Subscribe to RSS
DOI: 10.1055/s-0039-1695792
Providing Access: Differences in Pediatric Portal Activation Begin at Patient Check-in
Funding This project was supported in part by the Agency for Healthcare Research and Quality (grant numbers R00 HS022404 [R.A.B.] and K08 HS024597–01 [V.M.V.] as well as by the American Urological Association Rising Stars in Urology Research Award Program and the Frank and Marion Hinman Urology Research Fund (V.M.V.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality, the American Urological Association, or the Frank and Marion Hinman Urology Research Fund.Publication History
23 April 2019
10 July 2019
Publication Date:
11 September 2019 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035026/201904/lookinside/thumbnails/10-1055-s-0039-1695792_190097ra-1.jpg)
Abstract
Background The patient portal interface with individual electronic health records (EHR) was introduced as a tool to enhance participatory medicine. Recent studies suggest adults from racial and ethnic minorities as well as non-English speakers face disproportionate barriers to adoption; however, little data are available for pediatric patients.
Objective The purpose of this study was to examine patient portal offers and activation patterns among pediatric urology patients at two geographically diverse tertiary pediatric hospitals.
Methods Retrospective analysis of 2011 to 2016 electronic portal audit records was conducted among patients aged 18 and younger with at least one outpatient urology clinic visit at two tertiary academic pediatric hospitals and their affiliated networks. Differences in utilization among parents/caregivers and adolescents were examined using multivariate analysis.
Results Of 44,608 individuals seen in a participating urology department during the study period, 21,815 (48.9%) were offered a code for patient portal activation; of these, 8,605 (19.3% of total eligible individuals) activated portal access. Logistic regression demonstrated associations between an offer and site (p < 0.001), being female (p < 0.001), being Asian or white (p < 0.05), being non-Hispanic (p < 0.001), and reporting English as preferred language (p < 0.001). Activating patient portal access was associated with site (p < 0.001), being Asian or white (p < 0.001), and reporting English as preferred language (p < 0.001).
Conclusion This study found that demographic variations in portal began with demographic differences in which patients were offered an activation code. Fewer than half of those given an access code activated their account. Preferred language, race/ethnicity, and clinic location were associated with likelihood of portal activation. Although patients are increasingly expected to schedule appointments, manage correspondence, request prescription refills, obtain authorizations and referrals, and communicate with the medical team using the portal, this study suggests that in the pediatric specialty setting many patients and caregivers are not offered the opportunity to access these tools.
Keywords
meaningful use - electronic health records and systems - pediatric health disparities - health information technology - patient portal* Co-first coauthors.
-
References
- 1 Griffin A, Skinner A, Thornhill J, Weinberger M. Patient portals: who uses them? What features do they use? And do they reduce hospital readmissions?. Appl Clin Inform 2016; 7 (02) 489-501
- 2 Mendu ML, Waikar SS. Electronic health record patient portals in CKD and hypertension management: meaningfully used?. Clin J Am Soc Nephrol 2015; 10 (11) 1897-1899
- 3 Nguyen Q, Bartlett G, Rodriguez C, Tellier P-P. Young adults on the perceived benefits and expected use of personal health records: a qualitative descriptive study. J Innov Health Inform 2016; 23 (01) 171
- 4 Redelmeier DA, Kraus NC. Patterns in patient access and utilization of online medical records: analysis of MyChart. J Med Internet Res 2018; 20 (02) e43
- 5 Lyles CR, Fruchterman J, Youdelman M, Schillinger D. Legal, practical, and ethical considerations for making online patient portals accessible for all. Am J Public Health 2017; 107 (10) 1608-1611
- 6 Percent of Hospitals, By Type, that Possess Certified Health IT. Available at: /quickstats/pages/certified-electronic-health-record-technology-in-hospitals.php . Accessed March 5, 2019
- 7 Shaw CL, Casterline GL, Taylor D, Fogle M, Granger B. Increasing health portal utilization in cardiac ambulatory patients: a pilot project. Comput Inform Nurs 2017; 35 (10) 512-519
- 8 Irizarry T, Shoemake J, Nilsen ML, Czaja S, Beach S, DeVito Dabbs A. Patient portals as a tool for health care engagement: a mixed-method study of older adults with varying levels of health literacy and prior patient portal use. J Med Internet Res 2017; 19 (03) e99
- 9 Irizarry T, DeVito Dabbs A, Curran CR. Patient portals and patient engagement: a state of the science review. J Med Internet Res 2015; 17 (06) e148
- 10 Sieck CJ, Hefner JL, Schnierle J. , et al. The rules of engagement: perspectives on secure messaging from experienced ambulatory patient portal users. JMIR Med Inform 2017; 5 (03) e13
- 11 Jilka SR, Callahan R, Sevdalis N, Mayer EK, Darzi A. “Nothing About Me Without Me”: an interpretative review of patient accessible electronic health records. J Med Internet Res 2015; 17 (06) e161
- 12 Sorondo B, Allen A, Fathima S, Bayleran J, Sabbagh I. Patient portal as a tool for enhancing patient experience and improving quality of care in primary care practices. EGEMS (Wash DC) 2017; 4 (01) 1262
- 13 Chang E, Blondon K, Lyles CR, Jordan L, Ralston JD. Racial/ethnic variation in devices used to access patient portals. Am J Manag Care 2018; 24 (01) e1-e8
- 14 Fix GM, Hogan TP, Amante DJ, McInnes DK, Nazi KM, Simon SR. Encouraging patient portal use in the patient-centered medical home: three stakeholder perspectives. J Med Internet Res 2016; 18 (11) e308
- 15 Goel MS, Brown TL, Williams A, Hasnain-Wynia R, Thompson JA, Baker DW. Disparities in enrollment and use of an electronic patient portal. J Gen Intern Med 2011; 26 (10) 1112-1116
- 16 Turner K, Hong Y-R, Yadav S, Huo J, Mainous AG. Patient portal utilization: before and after stage 2 electronic health record meaningful use. J Am Med Inform Assoc 2019; ocz030
- 17 Ackerman SL, Sarkar U, Tieu L. , et al. Meaningful use in the safety net: a rapid ethnography of patient portal implementation at five community health centers in California. J Am Med Inform Assoc 2017; 24 (05) 903-912
- 18 Ancker JS, Osorio SN, Cheriff A, Cole CL, Silver M, Kaushal R. Patient activation and use of an electronic patient portal. Inform Health Soc Care 2015; 40 (03) 254-266
- 19 McCloud RF, Okechukwu CA, Sorensen G, Viswanath K. Beyond access: barriers to internet health information seeking among the urban poor. J Am Med Inform Assoc 2016; 23 (06) 1053-1059
- 20 Tieu L, Sarkar U, Schillinger D. , et al. Barriers and facilitators to online portal use among patients and caregivers in a safety net health care system: a qualitative study. J Med Internet Res 2015; 17 (12) e275
- 21 Jhamb M, Cavanaugh KL, Bian A. , et al. Disparities in electronic health record patient portal use in nephrology clinics. Clin J Am Soc Nephrol 2015; 10 (11) 2013-2022
- 22 Showell C. Barriers to the use of personal health records by patients: a structured review. PeerJ 2017; 5: e3268
- 23 Ancker JS, Nosal S, Hauser D, Way C, Calman N. Access policy and the digital divide in patient access to medical records. Health Policy Technol 2017; 6 (01) 3-11
- 24 Graetz I, Huang J, Brand RJ, Hsu J, Yamin CK, Reed ME. Bridging the digital divide: mobile access to personal health records among patients with diabetes. Am J Manag Care 2018; 24 (01) 43-48
- 25 Bush RA, Richardson AC, Cardona-Grau D, Din H, Kuelbs CL, Chiang GJ. Patient portal usage in pediatric urology: is it meaningful use for everyone?. Urol Pract 2018; 5 (04) 279-285
- 26 Grossman LV, Masterson Creber RM, Benda NC, Wright D, Vawdrey DK, Ancker JS. Interventions to increase patient portal use in vulnerable populations: a systematic review. J Am Med Inform Assoc 2019 Doi: 10.1093/jamia/ocz023. [Epub ahead of print]
- 27 Thompson LA, Martinko T, Budd P, Mercado R, Schentrup AM. Meaningful use of a confidential adolescent patient portal. J Adolesc Health 2016; 58 (02) 134-140
- 28 Ketterer T, West DW, Sanders VP, Hossain J, Kondo MC, Sharif I. Correlates of patient portal enrollment and activation in primary care pediatrics. Acad Pediatr 2013; 13 (03) 264-271
- 29 Kimball AB, Corey KC, Kvedar JC. Engaging patients to decrease costs and improve outcomes. Med Econ 2015; 92 (02) 36-37
- 30 Bush RA, Barlow H, Pérez A, Vazquez B, Mack J, Connelly CD. Internet access influences community clinic portal use. Health Equity 2018; 2 (01) 161-166
- 31 Featherall J, Lapin B, Chaitoff A, Havele SA, Thompson N, Katzan I. Characterization of patient interest in provider-based consumer health information technology: survey study. J Med Internet Res 2018; 20 (04) e128
- 32 Niemi A, Hupli M, Koivunen M. The use of electronic communication for patient-professional interaction – nursing staff's point of view. Finn J EHealth EWelfare 2016; 8 (04) 200-215
- 33 Coughlin SS, Prochaska JJ, Williams LB. , et al. Patient web portals, disease management, and primary prevention. Risk Manag Healthc Policy 2017; 10: 33-40
- 34 Voruganti T, Grunfeld E, Makuwaza T, Bender JL. Web-based tools for text-based patient-provider communication in chronic conditions: scoping review. J Med Internet Res 2017; 19 (10) e366
- 35 Kruse CS, Argueta DA, Lopez L, Nair A. Patient and provider attitudes toward the use of patient portals for the management of chronic disease: a systematic review. J Med Internet Res 2015; 17 (02) e40
- 36 Nakamura MM, Harper MB, Castro AV, Yu Jr FB, Jha AK. Impact of the meaningful use incentive program on electronic health record adoption by US children's hospitals. J Am Med Inform Assoc 2015; 22 (02) 390-398
- 37 Teufel II RJ, Yu Jr FB, Nakamura MM, Harper MB, Menachemi N. Factors associated with meaningful use incentives in children's hospitals. Pediatrics 2015; 135 (06) e1409-e1416
- 38 Veinot TC, Mitchell H, Ancker JS. Good intentions are not enough: how informatics interventions can worsen inequality. J Am Med Inform Assoc 2018; 25 (08) 1080-1088
- 39 Sands DZ, Wald JS. Transforming health care delivery through consumer engagement, health data transparency, and patient-generated health information. Yearb Med Inform 2014; 9: 170-176