Differential Effects of Outpatient Portal User Status on Inpatient Portal Use: Observational Study

Fareed, Naleef; Jonnalagadda, Pallavi; MacEwan, Sarah R.; Tosto, Gennaro Di; Scarborough, Seth; Huerta, Timothy R.; McAlearney, Ann Scheck

doi:10.2196/23866

Cited by 2 publications

(3 citation statements)

References 34 publications

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“…First, it is reasonable to believe that the racial digital divide will widen because of well-entrenched personal factors. One of the most important personal factors in SCT is self-efficacy, defined as beliefs about one's ability to perform a specific task [36][37][38]. Prior literature suggests that self-efficacy is an important precursor to the adoption of new technologies, particularly in health care contexts such as mobile health (mHealth) apps [39] and telemedicine services [40].…”

Section: Accelerated Digitization and Racial Digital Dividementioning

confidence: 99%

The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study

Mai¹,

Ko²,

Shan³

et al. 2023

J Med Internet Res

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Background Prior research on the digital divide has documented substantial racial inequality in using web-based health resources. The recent COVID-19 pandemic led to accelerated mass digitization, raising alarms that underprivileged racial minority groups are left further behind. However, it is unclear to what extent the use of health information and communications technology by underprivileged racial minority groups is affected. Objective We have considered the COVID-19 disruption as a rare exogenous shock and estimated the impact of the accelerated digitization on the quantity and variety of patient portal use. In this study, we aimed to answer the following 2 key research questions. Did patients alter their use of health information and communications technology owing to COVID-19–induced digital acceleration? Does the effect differ across racial lines? Methods We used a longitudinal patient portal use data set gathered from a large urban academic medical center to explore the effect of accelerated digitization on the racial digital gap in health care. We limited the sample period of our study to 2 same periods (March 11 to August 30) in 2019 and 2020. Our final sample consisted of 25,612 patients belonging to 1 of the 3 racial groups: Black or African American (n=5157, 20.13%), Hispanic (n=253, 0.99%), and White (n=20,202, 78.88%) patients. We estimated the panel data regression using 3 different models: pooled ordinary least squares (OLS), random effect (RE), and fixed effect (FE). Results Our study yielded 4 findings. First, we confirmed that the racial digital divide remains a significant issue for telehealth; underprivileged racial minority group patients had lower patient portal use than White patients before the pandemic (Minority: OLS, β=−.158; P<.001; RE, β=−.168; P<.001). Second, we found that the digital gap regarding patient portal use frequency between underprivileged racial minority groups and White patients is shrinking rather than widening after the COVID-19 pandemic started (COVID_Period×Minority: OLS, β=.028; P=.002; RE, β=.037; P<.001; FE, β=.043; P<.001). Third, the shrinking gap is foremost driven by access through mobile (vs desktop) devices (COVID_Period×Minority: web, β=−.020; P=.02; mobile, β=.037; P<.001). Finally, underprivileged racial minority groups expanded their use of a variety of portal functionalities faster than White patients during the pandemic (COVID_Period×Minority [for functionality]: OLS, β=−.004; P<.001; RE, β=−.004; P<.001; FE, β=−.003; P=.001). Conclusions Using the COVID-19 pandemic as a natural experiment, we offer empirical evidence that accelerated digitization has shrunk the racial digital divide in telehealth, and the trend is mostly driven by mobile devices. These findings provide new insights into the digital behaviors among underprivileged racial minority groups during accelerated digitization. They also offer policy makers an opportunity to identify new strategies to help close the racial digital gap in the postpandemic world.

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Section: Accelerated Digitization and Racial Digital Dividementioning

confidence: 99%

The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study

Mai¹,

Ko²,

Shan³

et al. 2023

J Med Internet Res

View full text Add to dashboard Cite

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Section: Discussionmentioning

confidence: 99%

“…Acute care episodes may be an opportunity to increase health literacy using inpatient portals through assisted registration processes and education. Research on the continuum of outpatient to inpatient portal use is important to identify other factors that may increase portal use [25,34]. Furthermore, since this review identified conflicting perspectives regarding the significance of educational resources for patients through the portal, more research should be done on the types of educational resources that may be valuable to patients and physicians alike.…”

Section: Future Directionsmentioning

confidence: 99%

Physicians’ Perspectives on Inpatient Portals: Systematic Review

Banguilan¹,

Sonnenberg²,

Chen³

2022

Interact J Med Res

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Background Inpatient portals are online platforms that allow patients to access their personal health information and monitor their health while in the acute care setting. Despite their potential to improve quality of care and empower patients and families to participate in their treatment, adoption remains low. Outpatient portal studies have shown that physician endorsement can drive patients' adoption of these systems. Insights on physicians’ perspectives on use of these platforms can help improve patient and physician satisfaction and inpatient portal uptake. Objective The purpose of this systematic review is to better understand physicians’ perspectives toward inpatient portals. Methods A systematic literature review was conducted for studies published between 1994 and November 2021 using keywords for physicians’ perspectives toward patient portals and personal health records. Databases included PubMed, MEDLINE, Web of Science, and Scopus. Articles solely focused on nonphysician clinicians or addressing only outpatient settings or shared notes were excluded from this review. Two reviewers performed title, abstract, and full-text screening independently. Bias assessment was performed using the JBI SUMARI Critical Appraisal Tool (Joanna Briggs Institute). Inductive thematic analysis was done based on themes reported by original authors. Data were synthesized using narrative synthesis and reported according to overarching themes. Results In all, 4199 articles were collected and 9 included. All but 2 of the studies were conducted in the United States. Common themes identified were communication and privacy, portal functionality and patient use, and workflow. In studies where physicians had no prior patient portal experience, concerns were expressed about communication issues created by patients’ access to laboratory results and potential impact on existing workflow. Concerns about negative communication impacts were not borne out in postimplementation studies. Conclusions Physicians perceived inpatient portals to be beneficial to patients and saw improvement in communication as a result. This is consistent with outpatient studies and highlights the need to improve training on portal use and include physicians during the design process. Health care organizations and information technology entities can take steps to increasing clinician comfort. Physician concerns involving patient portal usage and managing patient expectations also need to be addressed. With improved clinician support, initial pessimism about communication and workload issues can be overcome. Limitations of this review include the small number of pre- and postimplementation studies found. This is also not a review of perspectives on open notes, which merits separate discussion.

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Differential Effects of Outpatient Portal User Status on Inpatient Portal Use: Observational Study

Cited by 2 publications

References 34 publications

The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study

The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study

Physicians’ Perspectives on Inpatient Portals: Systematic Review

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