Abstract
BackgroundAs electronic health records and computerized workflows expand, there are unprecedented opportunities to digitally connect with patients using secure portals. To realize the value of patient portals, initial reach across populations will need to be demonstrated, as well as sustained usage over time.ObjectiveThe study aim was to identify patient factors associated with short-term and long-term portal usage after patients registered to access all portal functions.MethodsWe prospectively followed a cohort of patients at a large Department of Veterans Affairs (VA) health care facility who recently completed identity proofing to use the VA patient portal. Information collected at baseline encompassed patient factors potentially associated with portal usage, including: demographics, Internet access and use, health literacy, patient activation, and self-reported health conditions. The primary outcome was the frequency of portal log-ins during 6-month and 18-month time intervals after study enrollment.ResultsA total of 270 study participants were followed prospectively. Almost all participants (260/268, 97.0%) reported going online, typically at home (248/268, 92.5%). At 6 months, 84.1% (227/270) of participants had visited the portal, with some variation in usage across demographic and health-related subgroups. There were no significant differences in portal log-ins by age, gender, education, marital status, race/ethnicity, distance to a VA facility, or patient activation measure. Significantly higher portal usage was seen among participants using high-speed broadband at home, greater self-reported ability using the Internet, and routinely going online. By 18 months, 91% participants had logged in to the portal, and no significant associations were found between usage and demographics, health status, or patient activation. When examining portal activity between 6 and 18 months, patients who were infrequent or high portal users remained in those categories, respectively.ConclusionsShort-term and long-term portal usage was associated with having broadband at home, high self-rated ability when using the Internet, and overall online behavior. Digital inclusion, or ready access to the Internet and digital skills, appears to be a social determinant in patient exposure to portal services.
Highlights
Hopes for personal health records (PHRs) and patient portals run high
Short-term and long-term portal usage was associated with having broadband at home, high self-rated ability when using the Internet, and overall online behavior
Our study was conducted at a large Department of Veterans Affairs (VA) health care facility, where there is a requirement for a patient to complete in-person identity proofing in order to access all portal functions
Summary
Hopes for personal health records (PHRs) and patient portals run high. The spread of these technologies has been propelled by the US Electronic Health Record Incentive Program and Meaningful Use [1], and consumers’ desire to access their health information, email their providers, and request appointments online [2]. Disparities have been seen when comparing patients who do and do not register for a patient portal Older patients, those with lower levels of education or income, and African-Americans and Hispanics appear less likely to register for portals [6,7,8,9]. As electronic health records and computerized workflows expand, there are unprecedented opportunities to digitally connect with patients using secure portals. To realize the value of patient portals, initial reach across populations will need to be demonstrated, as well as sustained usage over time
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