Study finds age, race disparities in hospital patient portal use

Patient portals are often touted as a tool to improve patient engagement by giving patients digital access to their health records and ways to communicate with their care team.

But merely providing access to technology has not helped to close the digital divide for African American and older patients, a new study finds.

Older and African American patients have much lower usage of patient portals compared to younger and white patients, respectively, according to research from The Ohio State University College of Medicine published Wednesday in the journal Telemedicine and e-Health.

The lack of use of this technology may be limiting the potential of patient-facing health information technology to improve health and healthcare, said Daniel Walker, study author and assistant professor of family medicine and biomedical informatics in CATALYST, the Center for the Advancement of Team Science, Analytics and Systems Thinking in Health Services and Implementation Science Research in the College of Medicine at The Ohio State University.

“Patient-facing technology like inpatient portals are intended to engage patients in their healthcare by improving communication with the care team and allowing them to access test results, progress notes, and other information in their medical records,” Walker said.

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The study is part of a larger examination of patient portal use and looked specifically at the use of patient portals while people are admitted in the hospital.

The research focused on patients admitted to six Ohio State University Wexner Medical Center hospitals over a one-year period. The researchers examined the sociodemographic characteristics of users of the inpatient portal. Patients enrolled in the study used a hospital-provided tablet with a password-protected patient portal application they could access. Patients were not prompted to use the patient portal by the study team.

Over a one-year period, researchers found patients ages 60 to 69 used the inpatient portal 45% less than patients ages 18 to 29. Patients in the 70 and over age group used the inpatient portal 36% less than the 18-to-29 age group.

African American patients used the portal 40% less than white patients, according to the study.

“When we looked at the data, we saw older patients used the tutorial feature more than younger patients signifying older patients may need more training resources in order to increase use,” Walker said. “The use disparity between African American and white patients suggests the differences in use may be more nuanced and not simply an access issue."

To measure portal usage, researchers looked at the total number of tasks completed during the hospital stay such as logging into the application, sending messages to the care team, viewing test results, ordering meals and accessing tutorials.

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Walked noted that additional intervention is needed to close the digital divide.

Healthcare organizations may be able to help address the digital divide by developing targeted, in-person training interventions that support patient use of the inpatient portal and by providing patient-centered resources such as videos and handouts that explain how to use the technology, Walker told FierceHealthcare.

"More broadly, digital inclusion efforts that include increasing broadband availability, technology literacy, and education can also all help to close the digital divide," he said.

The researchers said future analyses will explore the factors that contribute to the age and race disparities to help develop educational interventions to close the gap in technology use.

“There’s been a rapid growth of technological resources to help patients manage their health,” said K. Craig Kent, M.D., dean of Ohio State’s College of Medicine, in a statement. “With continued innovation, it’s vital that all patients, regardless of age or race, are able to use these tools that can significantly enhance communication and patient care. As helpful as these tools can be, the research of our team at Ohio State shows that we need to create approaches that are usable to all patients, regardless of age and race.” 

The overall study has been led by Ann Scheck McAlearney, professor of family medicine and executive director of CATALYST, and was funded by the Agency for Healthcare Research and Quality. "This large, pragmatic, randomized and controlled trial has been recruiting patients admitted to six Ohio State University Wexner Medical Center hospitals over the past two years. It enables us to examine various factors influencing patients’ and providers’ use of and experience with the patient portal, including identifying these disparities we have found," McAlearney said.