The Digital Divide in Adoption and Use of a Personal Health Record

Abstract

Background: Personal health records (PHRs) offer the potential to improve the patient experience and the quality of patient care. However, the "digital divide," the population-level gap in Internet and computer access, may prevent certain groups from accessing the PHR.Methods: We conducted a cross-sectional analysis of a PHR within a northeastern health system. We compared adopters (ie, those activating a PHR account online) with nonadopters (ie, those who see a physician offering the PHR but do not activate an account). We further categorized adopters by intensity of PHR use, measured by number of log-ins and number of messages sent to physicians' practices.Results: As of September 30, 2009, among 75 056 patients, 43% had adopted the PHR since 2002. Blacks and Hispanics were less likely to adopt the PHR compared with whites (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.45-0.55; and 0.64; 0.57-0.73, respectively), and those with lower annual income were less likely to adopt the PHR than were those with higher income. Compared with nonadopters, adopters were more likely to have more than 2 comorbidities (OR, 1.27; 95% CI, 1.17-1.30). Use of an aggressive marketing strategy for PHR enrollment increased adoption nearly 3-fold (OR, 2.92; 95% CI, 1.58-5.40). Intensity of use was best predicted by increasing number of comorbidities, followed by race/ethnicity (whites more than blacks and Hispanics) and insurance status. We found no association between income and log-in frequency or secure messages sent.Conclusions: Despite increasing Internet availability, racial/ethnic minority patients adopted a PHR less frequently than white patients, and patients with the lowest annual income adopted a PHR less often than those with higher incomes. Among adopters, however, income did not have an effect on PHR use.

The Association Between Personal Health Record Use and Diabetes Quality Measures

“…As demonstrated in previous studies, 7,8 we found significant demographic differences in PHR users and non-users, including such factors as lower age and higher incomes. Given these differences, it was not surprising to find better unadjusted diabetes quality measure profiles in PHR users.…”

Disparities in Electronic Health Record Patient Portal Use in Nephrology Clinics

“…Covariates for adjustment were chosen according to clinical significance and possible effect on portal adoption (1,(3)(4)(5)(6)(7)(8)10,11,(13)(14)(15)29,31,33,34,36,(54)(55)(56)(57)(58)(59)(60)(61)(62)(63). Sociodemographic variables were age, sex, race, marital status, insurance status, neighborhood median household income, tobacco use, and follow-up duration.…”

“…We sought to address this gap by examining portal use, including secular trends, in universityaffiliated general nephrology clinics. Given previous literature indicating that underserved groups are less likely to use EHR portals (32)(33)(34)(35)(36), we hypothesized that race, neighborhood median household income, and insurance status would be associated with portal use and of particular concern in view of documented CKD disparities in these groups (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). In addition, we believed that BP control, a key modifiable outcome that affects CKD progression, would depend on patient adherence, self-monitoring, and patient-provider communication.…”

Disparities in the Use of Internet and Telephone Medication Refills among Linguistically Diverse Patients

“…A strength of this study is its focus on a linguistically diverse patient population with multiple chronic conditions receiving care in an integrated group practice setting. Research has shown that minorities in general are less likely to use online health-related patient SMRs or portals, [12][13][14] and our results suggest that speaking a non-English language is associated with low use of remote refill systems, including the Internet.…”

“…11 African Americans and Latinos are less likely to use an online SMR system that has options to request medication refills. [12][13][14] In view of the lack of reliable data on patient language use in most health care systems, and the enormous challenges of conducting cross-cultural and multi-lingual research, to our knowledge, there are no studies examining the use of the medication refill functionality of SMRs by linguistically diverse populations. This study addresses this gap by investigating the use of Internet and telephone medication refill systems integrated within an SMR among an ethnically diverse sample of insured patients with chronic illnesses, and investigates differences in use between patients with limited English proficiency (LEP) and English-proficient (EP) patients.…”