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Patient portal use in the ED paves path forward for health IT care gaps

Researchers said their findings about patient portal use in the ED may mean the care site could bridge health IT care gaps for underserved populations.

Data indicating real-time patient portal use in the emergency department is leading some experts to consider how ED clinicians can use the technology to bridge health IT gaps for traditionally underserved populations.

The study from UT Southwestern was published in JAMA Network Open and showed that patients are, in fact, using the patient portal during an ED visit. In particular, patients are using the tool to look at their lab results or read clinician notes.

“Patient portals such as Epic’s MyChart have grown in popularity in recent years, but they are still often seen as a tool for ambulatory chronic disease management,” Robert Turer, MD, assistant professor of Emergency Medicine at UT Southwestern and the study’s corresponding author, said in a statement.

“Our research suggests portals can be an asset in emergency medicine too, both to help patients with exacerbations of chronic conditions and to support those experiencing acute illness during and after the emergency department (ED) visit.”

Indeed, patient portal use has seen a spike since 2020. ONC data shows that 57 percent of patients were offered and accessed medical records and patient portals in 2022, while 73 percent were offered access. App-based patient portal use increased to 51 percent of patients, up from 38 percent of folks who used patient portal apps in 2020.

As Turer noted, patient portals have long been seen as key tools in chronic disease management by providing a lifeline for patients who needed regular contact with their healthcare providers and regular access to their health data.

This latest study shows that patient portal utility goes beyond chronic care.

In an assessment of more than a million patients visiting one of 36 EDs between April 2021 and April 2022, the researchers found that the patient portal gets used even during acute, emergency visits.

Overall, 17.4 percent of the patients included in the study used the patient portal to view test results and clinician notes during their ED visit. Odds of viewing the patient portal increased as the study went on, potentially an aftereffect of the 21st Century Cures Act’s information blocking rule.

Patients who already had active patient portal accounts or who were White, insured, and spoke English were more likely to use the patient portal during an ED visit.

That left Black patients, males, and individuals without insurance coverage less likely to use the patient portal. This could indicate gaps in primary care access and gaps in patient engagement efforts, the researchers indicated. Traditionally underserved patients, like populations of color and folks without insurance coverage, are often less likely to have a primary care provider or usual source of care, they said.

Meanwhile, they are also less likely to be offered access to the patient portal, even when they do visit with a PCP. January 2023 data from ONC showed that Black and Hispanic patients were less likely to have their clinician suggest patient portal access than their White counterparts.

The evidence that patients do find utility in accessing the patient portal during an ED encounter suggests that ED clinicians could help bridge that technology gap, Turer said.

“Emergency departments often serve as a safety net for patients without an ongoing relationship with a health care provider, so they have no patient portal account,” he explained. “Or, in many cases, there is a lack of familiarity with technology – which is especially true with older patients. There is a tremendous opportunity for EDs to help bridge this gap by supporting and aiding enrollment and educating patients on the portal’s key functions, using patient navigators or registration staff.”

To that end, it would be useful to investigate different patient portal functions that would serve patients after visiting the ED. The study indicated that patients are already inclined to access test results and clinician notes within the patient portal, but there’s room for the health IT to support after-care, too.

“Our findings in both studies support the need for further research to help us better understand portal features that are most useful within the ED,” Turer concluded. “For example, status updates, point-of-care education, and coordination of follow-up appointments are potential solutions to explore.”

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