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Research: Patient Portals Unable to Reduce Health Disparities

July 16, 2015
by Rajiv Leventhal
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Although patient portals have great potential to improve healthcare quality and efficiency, they are not yet able to reduce health disparities related to race/ethnicity and limited health literacy, according to new research from PLOS Medicine.

Racial/ethnic minority groups and those with limited literacy have consistently been shown to be less likely to use Internet-based patient portals in healthcare systems that were early adopters of this technology, the researchers said. Evidence suggests that this is not an issue of access or interest alone: almost all Americans have Internet access (across demographic subgroups such as income and race/ethnicity), and the vast majority of patients across healthcare settings are interested in Internet-based communication with providers or health systems, they said, as part of the research, “Connecting the Dots: Health Information Technology Expansion and Health Disparities.”

“We believe lack of usability is a formidable barrier to achieving widespread use of portals and other patient-facing health technology, particularly for diverse groups,” the researchers concluded. “Although usability data for portals remain relatively sparse, the few formal studies that have been conducted demonstrate that portals are difficult to use, with multiple challenges involved in apparently straightforward tasks, such as requesting access to the site, and in more complex tasks, such as comprehension of the medical information presented.”

The researchers offered an example of a 50-year-old Spanish-speaking woman with diabetes. From the research: At her latest visit with her primary care doctor (conducted in Spanish), her doctor adds insulin to her treatment regimen. He talks a lot about the new medication, tells her he is scheduling an appointment with a diabetes educator, and hands her several pages of information, in Spanish, about starting insulin. When she leaves the office, he mentions a visit summary available through the clinic’s new portal website. However, when she gets home and tries to sign up, she is unable to carry out the registration process on the English-only website. When her son finally helps her log on, she realizes that the visit summary section contains very general information about diabetes, but none of the specific instructions her doctor gave her during the visit—and she is now struggling to remember the details of their conversation. She tells her son that during the visit with her doctor, she felt scared and overwhelmed about starting insulin, and it made it hard to focus on what the doctor said.

In a recent study of a racially/ethnically diverse group of 51 older adults, 86 percent of participants shown a video documenting the available features of a portal website stated that they would use it, but only 12 percent were able to correctly complete a set of simple tasks during a simulation, and none were able to complete a set of complex tasks, the authors noted. As, such they offer suggestions for improvement moving forward:

  • Apply principles from product design and health communication science. User-centered product design involves understanding the needs, values, and abilities of users to improve the quality of users’ interactions with and perceptions of the technology.
  • Have federal agencies such as the Office of the National Coordinator for Health Information Technology (ONC) to address the usability and accessibility of portals.
  • Have the marketplace capitalize on these challenges with long-term patient engagement to differentiate products based on how well they are able to improve understanding and decision-making among patients and providers.

For what it’s worth, a recent study from researchers at Northwestern Medicine in Chicago looked at the usage of patient portals between white and African American patients. The researchers found that white patients were 2.5 times more likely to be registered as portal users than African American patients. For those who were not health literate, the gap was worse at 3.5 times less likely to register to use a portal. "Patient portals that offer access to electronic medical records could help individuals better manage their healthcare and personal needs, but people with less access to and comfort with computers are at risk of not receiving these benefits and will eventually be left behind," Michael Wolf, Ph.D. corresponding study author and a professor of medicine at Northwestern University Feinberg School of Medicine, said in a statement accompanying that study.

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