Patient portals and broadband internet inequality

Perzynski, Adam T.; Roach, Mary Joan; Shick, Sarah; Callahan, Bill; Gunzler, Douglas D.; Cebul, Randall D.; Kaelber, David C.; Huml, Anne M.; Thornton, J. Daryl; Einstadter, Douglas

doi:10.1093/jamia/ocx020

Cited by 197 publications

(126 citation statements)

References 35 publications

(48 reference statements)

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“…Among this VA cohort who took active steps to enroll in, and gain access to, patient portal functions, short-term and long-term portal usage were significantly associated with having broadband Internet at home, high self-rated ability to use the Internet, and overall online behavior. Access to broadband Internet has emerged as a social determinant of health [ 27 ], defined as, “a condition in which people are born, grow, live, work, and age, and which shapes their health status” [ 28 ]. As virtual health care becomes more commonplace, affordable broadband Internet and devices, and digital know-how, will be needed to ensure equity in care services [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

The Association of Patient Factors, Digital Access, and Online Behavior on Sustained Patient Portal Use: A Prospective Cohort of Enrolled Users

Woods¹,

Forsberg²,

Schwartz³

et al. 2017

J Med Internet Res

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BackgroundAs electronic health records and computerized workflows expand, there are unprecedented opportunities to digitally connect with patients using secure portals. To realize the value of patient portals, initial reach across populations will need to be demonstrated, as well as sustained usage over time.ObjectiveThe study aim was to identify patient factors associated with short-term and long-term portal usage after patients registered to access all portal functions.MethodsWe prospectively followed a cohort of patients at a large Department of Veterans Affairs (VA) health care facility who recently completed identity proofing to use the VA patient portal. Information collected at baseline encompassed patient factors potentially associated with portal usage, including: demographics, Internet access and use, health literacy, patient activation, and self-reported health conditions. The primary outcome was the frequency of portal log-ins during 6-month and 18-month time intervals after study enrollment.ResultsA total of 270 study participants were followed prospectively. Almost all participants (260/268, 97.0%) reported going online, typically at home (248/268, 92.5%). At 6 months, 84.1% (227/270) of participants had visited the portal, with some variation in usage across demographic and health-related subgroups. There were no significant differences in portal log-ins by age, gender, education, marital status, race/ethnicity, distance to a VA facility, or patient activation measure. Significantly higher portal usage was seen among participants using high-speed broadband at home, greater self-reported ability using the Internet, and routinely going online. By 18 months, 91% participants had logged in to the portal, and no significant associations were found between usage and demographics, health status, or patient activation. When examining portal activity between 6 and 18 months, patients who were infrequent or high portal users remained in those categories, respectively.ConclusionsShort-term and long-term portal usage was associated with having broadband at home, high self-rated ability when using the Internet, and overall online behavior. Digital inclusion, or ready access to the Internet and digital skills, appears to be a social determinant in patient exposure to portal services.

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Section: Discussionmentioning

confidence: 99%

The Association of Patient Factors, Digital Access, and Online Behavior on Sustained Patient Portal Use: A Prospective Cohort of Enrolled Users

Woods¹,

Forsberg²,

Schwartz³

et al. 2017

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…Patients who are unable to afford, access, or use these technologies will be unable to benefit from this technology. There is strong evidence that certain populations already experience this digital divide-for example, patients with low health literacy are less likely to use health information technology, 49 minorities and patients of lower socioeconomic status are less likely to use patient portals, 50 and users of mobile technology specifically are more likely to be younger, higher educated, male, and reside in zip codes with higher median income, 51,52 though there is evidence that smartphone ownership is increasing in low-income and low-education populations. 53 Further work is needed to understand how to close this divide further so that all populations are able to benefit from new digital health tools.…”

Section: Limitationsmentioning

confidence: 99%

Beyond validation: getting health apps into clinical practice

et al. 2020

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“…Similarly, Ancker et al found that the odds of being given an access code for a patient portal were higher for patients who were young, English speakers, white, insured, and female [ 6 ]. Patients with lower socioeconomic status were less likely to make use of patient portals [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Insights Into Older Adult Patient Concerns Around the Caregiver Proxy Portal Use: Qualitative Interview Study

Latulipe¹,

Quandt²,

Melius³

et al. 2018

J Med Internet Res

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BackgroundElectronic patient portals have become common and offer many potential benefits for patients’ self-management of health care. These benefits could be especially important for older adult patients dealing with significant chronic illness, many of whom have caregivers, such as a spouse, adult child, or other family member or friend, who help with health care management. Patient portals commonly contain large amounts of personal information, including diagnoses, health histories, medications, specialist appointments, lab results, and billing and insurance information. Some health care systems provide proxy accounts for caregivers to access a portal on behalf of a patient. It is not well known how much and in what way caregivers are using patient portals on behalf of patients and whether patients see any information disclosure risks associated with such access.ObjectiveThe objective of this study was to examine how older adult patients perceive the benefits and risks of proxy patient portal access by their caregivers.MethodsWe conducted semistructured interviews with 10 older adult patients with chronic illness. We asked them about their relationship with their caregivers, their use of their patient portal, their caregiver’s use of the portal, and their perceptions about the benefits and risks of their caregiver’s use of the portals. We also asked them about their comfort level with caregivers having access to information about a hypothetical diagnosis of a stigmatized condition. Two investigators conducted a thematic analysis of the qualitative data.ResultsAll patients identified caregivers. Some had given caregivers access to their portals, in all cases by sharing log-in credentials, rather than by setting up an official proxy account. Patients generally saw benefits in their caregivers having access to the information and functions provided by the portal. Patients generally reported that they would be uncomfortable with caregivers learning of stigmatized conditions and also with caregivers (except spouses) accessing financial billing information.ConclusionsPatients share their electronic patient portal credentials with caregivers to receive the benefits of those caregivers having access to important medical information but are unaware of all the information those caregivers can access. Better portal design could alleviate these unwanted information disclosures.

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Patient portals and broadband internet inequality

Cited by 197 publications

References 35 publications

The Association of Patient Factors, Digital Access, and Online Behavior on Sustained Patient Portal Use: A Prospective Cohort of Enrolled Users

The Association of Patient Factors, Digital Access, and Online Behavior on Sustained Patient Portal Use: A Prospective Cohort of Enrolled Users

Beyond validation: getting health apps into clinical practice

Insights Into Older Adult Patient Concerns Around the Caregiver Proxy Portal Use: Qualitative Interview Study

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