Disparities in Patient-Reported Interest in Web-Based Patient Portals: Survey at an Urban Academic Safety-Net Hospital

Abstract

Background Offering hospitalized patients’ enrollment into a health system’s patient portal may improve patient experience and engagement throughout the care continuum, especially across care transitions, but this process is less studied than portal engagement in the ambulatory setting. Patient portal disparities exist and may lead to differences in access or outcomes. As such, it is important to study upstream factors in a typical hospital workflow that could lead to those disparities in safety-net settings. Objective The objective of this study was to evaluate sociodemographic characteristics associated with interest in a health care system’s portal among hospitalized patients and reasons for no interest. Methods Nurses assessed interest in a Web-based patient portal, expressed by the patient as “yes” or “no,” as part of the admission nursing assessment among patients at an academic urban safety-net hospital and recorded responses in the electronic health record (EHR), including reasons for no interest. We extracted patient responses from the EHR. Results Among 23,994 hospitalizations over a 2-year period, 35.90% (8614/ 23,994) reported an interest in a Web-based portal. Reasons for no interest included the following: not interested/other reason 41.68% (6410/15,380), no ability to use/access computers/internet 29.59% (4551/15,380), doesn’t speak English 11.15% (1715/15,380), physically or mentally unable 8.70% (1338/15,380), does not want to say 8.70% (1338/15,380), security concerns 0.03% (4/15,380), and not useful 0.16% (24/15,380). Among the 16,507 unique patients included in this sample, portal interest was lower in older, African American, non-English speaking, and homeless patient populations. Conclusions In a safety-net system, patient interest at the time of hospitalization in a Web-based enterprise portal—a required step before enrollment—is low with significant disparities by sociodemographic characteristics. To avoid worsening the digital divide, new strategies are needed and should be embedded within routine workflows to engage vulnerable safety-net patients in the use of Web-based health technologies.

Patient Portal Functionalities and Uptake: Systematic Review Protocol

“…Patient portals are generally offered through the primary care providers, but can also be offered in hospital care, or during acute care [ 3 ]. The technology provides some benefits to patients and the health care system.…”

Patient Portal Barriers and Group Differences: Cross-Sectional National Survey Study (Preprint)

“…On the other hand, patients with a usual source of care, those having better patient-provider communication, and those with multiple chronic conditions are more likely to adopt patient portals [29,31,32]. Studies have also enumerated many barriers to adoption, such as computer literacy, lack of internet access, privacy concerns, difficulty logging in, and presence of different portals for different providers [33][34][35][36][37][38][39][40][41][42][43]. Many of these studies, however, involved small samples, limiting the ability to discern which barriers are most prominent and which patient subgroups are most likely to experience a specific barrier.…”

Factors influencing users’ perceived value of Electronic Health Record Patient Portals

“…According to a study involving almost 24,000 participants in an urban hospital, 64% of respondents were not interested in using an EHR portal (Sadasivaiah, Lyles, Kiyoi, Wong, & Ratanawongsa, 2019). About 30% of those who were not interested in using portals reported a lack of regular internet access.…”

“…About 30% of those who were not interested in using portals reported a lack of regular internet access. In contrast, only a small percentage reported security concerns or perceived the EHR portal to be useless (0.03% and 0.16% respectively) (Sadasivaiah et al, 2019). Trust in the EHR portals is another commonly examined factor to understand how patient portals are used (Lyles et al, 2013;Sieck, Hefner, & McAlearney, 2018).…”