Does Accelerated Digitization Widen Racial Digital Divide in Healthcare? Longitudinal Observational Study of Patient Portal Usage During COVID-19.

Abstract

Prior research on the digital divide has documented substantial racial inequality in using online health resources. The recent COVID-19 pandemic led to accelerated mass digitization, raising alarms that underprivileged racial minorities (URMs) are left further behind. However, lacking empirical evidence, it is unclear to what extent URMs' use of health information and communications technology is impacted. We consider the COVID-19 disruption as a rare exogenous shock and estimate the impact of the accelerated digitization on the quantity and variety of patient portal usage. In this study, we study two key research questions: 1) Did patients alter their use of health ICT due to COVID-induced digital acceleration? 2) Does the effect differ along racial lines? We use a longitudinal patient portal usage dataset gathered from a large urban academic medical center to explore the effect of accelerated digitization on the racial digital gap in healthcare. We limit the sample period of our study to two same periods (March 11 - August 30) in 2019 and 2020. Our final sample consists of 25,612 patients belonging to one of the three races: Black or African American (20%), Hispanic (1%), and White or Caucasian (79%). We estimate panel data regression using three different models: pooled OLS, random effect (RE), and fixed effect (FE). Our study offers four findings. First, we confirm that the racial digital divide remains a significant issue for telehealth; URM patients have lower patient portal usage compared to White patients before the pandemic (β of Minority = -0.158/-0.168 for OLS/RE, P<.001/.001). Second, we find that the digital gap regarding patient portal use frequency between URMs and White patients is shrinking rather than widening after the COVID pandemic started (β of COVID_Period×Minority = 0.028/0.037/0.043 for OLS/RE/FE, P=.002/.000/.000). Third, the shrinking gap is foremost driven by access through mobile (vs. desktop) devices (β of COVID_Period×Minority is -0.020/0.037 for the web/mobile, P=.017/.000). Lastly, and further contributing to the narrowing of the racial digital divide under accelerated digitalization, the URMs expanded their use of a variety of portal functionalities faster than those of White patients during the pandemic (For functionality, β of COVID_Period×Minority is -0.004/-0.004/-0.003 for OLS/RE/FE, P=.000/.000/.001). Using the COVID pandemic as a natural experiment, we offer empirical evidence that accelerated digitization has shrunk the racial digital divide in telehealth, and the trend is mostly driven by mobile devices. These findings provide new insights into the digital behaviors among the URMs during accelerated digitization. They also offer policymakers an opportunity to identify new strategies to help close the racial digital gap in the post-pandemic world and call for "knowledge gap" research for improving personal health literacy known to improve healthcare quality.