The Impact of Accelerated Digitization on Patient Portal Use by Underprivileged Racial Minority Groups During COVID-19: Longitudinal Study

Abstract

Background Prior research on the digital divide has documented substantial racial inequality in using web-based health resources. The recent COVID-19 pandemic led to accelerated mass digitization, raising alarms that underprivileged racial minority groups are left further behind. However, it is unclear to what extent the use of health information and communications technology by underprivileged racial minority groups is affected. Objective We have considered the COVID-19 disruption as a rare exogenous shock and estimated the impact of the accelerated digitization on the quantity and variety of patient portal use. In this study, we aimed to answer the following 2 key research questions. Did patients alter their use of health information and communications technology owing to COVID-19–induced digital acceleration? Does the effect differ across racial lines? Methods We used a longitudinal patient portal use data set gathered from a large urban academic medical center to explore the effect of accelerated digitization on the racial digital gap in health care. We limited the sample period of our study to 2 same periods (March 11 to August 30) in 2019 and 2020. Our final sample consisted of 25,612 patients belonging to 1 of the 3 racial groups: Black or African American (n=5157, 20.13%), Hispanic (n=253, 0.99%), and White (n=20,202, 78.88%) patients. We estimated the panel data regression using 3 different models: pooled ordinary least squares (OLS), random effect (RE), and fixed effect (FE). Results Our study yielded 4 findings. First, we confirmed that the racial digital divide remains a significant issue for telehealth; underprivileged racial minority group patients had lower patient portal use than White patients before the pandemic (Minority: OLS, β=−.158; P<.001; RE, β=−.168; P<.001). Second, we found that the digital gap regarding patient portal use frequency between underprivileged racial minority groups and White patients is shrinking rather than widening after the COVID-19 pandemic started (COVID_Period×Minority: OLS, β=.028; P=.002; RE, β=.037; P<.001; FE, β=.043; P<.001). Third, the shrinking gap is foremost driven by access through mobile (vs desktop) devices (COVID_Period×Minority: web, β=−.020; P=.02; mobile, β=.037; P<.001). Finally, underprivileged racial minority groups expanded their use of a variety of portal functionalities faster than White patients during the pandemic (COVID_Period×Minority [for functionality]: OLS, β=−.004; P<.001; RE, β=−.004; P<.001; FE, β=−.003; P=.001). Conclusions Using the COVID-19 pandemic as a natural experiment, we offer empirical evidence that accelerated digitization has shrunk the racial digital divide in telehealth, and the trend is mostly driven by mobile devices. These findings provide new insights into the digital behaviors among underprivileged racial minority groups during accelerated digitization. They also offer policy makers an opportunity to identify new strategies to help close the racial digital gap in the postpandemic world.

Disparities in Patient Portal Use Among Adults With Chronic Conditions

“…Our results were consistent with prior literature on digital health inequities among racial and ethnic minority groups, individuals with lower health literacy, and individuals with lower SES, as well as increased portal use among patients with multimorbidity . Study results were also similar to more recent health care portal studies that have illustrated increased portal use before and after the most restrictive phase of the pandemic and continued disparities in use (although some studies have reported that disparities attenuated during and after the most restrictive phase of the pandemic) . Consistent with other reports, our findings suggest that the pandemic widened disparities in portal use among patients with lower health literacy, who may have more difficulty navigating technology or digital health modalities …”

“…[28][29][30][31][32][33] Study results were also similar to more recent health care portal studies that have illustrated increased portal use before and after the most restrictive phase of the pandemic and continued disparities in use (although some studies have reported that disparities attenuated during and after the most restrictive phase of the pandemic). 17,[20][21][22]34 Consistent with other reports, our findings suggest that the pandemic widened disparities in portal use among patients with lower health literacy, who may have more difficulty navigating technology or digital health modalities. [35][36][37] Our findings also suggest that, compared with younger adults and male patients, older adults and female patients were less likely to use patient portals before the pandemic but had marked increases during the pandemic.…”

“…The few longitudinal studies available have indicated that, although portal use has generally increased with time, sociodemographic disparities (eg, age, sex, race) have persisted. 17,[20][21][22] In this investigation, we evaluated portal use between 2019 and 2022 among a diverse cohort of middle-aged and older adults with at least 1 chronic condition at a large health system. The study aims were to characterize level of portal use, evaluate temporal changes in use, and to examine any sociodemographic disparities in use.…”

“…Limited information is currently available on the longitudinal trends of portal use during the pandemic era. The few longitudinal studies available have indicated that, although portal use has generally increased with time, sociodemographic disparities (eg, age, sex, race) have persisted …”

Ensuring Equitable Access to Patient Portals—Closing the “Techquity” Gap

“…These disparities are exacerbated by limited technology access, inadequate technical knowledge, distrust in health care systems, language barriers, and personal preferences. During the COVID-19 pandemic, patients with portal access engaged more with the health care system, whereas those without access faced a widening disparity in care, as indicated by lower hospitalization rates among portal users . Notably, studies have associated patient portal use with better patient-reported outcomes, including increased knowledge and reduced disease-related stress .…”