Access policy and the digital divide in patient access to medical records

Ancker, Jessica S.; Nosal, Sarah; Hauser, Diane; Way, Christopher A.; Calman, Neil S.

doi:10.1016/j.hlpt.2016.11.004

Cited by 43 publications

(47 citation statements)

References 13 publications

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“…Migrants and those living more comfortably on present income are more likely to have an actual access to their EHR compared to those living less comfortably. As some studies highlight this might be linked to the ability to own technologies or broadband internet, or a higher awareness of their existence (10,16,38).…”

Section: Desire To Access Ehr and Actual Accessmentioning

confidence: 99%

“…At the moment, individuals who are aware of the existence of EHRs can voluntarily 375 access or they are invited to access their records by their clinicians. However, as evidenced 376 by Ancker et al, 2017, an opt-in policy of access to patient portals was associated with 377 socioeconomic disparities (10). Of course, for this policy to be fruitful more structural 378 factors have to be addressed such as access to a computer and the internet.…”

Section: Desire To Access Ehr and Actual Accessmentioning

confidence: 99%

“…84 85 However, even though individuals have physical access to the electronic health portals and 86 their EHRs, the uptake among certain socioeconomic and migrant populations has been 87 rather slow and socially patterned (5)(6)(7)(8). Health inequalities might thus be worsened by the 88 fact that technologies that facilitate self-management and patient engagement are used 89 more frequently by those who are already healthier and more socioeconomically 90 advantaged (9,10). To date, EHRs have been studied through two different approaches.…”

Section: Introductionmentioning

confidence: 99%

“…Those with a more advantaged socioeconomic position have a better access to digital technology and also more frequently have the skills required to used them, as compared to individuals from lower socioeconomic strata (7,12,18,19). Evidence, mainly from the United States, also suggests that racial and ethnic minority patients and those with lower incomes 108 are less likely to have access to and to adopt patient EHRs (10,18). Indeed, it is most likely 109 that those with higher incomes will have earlier access to material goods such as computers, portable health devices or various health monitoring software.…”

Section: Introductionmentioning

confidence: 99%

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Socioeconomic and behavioural factors associated with access to and use of patient Electronic Health Records: a cross-sectional analysis of four European countries.

Paccoud¹,

Baumann²,

Bihan³

et al. 2020

Preprint

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Background: Access to and use of digital technology are more common among people of higher socioeconomic status. These differences might be due to a lack of interest, not having physical access or having lower intentions to use this technology. By integrating the digital divide approach and the User Acceptance of Information Technology (UTAUT) model, this study aims to further our understanding of socioeconomic factors and the mechanisms linked to different stages in the use of individuals’ electronic health records (EHR): motivations, intentions and physical access to patients EHR.Methods: A cross-sectional online and in-person survey was undertaken in the areas of Lorraine (France), Luxembourg, Rhineland-Palatinate and Saarland (Germany), and Wallonia (Belgium). First, exploratory factor analysis was performed to group items derived from the UTAUT model. Next, we applied linear and logistic regressions controlling for country-level heterogeneity, health and sociodemographic factors.Results: A total of 829 individuals aged over 18 completed the questionnaire. We found evidence of socioeconomic inequalities in the access to and use of EHR. Education and income played a significant role in individual’s desire to access their EHR. Being older than 65 years, and migrant, were negatively related to the desire to access EHR. An income gradient was found in having a physical access to EHR, while for the subgroup of respondents who expressed desire to have access, higher educational level was positively associated with intentions to regularly use EHR. In fully adjusted model testing the contribution of UTAUT-derived factors, individuals who perceived EHRs to be useful and had the necessary digital skills were more inclined to use their EHR regularly. Social support and lack of anxiety in using technology were strong predictors of regular use of EHR.Conclusion: The findings highlight the importance of considering all stages in the use of EHR (desire, physical access, and regular use), while paying special attention to migrants and people with lower socioeconomic backgrounds who may not be able to exploit the potential of EHRs. As EHR use is expected to come with health benefits, facilitating access and regular use for those less inclined could lead to increases in health equity.

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Section: Desire To Access Ehr and Actual Accessmentioning

confidence: 99%

Section: Desire To Access Ehr and Actual Accessmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Socioeconomic and behavioural factors associated with access to and use of patient Electronic Health Records: a cross-sectional analysis of four European countries.

Paccoud¹,

Baumann²,

Bihan³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…43 Disadvantaged populations experience a higher burden of disease, and relatively low portal use among disadvantaged groups may worsen existing health disparities. 41,44 As portals gain in popularity, identifying strategies to reduce disparities in use is essential, to ensure portals benefit all populations. 41 To date, interventions designed to reduce disparities in portal use include universal access policies, 44 caregiver enrollment, 37 and computer literacy training.…”

Section: Background and Significancementioning

confidence: 99%

Technology Access, Technical Assistance, and Disparities in Inpatient Portal Use

et al. 2019

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Background Disadvantaged populations, including minorities and the elderly, use patient portals less often than relatively more advantaged populations. Limited access to and experience with technology contribute to these disparities. Free access to devices, the Internet, and technical assistance may eliminate disparities in portal use. Objective To examine predictors of frequent versus infrequent portal use among hospitalized patients who received free access to an iPad, the Internet, and technical assistance. Materials and Methods This subgroup analysis includes 146 intervention-arm participants from a pragmatic randomized controlled trial of an inpatient portal. The participants received free access to an iPad and inpatient portal while hospitalized on medical and surgical cardiac units, together with hands-on help using them. We used logistic regression to identify characteristics predictive of frequent use. Results More technology experience (adjusted odds ratio [OR] = 5.39, p = 0.049), less severe illness (adjusted OR = 2.07, p = 0.077), and private insurance (adjusted OR = 2.25, p = 0.043) predicted frequent use, with a predictive performance (area under the curve) of 65.6%. No significant differences in age, gender, race, ethnicity, level of education, employment status, or patient activation existed between the frequent and infrequent users in bivariate analyses. Significantly more frequent users noticed medical errors during their hospital stay. Discussion and Conclusion Portal use was not associated with several sociodemographic characteristics previously found to limit use in the inpatient setting. However, limited technology experience and high illness severity were still barriers to frequent use. Future work should explore additional strategies, such as enrolling health care proxies and improving usability, to reduce potential disparities in portal use.

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Effect of Electronic Outreach Using Patient Portal Messages on Well Child Care Visit Completion

Berset

Burkhardt

et al. 2022

JAMA Netw Open

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ImportanceOutreach messages to patients overdue for well child care (WCC) can be delivered different ways (ie, telephone calls and text messages). Use of electronic health record patient portals is increasingly common but their effectiveness is uncertain.ObjectiveTo determine the effectiveness of patient portal outreach messages, with and without the date of the last WCC, on the scheduling and completion of WCC visits and completion of vaccinations.Design, Setting, and ParticipantsAn intention-to-treat, multigroup, randomized clinical trial was conducted at 3 academic primary care practices from July 30 to October 4, 2021. The population included predominantly non-Hispanic Black, low-income children (age, 6-17 years) whose parent had an active portal account.InterventionsParticipants were randomized to the standard message, tailored message, or no message (control) group. Two messages were delivered to those in the message groups.Main Outcomes and MeasuresOutcomes included WCC visit scheduled within 2 weeks of the first intervention message, WCC visit completed within 8 weeks (primary outcome), and receipt of COVID-19 vaccine within 8 weeks.ResultsNine hundred forty-five patients participated (mean [SD] age, 9.9 [3.3] years, 493 [52.2%] girls, 590 [62.4%] non-Hispanic Black, 807 [85.4%] publicly insured). Scheduling rates were 18.4% in the standard message group (adjusted risk ratio [aRR], 1.97; 95% CI, 1.32-2.84) and 14.9% in the tailored message group (aRR, 1.57; 95% CI, 1.02-2.34) compared with the control group (9.5%). Well child care visit completion rates were 24.1% in the standard message group (aRR, 1.92; 95% CI, 1.38-2.60) and 19.4% in the tailored message group (aRR, 1.52; 95% CI, 1.06-2.13) compared with the control group (12.7%). Among eligible children, rates of receiving the COVID-19 vaccine were 16.7% in the standard message group compared with 4.8% in the tailored message (aRR, 3.41; 95% CI, 1.14-9.58) and 3.7% in the control groups (aRR, 4.84; 95% CI, 1.44-15.12).Conclusions and RelevanceIn this randomized clinical trial, outreach messages delivered via electronic health record patient portals increased the rates of scheduling and completing WCC visits and receiving the COVID-19 vaccine, providing a useful tool to help restore WCC in populations whose care was delayed during the pandemic.Trial RegistrationClinicalTrials.gov Identifier: NCT04994691

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Access policy and the digital divide in patient access to medical records

Cited by 43 publications

References 13 publications

Socioeconomic and behavioural factors associated with access to and use of patient Electronic Health Records: a cross-sectional analysis of four European countries.

Socioeconomic and behavioural factors associated with access to and use of patient Electronic Health Records: a cross-sectional analysis of four European countries.

Technology Access, Technical Assistance, and Disparities in Inpatient Portal Use

Effect of Electronic Outreach Using Patient Portal Messages on Well Child Care Visit Completion

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