In a single-institution retrospective study reported in a research letter in JAMA Oncology, Sinha et al found disparities in electronic health record (EHR) patient portal enrollment according to age, sex, race/ethnicity, and primary language among oncology patients.
Study Details
The study involved data from patients seen at University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center from adoption of an electronic patient portal in June 2012 through March 2020. Self-reported demographic characteristics, encounters data, and portal use were extracted from EHRs. Enrollment in the patient portal over the study period was assessed using the Kaplan-Meier method and log-rank test.
This study identified longitudinal disparities in patient portal enrollment, notably for patients who were older than 70 years, Black, nonpartnered, Hispanic, or had a non-English primary language.— Sinha et al
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Key Findings
Between June 2012 and March 2020, there were 266,917 patients with a completed visit at the cancer center.
Cumulative enrollment over time varied significantly by age (P < .0001), increasing in early adulthood, peaking among patients in their 40s, and decreasing thereafter, with the lowest rates seen in patients in their 70s and 80s. Cumulative enrollment over time varied significantly by race (P < .0001), with enrollment being highest among White patients and lowest among Black patients at virtually all time points. Men exhibited a slight delay in enrollment compared with women.
On multivariate analysis, compared with patients aged 18 to 29 years, hazard ratios for enrollment (all significant at P < .001) were 1.15 for patients aged 30 to 39 years, 0.94 for those aged 40 to 49 years, 0.86 for those aged 50 to 59 years, 0.88 for those aged 60 to 69 years, 0.80 for those aged 70 to 79 years, and 0.64 for those aged ≥ 80 years. Compared with men, the hazard ratio was 1.07 for women (P < .001).
Compared with White patients, hazard ratios (all P < .001) were 1.13 for Asian, 0.56 for Black, 0.84 for Pacific Islander, 0.84 for Native American, and 0.85 for other patients. Compared with other ethnicities, the hazard ratio was 0.87 for Hispanic patients (P < .001).
Compared with patients in a partnership, the hazard ratio was 0.76 for single patients (P < .001). Compared with English as primary language, the hazard ratio was 0.42 for patients with non-English primary languages (P < .001).
The investigators concluded, “This study identified longitudinal disparities in patient portal enrollment, notably for patients who were older than 70 years, Black, nonpartnered, Hispanic, or had a non-English primary language. In response, our institution (University of California, San Francisco) has focused on improving the ease of enrollment, which is a substantial barrier to entry, through text messages, email, use of third-party identification instead of activation codes, and simplified proxy registration. Prior work in primary care suggests that once enrollment is overcome, disparities in use are decreased. Translation of the patient portal is also underway.”
Julian C. Hong, MD, MS, of the Bakar Computational Health Sciences Institute, Department of Radiation Oncology, University of California, San Francisco, is the corresponding author for the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
