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Digital divide affects patient portal use in primary care

Black and Hispanic people had lower patient portal engagement, indicating a digital divide that health systems have yet to surmount.

Sara Heath
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Published: 23 May 2024

More evidence shows that some patients are slipping through the cracks of healthcare's digital transformation, with a recent study in JAMA Network Open showing disparities in patient portal engagement.

Over the course of a year-long retrospective cohort study, non-Hispanic Black patients were 47% less likely to engage with their patient portals, while Hispanic patients were 34% less likely.

These findings come as healthcare experts zero in on health IT equity, or "techquity," as some have termed it. Amid the throes of the industry's digital transformation, haves and have-nots emerged, creating inequities in who can benefit from these technologies.

This latest study examined how hypertension patients engaged with the patient portal offered at their primary care clinic in 2021.

Looking at a sample of nearly 357,000 adult patients, the researchers segmented patient portal engagement by race, insurance status and English proficiency. The findings showed that not every demographic uses patient engagement technology as often.

While overall patient portal usage was 70.5%, and 60.2% used the tool right around the time of their primary care provider (PCP) visits, rates were lower among racial/ethnic minorities. Black patients and Hispanic patients were both less likely to use the patient portal compared to their white counterparts, and they were 50% and 39% less likely to use the tool around their PCP visits, respectively.

There were also differences in patient portal super users, or the proportion of patients who use health IT frequently. While 35.7% of the total study population used the patient portal frequently (defined as having more than 28 log-ins during the study period), frequent use was much lower among Black and Hispanic people. Black people were 44% less likely to use the patient portal frequently, and Hispanic patients were 29% less likely.

Disparities persisted in patient portal messaging rates. Among the total study population, 28.9% used patient portal messaging more than twice during the study period. However, Black patients were 37% and Hispanic patients 29% less likely to send messages.

It wasn't just racial/ethnic minorities affected by health IT disparities; trends were consistent across folks with no insurance and limited English proficiency (LEP).

The researchers acknowledged that their investigation did not explore the reasons behind patient portal use disparities and the digital divide, but they did posit a few explanations. Factors like education levels, socioeconomic status and lack of broadband access could be at play.

The researchers also referenced studies indicating that health systems and providers might be less likely to offer or discuss patient portal access with certain demographics.

Exploring solutions to the digital divide

Disparities in patient portal engagement come with potential consequences, the researchers said, not least of which include perpetuating existing health disparities. Of note, the U.S. is already observing steep disparities in hypertension outcomes.

"Low patient portal use in vulnerable populations may result in intervention-generated inequity, which is a situation whereby an intervention inadvertently worsens existing health disparities instead of improving them," the researchers explained.

It'd be prudent for PCPs to consider current disparities in patient portal use when implementing studies, interventions, and quality improvement programs via patient portals, the researchers said.

But that is only half the battle.

Ensuring that the digital divide does not perpetuate the healthcare access gap will require closing it. Health systems should look into different programs that engage racial/ethnic minorities and other populations with lower patient portal access and use rates.

One such approach could be stronger overall patient access to care, the team posited. The study showed that hypertension patients with more PCP visits had higher patient portal engagement. Tailoring patient engagement and care access programs for patients with fewer than the recommended number of PCP visits for hypertension management could be a good first step.

Some health systems have also implemented an "every patient, every time" approach to patient engagement technology adoption. Asking each patient about health IT during every visit, regardless of whether the clinician believes the patient can or will use the tool, casts a wider net and ensures fewer patients slip through the cracks.

Sara Heath has been covering news related to patient engagement and health equity since 2015.

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