Digital divide affects patient portal use in primary care

More evidence shows that some patients are slipping through the cracks of healthcare's digital transformation, with a recent study in JAMA Network Open showing disparities in patient portal engagement.

Over the course of a year-long retrospective cohort study, non-Hispanic Black patients were 47% less likely to engage with their patient portals, while Hispanic patients were 34% less likely.

These findings come as healthcare experts zero in on health IT equity, or "techquity," as some have termed it. Amid the throes of the industry's digital transformation, haves and have-nots emerged, creating inequities in who can benefit from these technologies.

This latest study examined how hypertension patients engaged with the patient portal offered at their primary care clinic in 2021.

Looking at a sample of nearly 357,000 adult patients, the researchers segmented patient portal engagement by race, insurance status and English proficiency. The findings showed that not every demographic uses patient engagement technology as often.

While overall patient portal usage was 70.5%, and 60.2% used the tool right around the time of their primary care provider (PCP) visits, rates were lower among racial/ethnic minorities. Black patients and Hispanic patients were both less likely to use the patient portal compared to their white counterparts, and they were 50% and 39% less likely to use the tool around their PCP visits, respectively.

There were also differences in patient portal super users, or the proportion of patients who use health IT frequently. While 35.7% of the total study population used the patient portal frequently (defined as having more than 28 log-ins during the study period), frequent use was much lower among Black and Hispanic people. Black people were 44% less likely to use the patient portal frequently, and Hispanic patients were 29% less likely.

Disparities persisted in patient portal messaging rates. Among the total study population, 28.9% used patient portal messaging more than twice during the study period. However, Black patients were 37% and Hispanic patients 29% less likely to send messages.

It wasn't just racial/ethnic minorities affected by health IT disparities; trends were consistent across folks with no insurance and limited English proficiency (LEP).

The researchers acknowledged that their investigation did not explore the reasons behind patient portal use disparities and the digital divide, but they did posit a few explanations. Factors like education levels, socioeconomic status and lack of broadband access could be at play.

The researchers also referenced studies indicating that health systems and providers might be less likely to offer or discuss patient portal access with certain demographics.