Use of an electronic patient portal among disadvantaged populations

Background: Electronic patient portals give patients access to information from their electronic health record and the ability to message their providers. These tools are becoming more widely used and are expected to promote patient engagement with health care. Objective: To quantify portal usage and explore potential differences in adoption and use according to patients' socioeconomic and clinical characteristics in a network of federally qualified health centers serving New York City and neighboring counties. Design: Retrospective analysis of data from portal and electronic health records. Participants: 74,368 adult patients seen between April 2008 and April 2010. Main Measures: Odds of receiving an access code to the portal, activating the account, and using the portal more than once Key Results: Over the 2 years of the study, 16% of patients (n=11,903) received an access code. Of these, 60% (n=7138) activated the account, and 49% (n=5791) used the account two or more times. Patients with chronic conditions were more likely to receive an access code and to become repeat users. In addition, the odds of receiving an access code were significantly higher for whites, women, younger patients, English speakers, and the insured. The odds of repeat portal use, among those with activated accounts, increased with white race, English language, and private insurance or Medicaid compared to no insurance. Racial disparities were small but persisted in models that controlled for language, insurance, and health status. Conclusions: We found good early rates of adoption and use of an electronic patient portal during the first 2 years of its deployment among a predominantly low-income population, especially among patients with chronic diseases. Disparities in access to and usage of the portal were evident but were smaller than those reported recently in other populations. Continued efforts will be needed to ensure that portals are usable for and used by disadvantaged groups so that all patients benefit equally from these technologies.