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Study: Socioeconomic Digital Divide Remains in Personal Health Record Use

August 19, 2016
by Heather Landi
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More patients are using personal health records (PHRs), yet there are socioeconomics disparities in the adoption of PHRs and patient portals to access health records, according to a study published in the American Journal of Managed Care.

Researchers from the Department of Healthcare Policy and Research at Weill Cornell Medical College examined the rate of public adoption of health IT by accessing portal/PHR use. The researchers contend that the use of PHRs and electronic patient portals, referred to as “tethered PHRs,” has increased due to the Federal Electronic Health Record (EHR) incentive program, or Meaningful Use. Since 2010, Meaningful Use has been incentivizing healthcare providers and hospitals to adopt EHRs, and In turn, providers are required to make electronic data available to patients.

According to the researchers, early studies have indicated that patients in disadvantaged socioeconomic groups were less likely to use health IT to access their health records. There is concern that this “digital divide” prevents the neediest patients from benefitting from health IT, the study authors wrote.

The researchers utilized the Empire State Poll, a survey of 900 New York state residents about health services, including health IT. For the study, researchers looked at responses for the poll each year from 2012 to 2015.

The survey respondents were specifically asked about their use of PHRs or patient portals in order to obtain, keep or update their health information.

The study findings indicated that rates of personal health record use increased rapidly across the board, from 11 percent in 2012 to 27.1 percent in 2015. 

And, researchers noted that initially black respondents were substantially less likely to use portals/PHRs than white respondents. In the 2012 survey, only 4.3 percent of black respondents used PHRs or patient portals, however that percentage rose sharply to 23.9 percent in 2015.

“By 2015, the proportion of blacks who used portals/PHRs was not significantly different from the proportion of other races,” the study authors wrote, comparing the 23.9 percent of black respondents to the 28.1 percent of white respondents.

However, the researchers did notice disparities in PHR adoption among individuals of Hispanic ethnicity. While in 2012, the PHR adoption rate among Hispanics was not significantly lower than the rate among non-Hispanics at 9 percent versus 11 percent, by 2015, despite an increase, the adoption rate lagged significantly. The rate of adoption among respondents of Hispanic ethnicity increased to 15.8 percent by 2015, compared to 29.3 percent of non-Hispanic respondents.

The study authors also found that while adoption rate of PHRs/portals among low-income respondents, or respondents whose household income was less than $50,000, rose between 2012 and 2015, the adoption rate remained about half the rate reported by higher-income respondents. In 2012, the low-income demographic had an adoption rate of 7.2 percent and that rose to only 18.2 percent by 2015, compared to 32.6 percent of higher-income respondents.

“As previously reported, the use of portals/PHRs was also more common among patients who used the Internet more frequently, those with higher education, and those using prescription medications,” the study authors wrote.

The good news, according to the study authors, during the four-year period in which federal policies incentivized healthcare providers to give medical record access to patients through PHRs and electronic portals, the percentage of New Yorkers using these technologies more than doubled. “Racial disparities in technology adoption largely disappeared during this time,” the study authors wrote.

However, the study authors also concluded that there continues to be a digital divide on the basis of income and Hispanic ethnicity.

As electronic patient portals and PHRs are anticipated to be a critical tool for patient engagement, it is important for healthcare providers to determine whether they are reaching all patient populations, the study authors wrote.

Healthcare organizations using these health IT tools to engage patients need to examine their efforts to reach all patient groups, especially low-income and Hispanic patients, who seem less likely to use the technology, according to the study findings.

“Measures that should be investigated include making these technologies accessible in multiple languages, designing for usability by individuals with low levels of computer expertise and ensuring access via mobile phone and web browsers,” the study authors concluded.

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