Department of Quantitative Health Sciences
Health Information Technology | Health Services Administration
BACKGROUND: As electronic health records and computerized workflows expand, there are unprecedented opportunities to digitally connect with patients using secure portals. To realize the value of patient portals, initial reach across populations will need to be demonstrated, as well as sustained usage over time.
OBJECTIVE: The study aim was to identify patient factors associated with short-term and long-term portal usage after patients registered to access all portal functions.
METHODS: We prospectively followed a cohort of patients at a large Department of Veterans Affairs (VA) health care facility who recently completed identity proofing to use the VA patient portal. Information collected at baseline encompassed patient factors potentially associated with portal usage, including: demographics, Internet access and use, health literacy, patient activation, and self-reported health conditions. The primary outcome was the frequency of portal log-ins during 6-month and 18-month time intervals after study enrollment.
RESULTS: A total of 270 study participants were followed prospectively. Almost all participants (260/268, 97.0%) reported going online, typically at home (248/268, 92.5%). At 6 months, 84.1% (227/270) of participants had visited the portal, with some variation in usage across demographic and health-related subgroups. There were no significant differences in portal log-ins by age, gender, education, marital status, race/ethnicity, distance to a VA facility, or patient activation measure. Significantly higher portal usage was seen among participants using high-speed broadband at home, greater self-reported ability using the Internet, and routinely going online. By 18 months, 91% participants had logged in to the portal, and no significant associations were found between usage and demographics, health status, or patient activation. When examining portal activity between 6 and 18 months, patients who were infrequent or high portal users remained in those categories, respectively.
CONCLUSIONS: Short-term and long-term portal usage was associated with having broadband at home, high self-rated ability when using the Internet, and overall online behavior. Digital inclusion, or ready access to the Internet and digital skills, appears to be a social determinant in patient exposure to portal services.
Internet, broadband, digital inclusion, patient portal, personal health record, social determinants
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© Susan S Woods, Christopher W Forsberg, Erin C Schwartz, Kim M Nazi, Judith H Hibbard, Thomas K Houston, Martha Gerrity. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 17.10.2017. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.
DOI of Published Version
J Med Internet Res. 2017 Oct 17;19(10):e345. doi: 10.2196/jmir.7895. Link to article on publisher's site
Journal of medical Internet research
Woods, Susan S.; Forsberg, Christopher W.; Schwartz, Erin C.; Nazi, Kim M.; Hibbard, Judith H.; Houston, Thomas K.; and Gerrity, Martha, "The Association of Patient Factors, Digital Access, and Online Behavior on Sustained Patient Portal Use: A Prospective Cohort of Enrolled Users" (2017). University of Massachusetts Medical School Faculty Publications. 1415.
Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.