Impact of patient portal-based self-scheduling of diagnostic imaging studies on health disparities

Abstract

While many case studies have described the implementation of self-scheduling tools, which allow patients to schedule visits and imaging studies asynchronously online, none have explored the impact of self-scheduling on equitable access to care.1 Using an electronic health record patient portal, University of California San Francisco deployed a self-scheduling tool that allowed patients to self-schedule diagnostic imaging studies. We analyzed electronic health record data for the imaging modalities with the option to be self-scheduled from January 1, 2021 to September 1, 2021. We used descriptive statistics to compare demographic characteristics and created a multivariable logistic regression model to identify predictors of patient self-scheduling utilization. Among all active patient portal users, Latinx, Black/African American, and non-English speaking patients were less likely to self-schedule studies. Patients with Medi-Cal, California’s Medicaid program, and Medicare insurance were also less likely to self-schedule when compared with commercially insured patients. Efforts to facilitate use of patient portal-based applications are necessary to increase equitability and decrease disparities in access.

Individual-Level Digital Determinants of Health and Technology Acceptance of Patient Portals: Cross-Sectional Assessment

“…were positively associated with both enrollment in and intent to use the patient portal. Research since 2020 has included differential use of self-scheduling aspects of the patient portal by race, ethnicity, and primary spoken language [33], and differential use by patients with chronic health conditions by age, gender, race, and ethnicity [8]. These individual level DDoH factors were consistently observed within our study and corroborate those reported previously.…”

“…We observed that other patient factors, including being comfortable reading and speaking English, reported use of the internet to surf the web or to send or receive emails, having at-home internet access, and access to technology devices (computer, tablet, smartphone, etc), were positively associated with both enrollment in and intent to use the patient portal. Research since 2020 has included differential use of self-scheduling aspects of the patient portal by race, ethnicity, and primary spoken language [ 36 ], and differential use by patients with chronic health conditions by age, gender, race, and ethnicity [ 8 ]. These individual-level DDoH factors were consistently observed within this study and corroborate those reported previously.…”

Patient Engagement With and Perspectives on a Mobile Health Home Spirometry Intervention: Mixed Methods Study

“…Furthermore, the small sample size of our interview cohort increases the possibility of bias during the process of thematic analysis, particularly because we only interviewed 1 non-English speaker (using an interpreter, with the patient’s proxy present). Analyses from numerous implemented mHealth programs have shown that non-English speakers and patients of minority race or ethnicity are significantly less likely to engage in telemedicine [ 13 , 25 , 26 ]. Patient motivations for drop-off are nuanced and are likely strongly associated with sociocultural factors that can only be uncovered in larger, more diverse studies.…”

Access to technology, internet usage, and online health information-seeking behaviors in a racially diverse, lower-income population

“…However, work by Calixte noted that non-Hispanic Black individuals are less likely to fill prescriptions online compared to non-Hispanic Whites individuals ( 17 ). Similarly, an analysis by Ganeshan et al found that minoritized patients, non-English speaking, and Medicaid recipients were less likely to schedule appointments online ( 18 ).…”