Use of an electronic patient portal among disadvantaged populations

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An electronic patient portal, also known as a tethered personal health record (PHR), is linked to selected parts of a provider’s electronic health record (EHR) and allows a patient to message a provider, request an appointment, and order refills. The portal is an important part of a patient’s healthcare in that access to it allows the patient to manage their health information and assist the provider in monitoring their health; however portal access is dependent upon computer and internet availability. [1]


The authors used data from the Institute for Family Health’s (IFH) EHR system and patient portals (EpicCare and MyChart, Epic Systems , Verona, Wisconsin) that went live in 2008 and predominately serviced New York City’s low-income population. Only patients that were active between April 2008 and April 2010 and over the age of 18 were included in the study.


Between April 2008 and April 2010, IFH had 74,368 active, adult patients that could have received an access code to access the electronic patient portal. Of those active, adult patients, 11,903 (16%) received an access code from a physician, and of those that did receive an access code, 7,138 (60%) activated their account, and 5,791 (49%) used the account two or more times.


The study identified disparities between portal use on the basis of race, ethnicity, sex, language, insurance type, age, and health status in that the latter factors were prevalent in the likelihood of a patient receiving an access code from a physician. The authors concluded that disparities could be a result of the patients, physicians, or a combination of the two.


The study found a predominantly low-income population with chronic diseases in New York had a good electronic patient portal use. In order to ensure all patients have access to the portal, efforts will need to be made regarding computer and internet access.


This was an interesting article regarding electronic patient portals and disadvantaged populations. I am interested to know if the identified disparities could be narrowed down to insurance type and physician type or group. I would also be curious about other studies of disadvantaged populations in other states and how those results compare to the ones found in this article. Finally, since this article was written in 2011 when the authors note that EHR participation was around 7% nationally, I would like to know whether or not some of the disparities that the authors identified have been accounted for and if so, whether or not the IFH’s patient portal participation rate has increased as a result. I would also like to know what were the benefits to the patients for using the portal and if these benefits were worthwhile to the patients. Usability factors are also one consideration that can affect the use of the portal.


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  1. Ancker 2011. Use of an electronic patient portal among disadvantaged populations