Patients' adoption of and feature access within electronic patient portals

• Published in: The American journal of managed care Vol. 24; no. 11; pp. e352 - e357
• Main Authors: Elston Lafata, Jennifer, Miller, Carrie A, Shires, Deirdre A, Dyer, Karen, Ratliff, Scott M, Schreiber, Michelle
• Format: Journal Article
• Language: English
• Published: United States MultiMedia Healthcare Inc 01.11.2018
• Subjects: Adult; Age Factors; Aged; Appointments and Schedules; Comorbidity; Continental Population Groups - statistics & numerical data; Data base management; Electronic health records; Electronic Health Records - statistics & numerical data; Electronic Mail - statistics & numerical data; Female; Health administration; Health informatics; Humans; Male; Medical records; Michigan; Middle Aged; Patient Access to Records - statistics & numerical data; Patient Portals - statistics & numerical data; Patients; Primary Health Care - statistics & numerical data; Regression Analysis; Retrospective Studies; Sex Factors; Systems management; Web portals; Michigan
• ISSN: 1088-0224; 1936-2692

We describe online portal account adoption and feature access among subgroups of patients who traditionally have been disadvantaged or represent those with high healthcare needs. Retrospective cohort study of insured primary care patients 18 years and older (N = 20,282) receiving care from an integrated health system. Using data from an electronic health record repository, portal adoption was defined by 1 or more online sessions. Feature access (ie, messaging, appointment management, visit/admission summaries, and medical record access and management) was defined by user-initiated "clicks." Multivariable regression methods were used to identify patient factors associated with portal adoption and feature access among adopters. One-third of patients were portal adopters, with African Americans (odds ratio [OR], 0.50; 95% CI, 0.46-0.56), Hispanics (OR, 0.63; 95% CI, 0.47-0.84), those 70 years and older (OR, 0.48; 95% CI, 0.44-0.52), and those preferring a language other than English (OR, 0.43; 95% CI, 0.31-0.59) less likely to be adopters. On the other hand, the likelihood of portal adoption increased with a higher number of comorbidities (OR, 1.04; 95% CI, 1.02-1.07). Among adopters, record access and management features (95.9%) were accessed most commonly. The majority of adopters also accessed appointment management (76.6%) and messaging (59.1%) features. Similar race and age disparities were found in feature access among adopters. The diversity of portal features accessed may bode well for the ability of portals to engage some patients, but without purposeful intervention, reliance on portals alone for patient engagement may exacerbate known social disparities-even among those with an activated portal account.