September 27, 2023

As providers push more health data to patients through online portals and mobile apps, it’s critical to make sure there aren’t patient populations being left behind.

Small providers in underserved communities have adopted digital tools at a slower pace, said Dr. Dominic Mack, a professor of family medicine and director of the National Center for Primary Care at Morehouse School of Medicine. It’s expensive to purchase an electronic health record system and other health IT software, and costly to hire staff that manage and add new capabilities to the systems.

“Smaller practices just don’t have those resources,” he said.

As of 2019, which is the most recent data the Office of the National Coordinator for Health Information Technology has released on the subject, 96% of hospitals had adopted EHRs certified by the agency, compared with just 76% of office-based physicians. Post-acute care providers also tend to lag acute-care hospitals in EHR adoption.

As of 2020, 59% of patients nationwide were offered access to a patient portal, according to a separate ONC data brief.

Even among patients who are offered access to a patient portal, there are other disparities. in underserved communities might not have a computer or smartphone to access their medical records or might not live in an area with high-speed internet, Mack said.

A study published in the journal Kidney Medicine last year found that Black patients, patients with less formal education and those with lower incomes were less likely to use a patient portal.

Providers should consider whether patients are comfortable with technology, their health literacy and their English proficiency as they consider accessibility, said Patricia McGaffigan, vice president at the Institute for Healthcare Improvement.

Supplying patients with tutorials on how to access their health data, deploying software that’s available in multiple languages and ensuring there’s a clear process for how patients can request their medical records another way, such as by calling a health information management department, can address some of these challenges.

Hospitals should also ensure patients from all backgrounds are offered access to a patient portal, without making assumptions about their interest, said Cait DesRoches, an associate professor of medicine at Harvard Medical School and executive director of OpenNotes.

While many disadvantaged patient groups use patient portals at a lower rate, those who do read clinical notes have enjoyed it, she said. Patients who are not white, are older, have less education and who do not speak English at home have reported “major benefits” from reading clinical notes, according to a 2019 study published in the Journal of Medical Internet Research.

“Offer equitably,” DesRoches said. “Don’t assume that because your patient has limited English proficiency or a lower level of education that they won’t be interested in the portal.”

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