Substantial federal investments into the telehealth market over the past decade serves as a testament to the perceived medical and financial benefits of online patient portals. Not only do these patient portals provide fast, secure access to medical records, they promote patient-provider communication that improves overall quality of care. Still, a number of research findings report disparities in use, with racial minority groups, elderly patients, and people of lower socioeconomic status having decreased access to patient portals. What factors stand as barriers to portal access and how can these reasons be addressed in order to increase user engagement?
One such study conducted at the University of Michigan School of Public Health sought to determine just this, using data from the 2017 Health Information National Trends Survey (HINTS). A study sample of 2,325 adults was analyzed along the measures of (1) access to patient portals (2) use of patient portals within last 12 months and (3) potential reasons for non-access or non-use, with the collection of demographic covariates including sex, race/ethnicity, age, education, employment status, location, insurance type, and having a regular provider. Results reported the following:
- 63% of insured adults reported not using patient portals.
- 41% of those offered access to patient portals were non-users.
- Non-users more likely to be:
- Sixty-five or older
- Belong to racial minority group
- Less than college degree (high school education or below)
- Live in rural location
- Medicaid beneficiary
- Lack regular provider
- Reasons for non-use include:
- Preference of speaking directly to provider.
- Concerns about privacy and security.
- Lack of need to access patient portal.
With a reported two-thirds of insured Americans not utilizing telehealth tools, such as patient portals, it is important to identify, describe, and address barriers and/or concerns that contribute to disparities in use among patients. Older males, non-Hispanic minorities, and those with a high school diploma or less had a significantly higher probability of not being offered access to patient portals compared to their female, non-Hispanic white, and college- educated counterparts, respectively. A whopping 95% of users were offered access to portals, illustrating the power of provider communication with patients, specifically in introducing the benefits of such digital technologies. These discussions must address recurring reasons for non-use, such as patient confidentiality, to alleviate privacy and security concerns while simultaneously strengthening patient-provider trust and communication.
Interestingly enough, this study finds that user disparities do not lie along technological barriers, in contrast to past research citing socioeconomic status as a prominent variable affecting information technology use. These results demonstrate that the "digital divide" that exists between advantaged and disadvantaged groups has less to do with access and is more attributable to knowledge, skills, and comfort in using technology. Thus, addressing this discrepancy requires adjustments in technological designs and an increase in user education that enables patients to view and use portals as easy, effective tools to access medical information and communicate with providers. As telehealth innovation progresses, it will become increasingly important to monitor who is (and who is not) using digital technologies, underlying factors for use/nonuse, and incorporation of patient needs in design and delivery of these products to minimize disparities and improve quality of healthcare across the board.