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Geographic Location Impacts Patient Portal Use via Desktop and Mobile Devices

  • Patient Facing Systems
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Abstract

Disparities in patient portal use are impacted by individuals’ access to technology and the internet as well as their skills and health behaviors. An individual’s geographic location may impact these factors as well as contribute to their decision to use a portal, their choice of device to access the portal, and their use of portal functions. This study evaluated patient portal use by geographic location according to three comparators: proximity to the medical center offering the portal, urban/rural classification, and degree of digital distress. Patients residing farther from the medical center, in rural areas, or in areas of higher digital distress were less likely to be active portal users. Patients in areas of higher digital distress were more likely to use the mobile portal application instead of the desktop portal website alone. Users of the mobile portal application used portal functions more frequently, and being a mobile user had a greater impact on the use of some portal functions by patients residing in areas of higher digital distress. Mobile patient portal applications have the potential to increase portal use, but work is needed to ensure equitable internet access, to promote mobile patient portal applications, and to cultivate individuals’ skills to use portals.

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Availability of data and materials

Data sharing is not permitted under the Honest Broker protocol used to acquire the data for this study.

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References

  1. Irizarry T, DeVito Dabbs A, Curran CR (2015) Patient portals and patient engagement: a state of the science review. J Med Internet Res 17:e148. https://doi.org/10.2196/jmir.4255

    Article  Google Scholar 

  2. Han H-R, Gleason KT, Sun C-A, Miller HN, Kang SJ, Chow S, Anderson R, Nagy P, Bauer T (2019) Using patient portals to improve patient outcomes: systematic review. JMIR Hum Factors 6:e15038. https://doi.org/10.2196/15038

    Article  Google Scholar 

  3. Grossman LV, Masterson Creber RM, Benda NC, Wright D, Vawdrey DK, Ancker JS (2019) Interventions to increase patient portal use in vulnerable populations: a systematic review. J Am Med Inform Assoc 26:855-870. https://doi.org/10.1093/jamia/ocz023

    Article  Google Scholar 

  4. Perzynski AT, Roach MJ, Shick S, Callahan B, Gunzler D, Cebul R, Kaelber DC, Huml A, Thornton JD, Einstadter D (2017) Patient portals and broadband internet inequality. J Am Med Inform Assoc 24:927-932. https://doi.org/10.1093/jamia/ocx020

    Article  Google Scholar 

  5. Graetz I, Gordon N, Fung V, Hamity C, Reed ME (2016) The digital divide and patient portals: internet access explained differences in patient portal use for secure messaging by age, race, and income. Med Care 54:772-779. https://doi.org/10.1097/MLR.0000000000000560

    Article  Google Scholar 

  6. Dameff C, Clay B, Longhurst CA (2019) Personal health records: more promising in the smartphone era? JAMA 321:339-340. https://doi.org/10.1001/jama.2018.20434

    Article  Google Scholar 

  7. Stenberg PL. Elements in U.S. households broadband internet subscription rates. In: Thill J-C, ed. Innovations in urban and regional systems: contributions from GIS&T, spatial analysis and location modeling. Cham: Springer International Publishing, 2020:343–357

  8. Perrin A (2019) Digital gap between rural and nonrural America persists. Pew Research Center. https://www.pewresearch.org/fact-tank/2019/05/31/digital-gap-between-rural-and-nonrural-america-persists/. Accessed 26 Feb 2021

  9. Gallardo R, Geideman C (2019) Digital distress: what is it and who does it affect? Benton Institute for Broadband & Society. https://www.benton.org/headlines/digital-distress-what-it-and-who-does-it-affect. Accessed 26 Feb 2021

  10. Tomer A, Kneebone E, Shivaram R (2017) Signs of digital distress: mapping broadband availability and subscription in American neighborhoods. The Brookings Institution. https://www.brookings.edu/research/signs-of-digital-distress-mapping-broadband-availability/. Accessed 26 Feb 2021

  11. Mishori R, Antono B (2020) Telehealth, rural America, and the digital divide. J Ambul Care Manage 43:319-322. https://doi.org/10.1097/JAC.0000000000000348

    Article  Google Scholar 

  12. Benda NC, Veinot TC, Sieck CJ, Ancker JS (2020) Broadband internet access is a social determinant of health! Am J Public Health 110:1123-1125. https://doi.org/10.2105/AJPH.2020.305784

    Article  Google Scholar 

  13. Comber AJ, Brunsdon C, Radburn R (2011) A spatial analysis of variations in health access: linking geography, socio-economic status and access perceptions. Int J Health Geogr 10:44. https://doi.org/10.1186/1476-072X-10-44

    Article  Google Scholar 

  14. Desjarlais-deKlerk K, Wallace JE (2013) Instrumental and socioemotional communications in doctor-patient interactions in urban and rural clinics. BMC Health Serv Res 13:261. https://doi.org/10.1186/1472-6963-13-261

    Article  Google Scholar 

  15. Warshaw R (2017) Health disparities affect millions in rural U.S. communities. Association of American Medical Colleges. https://www.aamc.org/news-insights/health-disparities-affect-millions-rural-us-communities. Accessed 26 Feb 2021

  16. Loftus J, Allen EM, Call KT, Everson-Rose SA (2018) Rural-urban differences in access to preventive health care among publicly insured Minnesotans. J Rural Health 34:s48-s55. https://doi.org/10.1111/jrh.12235

    Article  Google Scholar 

  17. Littenberg B, Strauss K, MacLean CD, Troy AR (2006) The use of insulin declines as patients live farther from their source of care: results of a survey of adults with type 2 diabetes. BMC Public Health 6:198. https://doi.org/10.1186/1471-2458-6-198

    Article  Google Scholar 

  18. Bristow RE, Chang J, Ziogas A, Anton-Culver H, Vieira VM (2014) Spatial analysis of adherence to treatment guidelines for advanced-stage ovarian cancer and the impact of race and socioeconomic status. Gynecol Oncol 134:60-67. https://doi.org/10.1016/j.ygyno.2014.03.561

    Article  Google Scholar 

  19. Ohio statistical areas. Ohio Development Services Agency. https://development.ohio.gov/reports/reports_ohio_statistical_areas.htm. Accessed 26 Feb 2021

  20. Overview: the I3 connectivity explorer. Internet as Infrastructure. https://internet-is-infrastructure.org. Accessed 26 Feb 2021

  21. Oest SER, Hightower M, Krasowski MD (2018) Activation and utilization of an electronic health record patient portal at an academic medical center-impact of patient demographics and geographic location. Acad Pathol 5:2374289518797573. https://doi.org/10.1177/2374289518797573

    Article  Google Scholar 

  22. Guagliardo MF (2004) Spatial accessibility of primary care: concepts, methods and challenges. Int J Health Geogr 3:3. https://doi.org/10.1186/1476-072X-3-3

    Article  Google Scholar 

  23. Friedman SA, Frayne SM, Berg E, Hamilton AB, Washington DL, Saechao F, Maisel NC, Lin JY, Hoggatt KJ, Phibbs CS (2015) Travel time and attrition from VHA care among women veterans: how far is too far? Med Care 53:S15-S22. https://doi.org/10.1097/MLR.0000000000000296

    Article  Google Scholar 

  24. Everson J, Butler E (2020) Hospital adoption of multiple health information exchange approaches and information accessibility. J Am Med Inform Assoc 27:577-583. https://doi.org/10.1093/jamia/ocaa003

    Article  Google Scholar 

  25. Anthony DL, Campos-Castillo C, Lim PS (2018) Who isn’t using patient portals and why? Evidence and implications from a national sample of US adults. Health Aff (Millwood) 37:1948-1954. https://doi.org/10.1377/hlthaff.2018.05117

    Article  Google Scholar 

  26. Greenberg AJ, Haney D, Blake KD, Moser RP, Hesse BW (2018) Differences in access to and use of electronic personal health information between rural and urban residents in the United States. J Rural Health 34:s30-s38. https://doi.org/10.1111/jrh.12228

    Article  Google Scholar 

  27. Long AS, Hanlon AL, Pellegrin KL (2018) Socioeconomic variables explain rural disparities in US mortality rates: implications for rural health research and policy. SSM Popul Health 6:72-74. https://doi.org/10.1016/j.ssmph.2018.08.009

    Article  Google Scholar 

  28. James WL (2014) All rural places are not created equal: revisiting the rural mortality penalty in the United States. Am J Public Health 104:2122-2129. https://doi.org/10.2105/AJPH.2014.301989

    Article  Google Scholar 

  29. Anderson M, Horrigan JB (2016) Smartphones help those without broadband get online, but don’t necessarily bridge the digital divide. Pew Research Center. https://www.pewresearch.org/fact-tank/2016/10/03/smartphones-help-those-without-broadband-get-online-but-dont-necessarily-bridge-the-digital-divide/. Accessed 26 Feb 2021

  30. Sarkar U, Karter AJ, Liu JY, Adler NE, Nguyen R, Lopez A, Schillinger D (2010) The literacy divide: health literacy and the use of an internet-based patient portal in an integrated health system-results from the diabetes study of northern California (DISTANCE). J Health Commun 15:183-196. https://doi.org/10.1080/10810730.2010.499988

    Article  Google Scholar 

  31. Tieu L, Schillinger D, Sarkar U, Hoskote M, Hahn KJ, Ratanawongsa N, Ralston JD, Lyles CR (2017) Online patient websites for electronic health record access among vulnerable populations: portals to nowhere? J Am Med Inform Assoc 24:e47-e54. https://doi.org/10.1093/jamia/ocw098

    Article  Google Scholar 

  32. Singh GK, Kogan MD, Slifkin RT (2017) Widening disparities in infant mortality and life expectancy between Appalachia and the rest of the United States, 1990–2013. Health Aff (Millwood) 36:1423-1432. https://doi.org/10.1377/hlthaff.2016.1571

    Article  Google Scholar 

  33. Behringer B, Friedell GH (2006) Appalachia: where place matters in health. Prev Chronic Dis 3:A113.

    Google Scholar 

  34. Giacobbi P, Jr., Cushing P, Popa A, Haggerty T, Hansell A, Sedney C (2018) Mobile health (mHealth) use or non-use by residents of West Virginia. South Med J 111:625–627. https://doi.org/10.14423/SMJ.0000000000000879

    Article  Google Scholar 

  35. Casillas A, Abhat A, Vassar SD, Huang DY, Mahajan AP, Simmons S, Lyles C, Portz J, Moreno G, Brown AF (2021) Not speaking the same language-lower portal use for limited English proficient patients in the Los Angeles safety net. J Health Care Poor Underserved 32:2055-2070. https://doi.org/10.1353/hpu.2021.0182

    Article  Google Scholar 

  36. Foiles Sifuentes AM, Cornejo MR, Li NC, Castaneda-Avila MA, Tjia J, Lapane KL (2020) The role of limited English proficiency and access to health insurance and health care in the Affordable Care Act era. Health Equity 4:509-517. https://doi.org/10.1089/heq.2020.0057

    Article  Google Scholar 

  37. Smith DL (2009) Health care disparities for persons with limited English proficiency: relationships from the 2006 Medical Expenditure Panel Survey (MEPS). J Health Dispar Res Pract 3:Article 4.

  38. Free & low-cost internet plans. National Digital Inclusion Alliance. https://www.digitalinclusion.org/free-low-cost-internet-plans/. Accessed 26 Feb 2021

  39. McAlearney AS, Walker DM, Sieck CJ, Fareed N, MacEwan SR, Hefner JL, Di Tosto G, Gaughan A, Sova LN, Rush LJ, Moffatt-Bruce S, Rizer MK, Huerta TR (2022) Effect of in-person vs video training and access to all functions vs a limited subset of functions on portal use among inpatients: a randomized clinical trial. JAMA Network Open 5:e2231321. https://doi.org/10.1001/jamanetworkopen.2022.31321

    Article  Google Scholar 

  40. McAlearney AS, Gaughan A, MacEwan SR, Fareed N, Huerta TR (2019) Improving acceptance of inpatient portals: patients' and care team members' perspectives. Telemed J E Health 26:310-326. https://doi.org/10.1089/tmj.2019.0026

    Article  Google Scholar 

  41. Dworkowitz A (2022) Provider obligations for patient portals under the 21st Century Cures Act. Health Affairs Forefront. https://doi.org/10.1377/forefront.20220513.923426/. Accessed 13 Oct 2022

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Funding

This work was supported by grants from the Agency for Healthcare Research and Quality (R01HS024091 and P30HS024379).

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Authors and Affiliations

  1. Division of General Internal Medicine, College of Medicine, The Ohio State University, 700 Ackerman Road, Suite 4000, Columbus, OH, 43202, USA

    Sarah R. MacEwan

  2. The Center for Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA

    Sarah R. MacEwan, Cynthia J. Sieck & Ann Scheck McAlearney

  3. Center for Health Equity, Dayton Children’s Hospital, Dayton, OH, USA

    Cynthia J. Sieck

  4. Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA

    Ann Scheck McAlearney

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  1. Sarah R. MacEwan
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Correspondence to Sarah R. MacEwan.

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Data were acquired from the institutional Information Warehouse (IW) through an Honest Broker protocol, an Institutional Review Board (IRB)-established process whereby the IW provides de-identified data sets without requiring formal IRB protocol approval.

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MacEwan, S.R., Sieck, C.J. & McAlearney, A.S. Geographic Location Impacts Patient Portal Use via Desktop and Mobile Devices. J Med Syst 46, 97 (2022). https://doi.org/10.1007/s10916-022-01881-5

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