Friday, May 6, 2011

Patient Portals and Equity

Mita Goel, David Baker and the good folks at Northwestern University report in the Journal of General Internal Medicine about use of the patient portal in their large, academic practice in Chicago. Of 7,088 patients invited to open an account on the portal, 69% enrolled. However, older patients and minority patients were significantly less likely to use the technology.

Once they were enrolled, race and ehtnicity didn't seem to be associated with how the patients used the portal. However, younger patients were less likely to initiate a request for refill or advice, perhaps because they have fewer medical issues. Likewise, men used the system less than women, reflecting the general tendnecy for women to seek health care more often than men.

The good news for engaging patients and exchanging health information is that over 2/3 of patients in this large, complex population took the opportunity to enroll. Patients want to connect. The bad news is that it might not help resolve the racial and ethnic divides that continue to bedevil health care and American society - it might even make them worse.

Goel M, Brown T, Williams A, Hasnain-Wynia R, Thompson J, Baker D. Disparities in Enrollment and Use of an Electronic Patient Portal. Journal of General Internal Medicine 2011; Online first at


  1. I'm curious if the lack of connection was due to the lack of resources available to connect (owning a computer, having the knowledge to use a computer, access to high speed internet, access to a nearby public library with free computer access, etc.) or a lack of interest in using the portal.

    The word "accessible" in the conclusion at your link seems to indicate the lack of resources to connect, but was that actually studied or is it just a guess?

  2. Good question. Alas, they did not have information on interest, computer accessibility, computer literacy, or even written literacy. However, all the patients were invited by their doctors, whom may have asked or known about some of these factors, and excluded them as a consequence.

  3. I am interested in knowing which hospital was used. Chicago is a large city and it is possible the hospital location was bias to the study (in determining the number of minorities and elders that could have been eligible to participate). Maybe it would be feasible to replicate the study in another city with a greater number of minorities and elders (like Miami).

  4. My error - the authors are from Chicago, but the patients were actually from New York.

    "We conducted our study using data from the Institute for Family Health (IFH), a network of federally qualified health centers that provides primary care to a predominantly low-income population in New York City and the Hudson Valley north of the city, serving a highly racially, ethnically, and socio-economically diverse population."

    The subjects were 16% Black and 19% Hispanic. 55% had either no insurance or Medicaid. The average age was a bit young at 40, as is common in federally qualified health centers.

    I certainly can see the possibility of regional differences in the uptake of web portals, but these data are a very good start to understanding whats going on today.

  5. Chicago is a large city and it is possible the hospital location was bias to the study (in determining the number of minorities and elders that could have been eligible to participate)


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