Black patients are less likely to use patient portals than white patients, even when the technology is presented at the bedside, a new study suggests.
The findings are part of a growing discussion about disparities in patients' access to their own medical data, with previous studies identifying trends with minorities, elderly patients, rural residents and men being less likely to use patient portals to access their health information.
While previous research has tended to center on patient portal use after a hospital visit, the latest study published in the journal Telemedicine and e-Health focuses on inpatient portals.
"We expected that the disparities in age and race that have previously been observed in the outpatient setting might be less in the inpatient setting, because you've removed the barriers related to access. But we didn't see that," said Daniel Walker, first author on the study and an assistant professor at the Ohio State University Wexner Medical Center's Center for the Advancement of Team Science, Analytics and Systems Thinking in Health Services and Implementation Science Research, known as Catalyst.
In 2016 Wexner Medical Center began offering inpatients access to tablets equipped with a patient portal application. They can use the portal to view test results, order meals and send messages to their care team while at the hospital.
The academic medical center was one of the first in the nation to implement this type of patient portal systemwide, said Ann Scheck McAlearney, senior author on the study, professor of family medicine and executive director of Catalyst. Her research, funded by the Agency for Healthcare Research and Quality, is working to figure out how to best leverage the tool on an inpatient basis.
For the study, researchers from the Ohio State University College of Medicine recruited 842 patients over the course of a year, all of whom were admitted to six hospitals affiliated with Wexner. The researchers found black patients used the patient portal 40% less than white patients did.
Researchers also identified age disparities, with those over 70 using the patient portal 37% less than patients between the ages of 18 and 29. Those in their 60s used the patient portal 45% less than the 18-29 patient group, according to the study.
Recent research on patient portals outside of the hospital found similar disparities.
A study published last year in Academic Pathology found underrepresented minority and elderly patients were less likely to use a patient portal. A 2016 study published in the Journal of Medical Internet Research had similar findings, with its study authors noting that black patients age 75 and older were less likely to own digital devices or to use the internet as possible barriers to patient portal use.
But by focusing on patient portals provided in the hospital, study authors at the Ohio State University College of Medicine are suggesting that the "availability of the technology alone may be insufficient to overcome barriers to use."
It's important to note that the patient portals used within and outside of the hospital are two distinct types of technology, said Dr. S. Luke Webster, a consultant with Maestro Strategies and former chief medical information officer at Christus Health, who wasn't affiliated with either study. "Those are two very, very different things," he said.
While inpatient portals can be useful tools, few health systems have implemented the technology, he said. When they have, patient adoption has been slow across the board.
However, Webster added that the study findings fit into a larger pattern of racial inequalities in healthcare. Studies have found that black and Hispanic populations in the U.S. are more likely to receive unnecessary and potentially harmful healthcare services compared to whites, including receiving services of low value at a higher rate.
"Is this worsening the care-quality gap, which we already know exists?" Webster said of the study's observed racial disparity in patient portal use.
In future studies, the research team at the Ohio State University College of Medicine will investigate what factors contribute to the observed age and race disparities. While more research is needed, the team said there have been some hints.
McAlearney said interviews with study participants have suggested that nursing staff may have been less likely to train older patients on how to use the tablet, perhaps due to implicit bias regarding their ability to use technology.
The study authors emphasized it's not just about the technology—it's about improving patient care. Walker said inpatient portals provide a way for patients to follow and manage their own health, as well as an avenue for patients to communicate with the care team in a way that will follow them after they're discharged.
"Patient portals are really powerful in that respect, in how they can lead to and support patient engagement," Walker said.
