Understanding the Digital Divide in Healthcare
The digital divide in healthcare refers to the gap between those who have access to digital health tools and those who do not. This divide is evident in the use of patient portals, which are online platforms that allow patients to access their health information, communicate with healthcare providers, and manage their care.
Key Findings on Patient Portal Engagement
Lower Engagement Among Black and Hispanic Patients
A recent study published in JAMA Network Open highlights significant disparities in patient portal engagement among different racial and ethnic groups. The study found that:
– Non-Hispanic Black patients were 47% less likely to use patient portals compared to their non-Hispanic white counterparts.
– Hispanic patients were 34% less likely to use patient portals.
These findings indicate a persistent digital divide that healthcare systems have yet to address effectively.
Study Details and Demographics
The study analyzed the patient portal usage of nearly 357,000 adult patients with hypertension in 2021. The researchers segmented the data by race, insurance status, and English proficiency. They discovered that patient portal usage was lower among racial and ethnic minorities:
– Overall patient portal usage was 70.5%.
– Usage around primary care visits was 60.2%.
However, usage rates were significantly lower for Black and Hispanic patients compared to their white counterparts.
Frequency of Patient Portal Use
Super Users and Messaging Rates
The study also looked at the frequency of patient portal use, identifying “super users” as those who logged in more than 28 times during the study period. Among the total study population:
– 35.7% were frequent users.
– Black patients were 44% less likely to be frequent users.
– Hispanic patients were 29% less likely to be frequent users.
Patient portal messaging rates also showed disparities:
– 28.9% of the total population used messaging more than twice.
– Black patients were 37% less likely to send messages.
– Hispanic patients were 29% less likely to send messages.
Broader Health IT Disparities
Impact on Uninsured and Limited English Proficiency Patients
The digital divide extends beyond racial and ethnic minorities. Patients without insurance and those with limited English proficiency (LEP) also experienced lower engagement with patient portals. These trends suggest that multiple factors contribute to health IT disparities, including socioeconomic status and education levels.
Exploring the Causes of the Digital Divide
Potential Factors
The study did not delve into the specific reasons behind the disparities in patient portal use, but the researchers proposed several potential factors:
– Education levels
– Socioeconomic status
– Lack of broadband access
Other studies have suggested that healthcare providers might be less likely to offer or discuss patient portal access with certain demographics, further contributing to the divide.
Addressing the Digital Divide
Consequences of Disparities
Disparities in patient portal engagement can exacerbate existing health disparities, particularly in conditions like hypertension where outcomes already show significant racial and ethnic differences. Low patient portal use among vulnerable populations may lead to intervention-generated inequity, where interventions unintentionally worsen health disparities.
Strategies for Improvement
Healthcare providers and systems must take proactive steps to bridge the digital divide and ensure equitable access to patient portals. Here are some potential strategies:
Increasing Patient Access
Improving overall patient access to care can enhance patient portal engagement. The study found that hypertension patients with more primary care visits had higher patient portal usage. Tailoring engagement and care access programs for patients with fewer visits could be an effective approach.
Implementing Consistent Engagement Practices
Some health systems have adopted an “every patient, every time” approach to health IT adoption. This strategy involves asking every patient about patient portal use during each visit, regardless of the clinician’s assumptions about the patient’s likelihood to use the tool. This ensures that more patients are informed about and encouraged to use patient portals.
Conclusion
The Path Forward
To close the digital divide in healthcare, it is crucial to implement targeted programs that engage underserved populations. This involves understanding the specific barriers these populations face and addressing them through tailored interventions. By doing so, healthcare systems can ensure that all patients have the opportunity to benefit from digital health tools, ultimately leading to better health outcomes and reduced disparities.
