The status of patient portal use among Emergency Department patients experiencing houselessness: A large-scale single-center observational study

Holmes, Chad; Holmes, Katherine A.; Scarborough, Jon; Hunt, Joel J.; d'Etienne, James P; Ho, Amy F.; Alanis, Naomi; Kirby, Ryan; Schrader, Chet D.; Wang, Hao

doi:10.1016/j.ajem.2023.01.029

Cited by 2 publications

(2 citation statements)

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“…Literature about ED portal use is sparse, which is problematic because the ED represents the primary care environment for many medically underserved and underinsured patients who use portals at lower rates despite equally or more complex care needs . Preliminary studies suggested that portal access initiated in the ED, especially among patients experiencing houselessness, is associated with increased clinic attendance and care adherence . Improved care adherence may follow from the ability to manage care asynchronously by scheduling appointments, messaging care teams, and reviewing results, which extends the care network beyond the doors of the ED .…”

Section: Introductionmentioning

confidence: 99%

“… 6 , 11 Preliminary studies suggested that portal access initiated in the ED, especially among patients experiencing houselessness, is associated with increased clinic attendance and care adherence. 12 , 13 , 14 Improved care adherence may follow from the ability to manage care asynchronously by scheduling appointments, messaging care teams, and reviewing results, which extends the care network beyond the doors of the ED. 15 , 16 More acutely, real-time ED portal access might facilitate sooner identification of critical results or empower patients to detect missed incidental findings.…”

Section: Introductionmentioning

confidence: 99%

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Real-Time Electronic Patient Portal Use Among Emergency Department Patients

Turer,

McDonald,

Lehmann

et al. 2024

JAMA Netw Open

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ImportancePatients with inequitable access to patient portals frequently present to emergency departments (EDs) for care. Little is known about portal use patterns among ED patients.ObjectivesTo describe real-time patient portal usage trends among ED patients and compare demographic and clinical characteristics between portal users and nonusers.Design, Setting, and ParticipantsIn this cross-sectional study of 12 teaching and 24 academic-affiliated EDs from 8 health systems in California, Connecticut, Massachusetts, Ohio, Tennessee, Texas, and Washington, patient portal access and usage data were evaluated for all ED patients 18 years or older between April 5, 2021, and April 4, 2022.ExposureUse of the patient portal during ED visit.Main Outcomes and MeasuresThe primary outcomes were the weekly proportions of ED patients who logged into the portal, viewed test results, and viewed clinical notes in real time. Pooled random-effects models were used to evaluate temporal trends and demographic and clinical characteristics associated with real-time portal use.ResultsThe study included 1 280 924 unique patient encounters (53.5% female; 0.6% American Indian or Alaska Native, 3.7% Asian, 18.0% Black, 10.7% Hispanic, 0.4% Native Hawaiian or Pacific Islander, 66.5% White, 10.0% other race, and 4.0% with missing race or ethnicity; 91.2% English-speaking patients; mean [SD] age, 51.9 [19.2] years). During the study, 17.4% of patients logged into the portal while in the ED, whereas 14.1% viewed test results and 2.5% viewed clinical notes. The odds of accessing the portal (odds ratio [OR], 1.36; 95% CI, 1.19-1.56), viewing test results (OR, 1.63; 95% CI, 1.30-2.04), and viewing clinical notes (OR, 1.60; 95% CI, 1.19-2.15) were higher at the end of the study vs the beginning. Patients with active portal accounts at ED arrival had a higher odds of logging into the portal (OR, 17.73; 95% CI, 9.37-33.56), viewing test results (OR, 18.50; 95% CI, 9.62-35.57), and viewing clinical notes (OR, 18.40; 95% CI, 10.31-32.86). Patients who were male, Black, or without commercial insurance had lower odds of logging into the portal, viewing results, and viewing clinical notes.Conclusions and RelevanceThese findings suggest that real-time patient portal use during ED encounters has increased over time, but disparities exist in portal access that mirror trends in portal usage more generally. Given emergency medicine’s role in caring for medically underserved patients, there are opportunities for EDs to enroll and train patients in using patient portals to promote engagement during and after their visits.

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Section: Introductionmentioning

confidence: 99%