposed Rule. In: Services DoHaH, editor.: Federal Register; 2010 (January 13).
Smith A. Home Broadband Adoption 2010. Washington, DC: Pew Internet & American Life Project; 2010.
Poynton T. Computer literacy across the lifespan: a review with implications for educators. Comput Hum Behav. 2005;21:861–72.
Nielsen-Bohlman L, Panzer AM, Kindig DA, Editors, Committee on Health Literacy. Health Literacy: A Prescription to End Confusion. Washington, DC: Institute of Medicine. The National Academies Press. 2004.
Zarcadoolas C, Pleasant A, Greer DS. Understanding health literacy: an expanded model. Health Promot Int. 2005;20(2):195–203.
Ancker JS, Kaufman DR. Rethinking health numeracy: A multidisciplinary literature review. J Am Med Informat Assoc. 2007;14(6):713–21.
Hesse B, Nelson D, Kreps G, Croyle R, Arora N, Rimer B, et al. Trust and sources of health information: the impact of the Internet and its implications for health care providers: findings from the first Health Information National Trends Survey. Arch Intern Med. 2005;165(22):2618–24.
Jacobs E, Rolle I, Ferrans C, Whitaker E, Warnecke R. Understanding African Americans’ views of the trustworthiness of physicians. J Gen Intern Med. 2006;21(6):642–7.
Miller H, Vandenbosch B, Ivanov D, Black P. Determinants of personal health record use. J Healthc Inform Manag. 2007;21(3):44–8.
Roblin DW, Houston TK, 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):683–9.
Kahn JS, Hilton JF, Nunnery TV, Leasure S, Bryant KM, Hare CB, et al. Personal health records in a public hospital: experience at the HIV/AIDS clinic at San Francisco General Hospital. J Am Med Inform Assoc. 2010;17:224–8.
Zickmund SL, Hess R, Bryce CL, McTigue K, Olshansky E, Fitzgerald K, et al. Interest in the use of computerized patient portals: Role of the provider-patient relationship. J Gen Intern Med. 2007;23(Suppl 1):20–6.
Winkelman W, Leonard K, Rossos P. Patient-perceived usefulness of online electronic medical records: Employing grounded theory in the development of information and communication technologies for use by patients living with chronic illness. J Am Med Informat Assoc. 2005;12:306–14.
Leveille SG, Huang A, Tsai SB, Weingart SN, Iezzoni LI. Screening for chronic conditions using a patient Internet portal: recruitment for an Internet-based primary care intervention. J Gen Intern Med. 2007;23(4):472–5.
Weingart SN, Rind D, Tofias Z, Sands DZ. Who uses the patient Internet portal? Journal of the Medical Informatics Association (Symposium Supplement): The PatientSite experience; 2005.
Hassol A, Walker JM, Kidder D, Rokita K, Young D, Pierdon S, et al. Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging. J Am Med Informat Assoc. 2004;11(6):505–13.
This work was funded by HRSA grant 1 H2HIT086130101. A portion of the descriptive statistics was presented at the annual symposium of the American Medical Informatics Association, November 16, 2010, Washington DC. During a portion of the study, Dr. Ancker was supported by NLM training grant T15-LM007079.
Conflict of interest
About this article
Cite this article
Ancker, J.S., Barrón, Y., Rockoff, M.L. et al. Use of an Electronic Patient Portal Among Disadvantaged Populations. J GEN INTERN MED 26, 1117–1123 (2011). https://doi.org/10.1007/s11606-011-1749-y
- personal health record
- health information technology
- health disparities
- chronic illness
- insurance status