Racial Disparities in Patient Portal Use Fueled by Provider Engagement

Black and Hispanic patients are less likely to use the patient portal, likely because they are less likely to hear from their providers that they should use it.

Black and Hispanic patients are being offered patient portal access at a rate that’s 5 percentage points lower than White people, translating to lower patient portal adoption and access, according to figures from the Office of the National Coordinator for Health IT.

Despite promises to revolutionize patient engagement and self-management, patient portal use leaves a lot on the table. According to separate ONC data, nearly every hospital offered patient portal access in 2020, but only about 40 percent of patients accessed their own health records through the patient portal.

The reasons for low patient portal use and adoption may be varied, with access to broadband, digital health literacy, and other elements of the digital divide likely at play.

This most recent ONC study adds to that, indicating that there are racial disparities in how often different groups get encouraged to use the patient portal. When not every group gets equitable encouragement to adopt the technology, uptake numbers will naturally shift. After all, provider engagement and testimony are essential to increasing patient portal adoption, the data concluded.

Using 2019 and 2020 data from the Health Information National Trends Survey, ONC researchers found that Black and Hispanic patients were offered patient portal access less often than their White counterparts. While 65 percent of White patients said their provider offered them access to the patient portal, only 54 percent of Black patients and 49 percent of Hispanic patients reported the same.

That played out in patient portal access figures. When looking at the entire survey population, around half of White respondents said they had accessed the patient portal, regardless of whether their clinicians encouraged them to do so. That compares to 36 and 33 percent of Black and Hispanic patients who did the same, respectively.

Things changed a bit when looking at folks whose providers encouraged them to use the patient portal.

“Once we conditioned on being offered a portal, differences in access were no longer significant in the nonpooled samples, which suggests differences in access may be driven by disparities in being offered a portal and points to the importance of healthcare providers offering portals to promote access,” the ONC researchers wrote.

Healthcare providers may be able to flip this paradigm on its head if they engage all patients, regardless of race, in patient portal use. Overall, folks of any race were 21 percentage points more likely to use the patient portal after hearing from their providers about the tool.

And when zooming in on racial disparities, Black and Hispanic patients who received patient portal engagement and encouragement were more likely to use the tool than their peers who did not receive such engagement.

Although White people were still more likely to use the patient portal to look at test results, Black and Hispanic people who received engagement were actually more likely to leverage the tool to download and transmit their own health data. Black people were also more likely than any other racial group to use the secure messaging function in the patient portal for patient-provider communication.

Provider organizations may also facilitate more equitable patient portal access by directly addressing the perceived barriers that keep Black and Hispanic patients from using the technology.

Black and Hispanic patients were more likely to report security concerns (33 and 27 percent, compared to 19 percent of White respondents). Black patients were also more likely to say they want to communicate directly with their providers, a paradoxical finding considering their outsized preference for secure messaging.

“These findings reinforce the importance of building patient-provider trust, which in turn, can help increase communication between patients and providers,” the researchers wrote, indicating that community health workers may be important in this endeavor.

Organizations may also consider how providers can encourage limited English proficiency (LEP) patients in patient portal use. Black and Hispanic patients both have proven more likely to use mobile patient portals than other racial groups, indicating that mobile-optimized design could bridge the gap in patient portal use, the researchers concluded.

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