How to Achieve Patient Portal ‘Techquity’ & Digital Health Equity

A group of health IT academics is laying out the argument for closing the digital divide, saying that achieving what they termed as “techquity” in patient portal adoption is actually important for achieving overall digital health equity.

Writing in an editorial in JAMA Health Forum, the experts from the University of Pennsylvania, Northwell Health, and Vanderbilt University Medical Center, outlined the key steps to achieving digital health equity, ranging from measuring patient portal adoption and use by demographic to exploring barriers to patient portal use.

The patient portal isn’t exactly new, relatively speaking. Packaged alongside most EHRs, the tool has been pushed out to healthcare consumers for more than a decade by way of federal programs like meaningful use and the 21st Century Cures Act. The logic was that patients who could access their own health data would be more empowered to engage in their own care, the experts wrote in the editorial.

But as patient portal developers have added more sophisticated functionality in response to a phenomenon of consumerism in healthcare, the technology has moved beyond patient data access.

“Patient portals are no longer a tool for only motivated and engaged patients who wish to partner with their health care professionals,” the experts wrote. “Instead, portals are now central to how basic health care services are delivered.”

Patient portals facilitate appointment scheduling, bill pay, prescription refill requests, secure direct messaging, and even uploading of insurance information or patient intake forms. The editorial authors noted that data links patient portal use with better patient-reported outcomes and more knowledge about individual health.

But patient portal use is not equal across demographics, the editorial team added. Patient portal users are mostly middle-aged, English-speaking, affluent, and educated, and are usually White women.

Factors like poor access to technology, limited digital health literacy, low patient trust, language barriers, and personal preferences keep Black and Hispanic patients and those with limited English proficiency (LEP) from using the technology.

“The historic gap in access to these technologies appears to be widening at a time when technology dependence is growing,” the editorial authors explained. “This widening chasm threatens to exacerbate health care disparities among marginalized communities, underscoring the urgent need for equitable access to patient portals.”

With healthcare’s priority toward closing racial and other demographic-based health disparities, the editorial authors indicated that achieving digital health equity will be a key piece of the puzzle.

To get there, organizations need to first understand the current state of patient portal adoption. This means measuring patient portal access and use stratified by race/ethnicity and other demographics.

And for their part, providers need to be equitable in talking about the patient portal with their patients. Black and Hispanic patients are just as likely to download and use the patient portal as their White peers, but data has shown that they don’t get offered access as often.

Providers must ensure they offer patient portal access to all patients, regardless of any preconceived notions about whether the patient will heed that offer.

With that recommendation, providers need to outline why patient portal access is important. With more healthcare organizations leveraging the patient portal for all patient-facing business—prescription refills, secure direct messaging, appointment scheduling, collection of patient financial responsibility—it is crucial for the patient to download the tool. Organizations need to help patients download the tool and teach them how to use it effectively.

Relatedly, organizations should consider the potential barriers to patient portal use, as listed above, and create workarounds to eliminate those challenges. That could include offering a tool that can be translated into different languages and offering digital health literacy assistance for patients who are interested.

Finally, the editorial authors advised provider offices and health systems to assess the entire ecosystem around the patient portal. This means constant examination of digital health inequity, barriers to patient portal proxy use, and new avenues for virtual care access.

“This technology-supported partnership between patients and their health care professionals promises to improve patient and clinician satisfaction, adherence to treatment, and clinical outcomes,” they concluded. “Although research to date strongly supports the use of patient portals, realizing their full potential to improve health care delivery will require continued and deliberate focus to achieve ‘techquity’ in their adoption and use.”