Determinants of Use of the Care Information Exchange Portal: Cross-sectional Study

Abstract

Background Sharing electronic health records with patients has been shown to improve patient safety and quality of care. Patient portals represent a convenient tool to enhance patient access to their own health care data. However, the success of portals will only be possible through sustained adoption by its end users: the patients. A better understanding of the characteristics of users and nonusers is critical for understanding which groups remain excluded from using such tools. Objective This study aims to identify the determinants of the use of the Care Information Exchange, a shared patient portal program in the United Kingdom. Methods A cross-sectional study was conducted using a web-based questionnaire. Information collected included age, gender, ethnicity, educational level, health status, postcode, and digital literacy. Registered individuals were defined as having had an account created in the portal, independent of their actual use of the platform; users were defined as having ever used the portal. Multivariate logistic regression was used to model the probability of being a user. Statistical analysis was performed in R and Tableau was used to create maps of the proportion of Care Information Exchange users by postcode area. Results A total of 1083 participants replied to the survey (186% of the estimated minimum target sample). The proportion of users was 61.58% (667/1083). Among these, most (385/667, 57.7%) used the portal at least once a month. To characterize the system’s users and nonusers, we performed a subanalysis of the sample, including only participants who had provided at least information regarding gender and age. The subanalysis included 650 individuals (389/650, 59.8% women; 551/650, 84.8% >40 years). Most participants were White (498/650, 76.6%) and resided in London (420/650, 64.6%). Individuals with a higher educational degree (undergraduate and professional, or postgraduate and higher) had higher odds of being a portal user (adjusted odds ratio [OR] 1.58, 95% CI 1.04-2.39 and OR 2.38, 95% CI 1.42-4.02, respectively) compared with those with a secondary degree or below. Higher digital literacy scores (≥30) were associated with higher odds of being a user (adjusted OR 2.96, 95% CI 2.02-4.35). Those with a good overall health status had lower odds of being a user (adjusted OR 0.58, 95% CI 0.37-0.91). Conclusions This work adds to the growing body of evidence highlighting the importance of educational aspects (educational level and digital literacy) in the adoption of patient portals. Further research should not only describe but also systematically address these inequalities through patient-centered interventions aimed at reducing the digital divide. Health care providers and policy makers must partner in investing and delivering strategic programs that improve access to technology and digital literacy in an effort to improve digital inclusion and reduce inequities in the delivery of care.

Patients’ Willingness and Ability to Identify and Respond to Errors in Their Personal Health Records: Mixed Methods Analysis of Cross-sectional Survey Data

“…Equitable patient involvement in error surveillance is, on a basic level, contingent on all patients being able to access and understand PHR information. The characteristics of our sample are consistent with those of previous studies, reinforcing a distinct demographic profile associated with portal use, with users tending to be female, older, highly educated, with higher digital health literacy [ 14 , 22 , 23 , 41 ]. Previous studies have demonstrated that patients who struggle to use web-based information for health purposes are less likely to use PHR systems and that lacking these eHealth literacy skills may contribute to adverse health outcomes [ 23 , 42 - 44 ].…”

“…The characteristics of our sample are consistent with those of previous studies, reinforcing a distinct demographic profile associated with portal use, with users tending to be female, older, highly educated, with higher digital health literacy [ 14 , 22 , 23 , 41 ]. Previous studies have demonstrated that patients who struggle to use web-based information for health purposes are less likely to use PHR systems and that lacking these eHealth literacy skills may contribute to adverse health outcomes [ 23 , 42 - 44 ]. Our analysis reveals that patients with lower digital health literacy are also less likely to understand the information held in the PHR, which may partly explain the health disparities observed in this patient group.…”

“…In 2018, the CIE was rolled out to the diverse 2.3 million patients treated in North West London. At the time of this survey, the CIE held patient information from both hospitals and general practitioner practices in North West London, and records from 15 hospitals outside London—in Birmingham, Bristol, Liverpool, Manchester, Scotland, and Wales [ 23 ].…”

“…We have previously characterized individuals registered with the CIE and evaluated the differences between users and nonusers of the CIE with respect to their sociodemographic characteristics, health status, and motivation related to being involved in their own care [ 23 ]. Our findings highlight the importance of addressing educational aspects (educational level and digital literacy) to ensure equitable and sustainable portal adoption [ 23 ]. Building on this previous work, we sought to understand how portal use could be leveraged to improve patient safety and care quality.…”

Digital technologies in primary care: Implications for patient care and future research

“…Equally, special attention must be paid to disparities in access and use of electronic health records by low-income, racial and ethnic minorities, lower literate and linguistically diverse populations [ 12 ]. Recently, we have evaluated the determinants of usage of the Care Information Exchange (the largest shared patient portal programme in the UK, hosting the records of over 2.3 million people living in North West London) and observed that individuals with a higher educational degree or higher digital literacy scores had higher odds of being a portal user [ 13 ]. It is critical that further research systematically addresses these inequalities through patient-centred interventions aiming to reduce the digital divide and engage effectively with underserved or excluded groups of patients.…”