Disparities in Pediatric Patient Portal Activation and Feature Use

Abstract

Objective Disparities in adult patient portal adoption are well-documented; however, less is known about disparities in portal adoption in pediatrics. This study examines the prevalence and factors associated with patient portal activation and the use of specific portal features in general pediatrics. Materials and methods We analyzed electronic health record data from 2012 to 2020 in a large academic medical center that offers both parent and adolescent portals. We summarized portal activation and use of select portal features (messaging, records access and management, appointment management, visit/admissions summaries, and interactive feature use). We used logistic regression to model factors associated with patient portal activation among all patients along with feature use and frequent feature use among ever users (ie, ≥1 portal use). Results Among 52 713 unique patients, 39% had activated the patient portal, including 36% of patients aged 0–11, 41% of patients aged 12–17, and 62% of patients aged 18–21 years. Among activated accounts, ever use of specific features ranged from 28% for visit/admission summaries to 92% for records access and management. Adjusted analyses showed patients with activated accounts were more likely to be adolescents or young adults, white, female, privately insured, and less socioeconomically vulnerable. Individual feature use among ever users generally followed the same pattern. Conclusions Our findings demonstrate that important disparities persist in portal adoption in pediatric populations, highlighting the need for strategies to promote equitable access to patient portals.

Pediatric primary care provider and staff perspectives on the implementation of electronic health record-based social needs interventions: A mixed-methods study

“…These views were influenced both by clinic portal activation rates and patient population characteristics. This finding demonstrates the need for multiple screening administration options and tailored strategies by setting, especially in light of the potential for patient portal-based interventions to exacerbate existing disparities [41,42]. Some providers and staff felt self-administered questionnaires would mitigate potential embarrassment and encourage patient disclosure; however, others felt screening methods should be contingent on the sensitivity of the topic.…”

“…These views were influenced both by clinic portal activation rates and patient population characteristics. This finding demonstrates the need for multiple screening administration options and tailored strategies by setting, especially in light of the potential for patient portal-based interventions to exacerbate existing disparities [41,42].…”

Effect of Electronic Outreach Using Patient Portal Messages on Well Child Care Visit Completion

“…Previous research highlights substantial disparities in pediatric patient portal use among Medicaid-enrolled, low-income, and Black and Latinx patients. 16 , 17 , 25 , 36 Others attribute these differences to less internet access or computers, 37 yet cell phone use and desire to receive health information via cell phones has been found to be prevalent among low-income populations. 38 Past research has found that White patients are more likely to receive access codes to activate their portal account compared with Black or Latinx patients.…”

“…Compared with those included in our study, patients excluded due to lack of an active portal account differed on race (higher proportion of Black children), age (younger), and insurance (higher proportion with self-pay and publicly insured children). Previous research highlights substantial disparities in pediatric patient portal use among Medicaid-enrolled, low-income, and Black and Latinx patients . Others attribute these differences to less internet access or computers, yet cell phone use and desire to receive health information via cell phones has been found to be prevalent among low-income populations .…”

Electronic Health Record Adolescent Confidentiality in a Safety Net Setting

“…Specifically, those who may be less likely to have portal access include those who do not have access to a mobile device or a stable internet connection due to socioeconomic barriers 22 and those for whom language barriers pose obstacles to accessing portals. 21 During family advisory group meetings, family members of adolescents voiced a strong interest in maximizing parent/guardian access to adolescent records. We were unfortunately unable to obtain adolescent representation in discussions of updating our adolescent proxy access and relied on the advocacy and perspectives of adolescent clinic physicians.…”