Ensuring Equitable Access to Patient Portals—Closing the “Techquity” Gap

Abstract

Over the past 25 years, patient portals have expanded from small demonstration projects, such as seminal work by Masys et al 1 and Cimino et al, 2 to nearly ubiquitous components of electronic health records. This success has been associated with several factors, including regulatory pressures-eg, the Meaningful Use program and the 21st Century Cures Act-and recent changes to health care delivery models supporting asynchronous and virtual telehealth care. Use of patient portals is also influenced by important but relatively understudied cultural changes in people's expectations of seamless access to all data, including banking, entertainment, social media, and health data.Recent studies suggest that patient portal access is associated with greater engagement by patients in their health care. 3 For patients, being in a partnership with a health care team implies full access to one's health information, participation in decision-making, and engaging in self-managed health care. Today's portals enable this degree of partnership by sharing access to most electronic clinical information, including test results, clinical notes taken by health care professionals, and information regarding the patient's general health management. Modern patient portals also uniformly provide patients with tools to send secure messages to their health care team in the context of their medical record, to manage their prescription renewals, arrange appointments, and pay their bills. In many cases, patient portals have become a source of context-based educational materials for many patients and have offered interfaces that support self-management of chronic diseases such as hypertension and diabetes.Adoption and use of patient portals have surged in the US in the past 5 years, making them a crucial channel for timely health care access. 4 They now facilitate various health care services, including telehealth, virtual visits, secure messaging, preventive care alerts, previsit screening forms, and patient-reported outcome measures. Patient portals are no longer a tool for only motivated and engaged patients who wish to partner with their health care professionals. Instead, portals are now central to how basic health care services are delivered. For example, patients increasingly use portal-based secure messaging rather than calling the physician's office; they pay bills via a portal rather than mailing checks; and they schedule clinical visits and ancillary testing primarily using a portal.A concerning trend has emerged with the growing reliance on digital health care tools. The concept of "techquity" underscores the need for technology solutions to enhance health equity, but persistent evidence reveals disparities in patient portal access and utilization. 5 The current user community is overrepresented by middle-aged, English-speaking, affluent, and educated White women. 6 This digital divide is especially pronounced among historically marginalized groups, such as Black, Hispanic, and non-English-speaking individuals, who have faced long-stan...

Socioeconomic and demographic patterning of family uptake of a paediatric electronic patient portal innovation

“…We identified 3687 eligible patients, of whom 48% were female (table 1). 9) Pre-school (2)(3)(4) 640 (17) Early childhood (5)(6)(7)(8)(9)(10) 1423 (39) Late childhood (11)(12)(13)(14)(15) 1293 ( The median age of the patient cohort was 8 years (interquartile range, IQR 4 to 12, range 0 to 18 years). There were a diverse range of eye conditions, including inflammatory ocular disease (796, 22%), cataract (342, 9%), and glaucoma (132, 4%).…”

“…3 Increasingly, these barriers are being addressed in the attempt to improve patient care and experience. 4–7…”

Enhanced Patient Portal Engagement Associated with Improved Weight Loss Outcomes in Post-Bariatric Surgery Patients

“…These findings align with prior study, which indicates that portal may be a source of context-based educational materials for self-management. [12] While “Billing” and “other functions” showed positive associations with %BMI reduction, they frequently co-occurred with other functions. In particular, “Billing” and “other functions” occurred together with “Visit” functions in 92% and 90% active days, respectively, suggesting that their statistical significance may be an artifact of metric design rather than evidence of clinically meaningful postoperative patient engagement through the portal.…”

“…Growing evidence underscores the efficacy of portal usage in delivering continuous support and guidance, monitoring key indicators related to primary interventions, enhancing medication adherence, and fostering self-management in promoting behavioral and lifestyle modifications. [11,12] Despite the reported merits of patient portal usage in general settings of care, its application to bariatric surgery has not been evaluated. In particular, there remains a gap in understanding the link between patient portal engagement and weight loss following bariatric surgery.…”

Automating Responses to Patient Portal Messages Using Generative AI

“…1 With the rapid adoption of patient portal messaging during the COVID-19 pandemic, 2 the continually increasing volume of in-basket patient messages has emerged as a pressing issue in the healthcare sector that appears to be exacerbating health care provider burnout. 1,[3][4][5] First documented in 1974, physician burnout has been linked to the demands of EHR documentation, consuming substantial clinical time. 3,6 Primary care providers face uniquely heightened burnout risks among all HCPs, emphasizing the pressing need for interventions to alleviate EHR-related burdens and support clinician well-being.…”