Real-Time Electronic Patient Portal Use Among Emergency Department Patients

Abstract

Importance: Patients with inequitable access to patient portals frequently present to emergency departments (EDs) for care. Little is known about portal use patterns among ED patients.

Objectives: To describe real-time patient portal usage trends among ED patients and compare demographic and clinical characteristics between portal users and nonusers.

Design, setting, and participants: In this cross-sectional study of 12 teaching and 24 academic-affiliated EDs from 8 health systems in California, Connecticut, Massachusetts, Ohio, Tennessee, Texas, and Washington, patient portal access and usage data were evaluated for all ED patients 18 years or older between April 5, 2021, and April 4, 2022.

Exposure: Use of the patient portal during ED visit.

Main outcomes and measures: The primary outcomes were the weekly proportions of ED patients who logged into the portal, viewed test results, and viewed clinical notes in real time. Pooled random-effects models were used to evaluate temporal trends and demographic and clinical characteristics associated with real-time portal use.

Results: The study included 1 280 924 unique patient encounters (53.5% female; 0.6% American Indian or Alaska Native, 3.7% Asian, 18.0% Black, 10.7% Hispanic, 0.4% Native Hawaiian or Pacific Islander, 66.5% White, 10.0% other race, and 4.0% with missing race or ethnicity; 91.2% English-speaking patients; mean [SD] age, 51.9 [19.2] years). During the study, 17.4% of patients logged into the portal while in the ED, whereas 14.1% viewed test results and 2.5% viewed clinical notes. The odds of accessing the portal (odds ratio [OR], 1.36; 95% CI, 1.19-1.56), viewing test results (OR, 1.63; 95% CI, 1.30-2.04), and viewing clinical notes (OR, 1.60; 95% CI, 1.19-2.15) were higher at the end of the study vs the beginning. Patients with active portal accounts at ED arrival had a higher odds of logging into the portal (OR, 17.73; 95% CI, 9.37-33.56), viewing test results (OR, 18.50; 95% CI, 9.62-35.57), and viewing clinical notes (OR, 18.40; 95% CI, 10.31-32.86). Patients who were male, Black, or without commercial insurance had lower odds of logging into the portal, viewing results, and viewing clinical notes.

Conclusions and relevance: These findings suggest that real-time patient portal use during ED encounters has increased over time, but disparities exist in portal access that mirror trends in portal usage more generally. Given emergency medicine's role in caring for medically underserved patients, there are opportunities for EDs to enroll and train patients in using patient portals to promote engagement during and after their visits.

Figure 1.. Temporal Trends of Real-Time Emergency Department Patient Portal Use

Figure 2.. Pooled Odds of Logging Into the Patient Portal During an Emergency Department Encounter

^aRepresents dichotomous variables that are referenced against the inverse of themselves (ie, not Hispanic, no activated portal account). ^bIncludes workers’ compensation and nonclassified payers. ^cIncludes patients who left without being seen, before the completion of care, or against medical advice or who immediately went to labor and delivery.

Figure 3.. Pooled Odds of Viewing Test Results on the Patient Portal During an Emergency Department Encounter

^aRepresents dichotomous variable that is referenced against the inverse of itself (ie, not Hispanic, no activated portal account). ^bIncludes workers’ compensation and nonclassified payers. ^cIncludes patients who left without being seen, before the completion of care, or against medical advice or who immediately went to labor and delivery.

Figure 4.. Pooled Odds of Viewing Clinical Notes on the Patient Portal During an Emergency Department Encounter

^aRepresents dichotomous variable that is referenced against the inverse of itself (ie, not Hispanic, no activated portal account). ^bIncludes workers’ compensation and nonclassified payers. ^cIncludes patients who left without being seen, before the completion of care, or against medical advice or who immediately went to labor and delivery.