Introduction: Electronic portals are secure Web-based

SUMMARY ANSWER: Cancer center staff electronic patient portal activities have increased approximately 10-fold over a recent 3-year period. Nursing staff account for the majority of this effort. WHAT WE DID:We identified and characterized cancer center providers and clinic staff who performed electronic activities related to MyChart, our institution's personal health records portal, from 2009 to 2014. Total MyChart actions and messages received were quantified and characterized according to type, timing, and staff category. We applied descriptive statistics to nurses, who exhibited the greatest use of MyChart. Mean and median action/message counts for individual nurses were calculated for 2011 and 2014 and compared using t tests (assessing for a significant increase in actions and messages during this time frame). Mean and median action/message counts were also compared between clinical divisions (medical oncology, radiation oncology, and surgical oncology) using t tests. WHAT WE FOUND:In our analysis, 289 employees performed 740,613 MyChart actions and received 117,799 messages. Seventy-seven percent of actions were performed by nurses, 11% by ancillary staff, 6% by midlevel providers, 5% by physicians, and 1% by clerical/managerial staff. On average, 6.3 staff MyChart actions were performed per patient-initiated message. In 2014, nurses performed an average of 3,838 MyChart actions and received an average of 589 messages compared with 591 actions and 87 messages in 2011 (P , .001). Sixteen percent of all actions occurred outside clinic hours. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS:Although we present a quantitative analysis of staff portal use, as defined by numbers of actions and messages, we are not able to determine the amount of time employees devoted to these tasks or the impact on clinic work flow. Due to inherent limitations within the available data tables, we were unable to capture messages initiated de novo by providers, only those received from patients. Finally, generalizability of our findings may be limited by the study cohort, as patients seeking care at NCI-designated comprehensive centers may differ from the broader population by race, geographic location, and socioeconomic status. REAL-LIFE IMPLICATIONS:Given the disease severity, longitudinal course, and data intensive practice of oncology, understanding how patients and providers use electronic portals is key to practice quality and safety. While this technology has been implemented widely in the last decade, few studies have directly examined the impact of electronic patient portals on cancer care providers. In the present analysis, we identified a dramatic and sustained increase in staff use of an electronic patient portal at an NCI-designated comprehensive cancer center. Most of this work falls to nurses, and a substantial proportion occurs outside clinic hours. Future research into the impact of this technology on staff and patient satisfaction, utilization of other healthcare resources, practice finances, and clinical outcomes will be e...

had full access to all the data in the study and takes full responsibility for the integrity of the data and the accuracy of the data analysis.

Objective Determine whether women and men differ in volunteering to join a Research Recruitment Registry when invited to participate via an electronic patient portal without human bias. Materials and Methods Under-representation of women and other demographic groups in clinical research studies could be due either to invitation bias (explicit or implicit) during screening and recruitment or by lower rates of deciding to participate when offered. By making an invitation to participate in a Research Recruitment Registry available to all patients accessing our patient portal, regardless of demographics, we sought to remove implicit bias in offering participation and thus independently assess agreement rates. Results Women were represented in the Research Recruitment Registry slightly more than their proportion of all portal users (n = 194 775). Controlling for age, race, ethnicity, portal use, chronic disease burden, and other questionnaire use, women were statistically more likely to agree to join the Registry than men (odds ratio 1.17, 95% CI, 1.12–1.21). In contrast, Black males, Hispanics (of both sexes), and particularly Asians (both sexes) had low participation-to-population ratios; this under-representation persisted in the multivariable regression model. Discussion This supports the view that historical under-representation of women in clinical studies is likely due, at least in part, to implicit bias in offering participation. Distinguishing the mechanism for under-representation could help in designing strategies to improve study representation, leading to more effective evidence-based recommendations. Conclusion Patient portals offer an attractive option for minimizing bias and encouraging broader, more representative participation in clinical research.

PURPOSE Mobile devices provide individuals with rapid and frequent access to electronic patient portals. We investigated how oncology patients use this technology to review test results and communicate with providers. PATIENTS AND METHODS We performed a retrospective study of patients enrolled in the MyChart electronic health portal associated with the Epic electronic medical record at the Harold C. Simmons Comprehensive Cancer Center from 2012 to 2017. We recorded type of portal access according to year and patient characteristics. Associations among patient characteristics and types of portal access were tested using Mann-Whitney U test, χ2 test, and linear Gaussian regression models. RESULTS Since the availability of a mobile device application in 2012, 2,524 patients with cancer accessed MyChart from a mobile device at least once, which accounted for 291,526 mobile log-ins. The number of patients with MyChart mobile application log-ins increased from 4% in 2012 to 13% in 2017 ( P = .004). Among these patients, the median proportion of log-ins that occurred through mobile device use increased from 22% to 72% during this time period ( P < .001). Mobile access occurred more frequently among younger ( P < .001), black ( P = .002), and Hispanic ( P = .004) patients. Since 2012, total portal log-in frequency increased approximately 110% among patients who used the mobile application compared with 25% among those who did not use the mobile application ( P < .001). CONCLUSION Mobile access to electronic health portals has increased patient portal use, particularly among traditionally underserved populations. How this widely and immediately available technology affects patient expectations and experiences warrants additional study.