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. 2023 Nov 3;4(11):e233883.
doi: 10.1001/jamahealthforum.2023.3883.

Progress and Persistent Disparities in Patient Access to Electronic Health Information

Chelsea Richwine  1
Affiliations

Progress and Persistent Disparities in Patient Access to Electronic Health Information

Chelsea Richwine. JAMA Health Forum. .

Abstract

Importance: Patient access to electronic health information (EHI) available via online medical records and through patient portals has been shown to help individuals make informed health decisions, which are associated with better health outcomes.

Objective: To assess progress in patient engagement with EHI and to identify racial or ethnic disparities in access to patient portals.

Design, setting, and participants: This was a repeated cross-sectional study using data from the US Health Information National Trends Survey (HINTS), a nationally representative survey of US adults that tracks individuals' access and use of their health information. Six cycles of HINTS were included (2014, 2017-2020, 2022); data for the disparities analysis came from the 2022 HINTS. Data analyses were performed in April 2023.

Main outcomes and measures: Patient reports of (1) being offered portal access by a health care provider (HCP); (2) being encouraged by the HCP to use the portal; (3) accessing their portal; and (4) using the portal for various purposes. Additional key measures included methods used to access portals and self-reported ease of understanding information contained in the online medical records or portals.

Results: The total study population included 22 266 individuals (mean [SE] age, 49.9 [0.15] years) of whom 13 348 (54%) were female; 909 (5%) self-identified as Asian, 3523 (12%) as Black, 3178 (14%) as Hispanic, 13 555 (66%) as White, and 785 (3%) as another or more than 1 race. Nationally, patient portal access increased each year from 2014 through 2022, with a 46% increase observed between 2020 (n = 3319) and 2022 (n = 5437). However, in 2022, Black and Hispanic individuals reported being offered access to a portal by their HCP at significantly lower rates compared with White individuals (73% vs 81%; χ21 = 22.24; P < .001; and 62% vs 81%; χ21 = 135.57; P < .001, respectively) as well as accessing a patient portal at lower rates (60% vs 70%; χ21 = 23.80; P < .001; and 57% vs 70%; χ21 = 49.02; P < .001, respectively).

Conclusions and relevance: The findings of this repeated cross-sectional study of US adult respondents to the HINTS suggest that access to and engagement with patient portals increased significantly from 2014 through 2022, but racial and ethnic disparities in patient access persisted in 2022. However, there were no significant differences in use or understanding of information available in the online medical records among those who accessed them, which suggests that efforts to promote equitable opportunities to access EHI would likely be associated with increased patient access.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Percentage of Total Sample of US Health Information National Trends Survey (HINTS) Respondents Who Were Offered Access to a Patient Portal and Who Accessed It, 2014 to 2022
Offered a patient portal indicates % of individuals who reported being offered access to online medical records or a patient portal by an HCP. Accessed a patient portal indicates % of individuals who reported they accessed their portal at least once in the past 12 months. Only includes individuals who had a health care visit in the past 12 months. Data collected from HINTS 4, cycle 4 (2014); HINTS 5, cycles 1-4 (2017-2020); and HINTS 6 (2022). HCP indicates a health care provider (ie, an individual practitioner). aStatistically significant increase from prior year (P < .05). Supporting data are available in eTable 3 in Supplement 1.
Figure 2.
Figure 2.. Patient Reports of Being Offered or Encouraged to Use a Portal by an HCP and Patient-Reported Portal Access (Overall and Among Those Who Were Offered or Encouraged)
Offered patient portal by HCP indicates % of individuals who reported being offered access to online medical records or a patient portal by an HCP. Encouraged to use portal by HCP indicates % of individuals who reported they were encouraged by HCPs to use a patient portal. Accessed among offered (encouraged) indicates % of individuals who reported they accessed their portal at least once in the past 12 months, from among those who were offered (encouraged). These data include only individuals who had a health care visit in the past 12 months. Data collected from HINTS 5, cycle 4 (2020) and HINTS 6 (2022). HCP indicates a health care provider (ie, an individual practitioner). aStatistically significant increase from prior year (P < .05). Supporting data are available in eTable 4 in Supplement 1.
Figure 3.
Figure 3.. Methods of Accessing Online Medical Records or Patient Portal, 2020 to 2022
Only includes individuals who accessed their online medical record and had a health care visit in the past 12 months. Data collected from US Health Information National Trends Survey (HINTS) 5, cycle 4 (2020); and HINTS 6 (2022). aStatistically significant increase from prior year (P < .05). Supporting data available in eTable 5 in Supplement 1.
Figure 4.
Figure 4.. Racial and Ethnic Disparities in Patient Reports of Being Offered or Encouraged to Use a Portal by an HCP and Patient-Reported Portal Access (Overall and Among Those Who Were Offered or Encouraged)
Only includes individuals who accessed their online medical record and had a health care visit in the past 12 months. Data collected from US Health Information National Trends Survey 6 (2022). HCP indicates a health care provider (ie, an individual practitioner). aStatistically significant difference between outcomes and race and ethnicity, with White as the reference group to allow for comparison with prior literature. (P < .05). Supporting data are available in eTable 7 in Supplement 1.
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