Disparities in Electronic Health Record Patient Portal Use in Nephrology Clinics

Abstract

Background and objectives Electronic health record (EHR) patient portals allow individuals to access their medical information with the intent of patient empowerment. However, little is known about portal use in nephrology patients. We addressed this gap by characterizing adoption of an EHR portal, assessing secular trends, and examining the association of portal adoption and BP control (,140/90 mmHg).Design, setting, participants, & measurements Patients seen between January 1, 2010, and December 31, 2012, at any of four university-affiliated nephrology offices who had at least one additional nephrology follow-up visit before June 30, 2013, were included. Sociodemographic characteristics, comorbidities, clinical measurements, and office visits were abstracted from the EHR. Neighborhood median household income was obtained from the American Community Survey 2012.Results Of 2803 patients, 1098 (39%) accessed the portal. Over 87% of users reviewed laboratory results, 85% reviewed their medical information (e.g., medical history), 85% reviewed or altered appointments, 77% reviewed medications, 65% requested medication refills, and 31% requested medical advice from their renal provider. ConclusionWhile portal adoption appears to be increasing, greater attention is needed to understand why vulnerable populations do not access it. Future research should examine barriers to the use of e-health technologies in underserved patients with CKD, interventions to address them, and their potential to improve outcomes.

Electronic Health Record Patient Portals in CKD and Hypertension Management

“…In their article "Disparities in Electronic Health Record Patient Portal Use in Nephrology Clinics," Jhamb et al (11) examined the use of an electronic health record (EHR) portal among patients cared for by four university-affiliated nephrology practices, including 24 nephrologists. Jhamb et al (11) report results on two related but conceptually distinct domains: (1) descriptive analyses of secular trends and socioeconomic determinants of use (i.e., was the portal used less by those who were poorer, older, or from underserved minorities?)…”

“…Jhamb et al (11) report results on two related but conceptually distinct domains: (1) descriptive analyses of secular trends and socioeconomic determinants of use (i.e., was the portal used less by those who were poorer, older, or from underserved minorities?) and (2) analyses of the effect of the portal on BP control (i.e., did the portal make a difference on probably the most important modifiable risk factor in CKD management?).…”

“…and (2) analyses of the effect of the portal on BP control (i.e., did the portal make a difference on probably the most important modifiable risk factor in CKD management?). Jhamb et al (11) succeed on the first domain by showing stark disparities in portal adoption, but ultimately fail to make the case that the portal influenced clinical outcomes. The report is nevertheless important and timely and highlights action items for the optimal use of technology in CKD care.…”

“…Over a 3-year period, several months after portal launch, Jhamb et al (11) studied whether and how the portal was used by 2803 patients. Patients were invited to sign up for the portal by staff during appointment check in, and 5th to 6th grade-level materials were displayed.…”

“…As Jhamb et al point out, it is not surprising that disadvantaged patient populations are at risk for portal adoption failure and potentially worse clinical outcomes given the established disparities in both access to technology (12) and delivery of kidney disease care among these patients (13). Shedding light on how implementation of technology-based care innovations can introduce further inequities in care delivery for a condition where stark disparities already exist is an important finding of the study by Jhamb et al The study shows that portals could perversely widen existing disparities in care by advantaging those who are already at an advantage, while not helping the disadvantaged (11). These findings illustrate the importance of incorporating strategies inclusive of vulnerable patient populations when implementing care delivery interventions.…”