Use of an Electronic Patient Portal Among Disadvantaged Populations

Abstract

BACKGROUND

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.

OBJECTIVE

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.

DESIGN

Retrospective analysis of data from portal and electronic health records.

PARTICIPANTS

74,368 adult patients seen between April 2008 and April 2010.

MAIN MEASURES

Odds of receiving an access code to the portal, activating the account, and using the portal more than once

KEY RESULTS

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.

CONCLUSIONS

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.

References

  1. 1.

    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.

    PubMed  Article  Google Scholar 

  2. 2.

    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.

  3. 3.

    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.

    Google Scholar 

  4. 4.

    The Markle Foundation. Connecting for Health: A Public-Private Collaborative: The Markle Foundation; 2003.

  5. 5.

    Undem T. Consumers and health information technology: A national survey. Oakland, CA: California HealthCare Foundation; 2010.

    Google Scholar 

  6. 6.

    Halamka JD, Mandl KD, Tang PC. Early experiences with personal health records. J Am Med Informat Assoc. 2008;15(1):1–7.

    Article  Google Scholar 

  7. 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).

  8. 8.

    Smith A. Home Broadband Adoption 2010. Washington, DC: Pew Internet & American Life Project; 2010.

    Google Scholar 

  9. 9.

    Poynton T. Computer literacy across the lifespan: a review with implications for educators. Comput Hum Behav. 2005;21:861–72.

    Article  Google Scholar 

  10. 10.

    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.

  11. 11.

    Zarcadoolas C, Pleasant A, Greer DS. Understanding health literacy: an expanded model. Health Promot Int. 2005;20(2):195–203.

    PubMed  Article  Google Scholar 

  12. 12.

    Ancker JS, Kaufman DR. Rethinking health numeracy: A multidisciplinary literature review. J Am Med Informat Assoc. 2007;14(6):713–21.

    Article  Google Scholar 

  13. 13.

    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.

    PubMed  Article  Google Scholar 

  14. 14.

    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.

    PubMed  Article  Google Scholar 

  15. 15.

    Miller H, Vandenbosch B, Ivanov D, Black P. Determinants of personal health record use. J Healthc Inform Manag. 2007;21(3):44–8.

    Google Scholar 

  16. 16.

    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.

    PubMed  Article  Google Scholar 

  17. 17.

    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.

    PubMed  Article  Google Scholar 

  18. 18.

    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.

    Google Scholar 

  19. 19.

    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.

    Article  Google Scholar 

  20. 20.

    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.

    Article  Google Scholar 

  21. 21.

    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.

    Google Scholar 

  22. 22.

    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.

    Article  Google Scholar 

Download references

Acknowledgments

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

None disclosed.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Jessica S. Ancker MPH, PhD.

Rights and permissions

Reprints and Permissions

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

Download citation

KEY WORDS

  • personal health record
  • health information technology
  • health disparities
  • chronic illness
  • insurance status