Did COVID-19 Help Close Disparities in Patient Portal Use?

The COVID-19 pandemic may have increased patient portal use and reduced age- and sex-based utilization disparities, but there are still differences in how often people of certain races and health literacy levels use the technology, according to a JAMA Network Open study.

The study, completed by researchers from Rush University Medical Center and the Feinberg School of Medicine at Northwestern, showed that patient portal access and utilization were higher during the first three years of the pandemic than they were in 2019.

This is good news, considering the role the patient portal can play in patient engagement. The technology enables patient data access, and most experts agree that patients who view their health data are better informed about their care. The patient portal also allows individuals to review their care and treatment plans, which can improve adherence and patient safety.

But although patient portal access and use generally increased during the pandemic, the study showed that there are still disparities in who is using the technology.

In a cohort study looking at 536 patients, the researchers found vast gulfs in patient portal use based on multimorbidity, or presence of multiple chronic illnesses, and health literacy levels. Specifically, people with multiple chronic illnesses and at least adequate health literacy levels were more likely to use the patient portal before and throughout the pandemic.

Notably, some patient portal use disparities that were salient in 2019 became non-factors by 2022, the researchers found. For example, disparities between men and women went away throughout the pandemic. In 2019, women used the patient portal a mean of 12.35 fewer times than men, but by 2021, this difference was no longer statistically significant.

Similar trends emerged for age-based disparities. While older adults were less likely to use the patient portal in 2019, that difference was no longer statistically significant by 2021.

This indicates that the pandemic did spark some health technology equity.

What’s more, the data showed and general uptick in how often patients are using the portal to manage their own health, driven in part by the pandemic. In 2019, the median number of days of patient portal log-ins was 16. By 2022, that number was 31.

Patients were mostly using the patient portal to check on labs or test results. To a lesser extent, users leveraged appointment scheduling (including virtual check-in and requesting, canceling, and confirming appointments) and secure direct messaging with providers.

These are the very activities that illustrate why the patient portal can be integral to overall patient health and engagement. During the pandemic, patient portal use may have increased due to public health guidelines to social distance, the closure of many clinics’ waiting rooms, and the push for virtual-first and telehealth care access. Increases in patient portal use to check labs could stem from laboratory testing for COVID-19 and receipt of test results.

Given these benefits, the researchers said more needs to be done to push for equity in patient portal access and utilization.

“As telemedicine and digital health continue to evolve, it is important to consider how future directions for health care organizations might address digital health disparities and meaningful use,” the researchers advised. “It may be important to consider how attitudes and perceptions of patient portals might hinder (eg, concerns about privacy and data security) or facilitate portal adoption and meaningful use.”

This study comes as the healthcare industry begins to examine health technology inequities. While health IT and patient engagement technologies have become more popular in recent years, driven in particular by the COVID-19 pandemic, there are disparities in who uses the tools.

In January 2023, ONC data outlined racial and ethnic disparities in patient portal use, driven mostly by differences in how providers discuss the tool with patients. Overall, Black and Hispanic patients were offered patient portal access at a rate that was 5 percentage points lower than White people.

That played out in patient portal access figures. When looking at the entire survey population, around half of White respondents said they had accessed the patient portal, regardless of whether their clinicians encouraged them to do so. That compares to 36 and 33 percent of Black and Hispanic patients who did the same, respectively.

Things changed a bit when looking at folks whose providers encouraged them to use the patient portal.

“Once we conditioned on being offered a portal, differences in access were no longer significant in the nonpooled samples, which suggests differences in access may be driven by disparities in being offered a portal and points to the importance of healthcare providers offering portals to promote access,” the ONC researchers wrote.

While some issues get in the way of patient portal adoption across demographics—access to a tool on which to view the portal, poor broadband, limited trust in digital tools—healthcare providers should consider their own role in promoting adoption. Offering patient portal access to every patient during every encounter may go a long way in driving health technology equity.