Study Digs into Patient Access to Electronic Health Information

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Findings suggest that participants nationwide who were offered and accessed their online medical record has more than doubled in the past eight years, but racial and ethnic disparities continue.

A study published in JAMA Health Forum recently explored how patient access to electronic health information (EHI) via online medical records and patient portals changed during the COVID-19 pandemic.

This repeated cross-sectional study featured 22,266 US adults using data from six cycles of the Health Information National Trends Survey (2014, 2017-2020, 2022). The study authors determined that patient access to EHI more than doubled during the pandemic, but racial and ethnic disparities persisted—Black and Hispanic participants reported being offered access to a patient portal at significantly lower rates compared to White individuals. There were no disparities found in use or understanding of EHI among those who accessed it.

Taking a closer look, the study population featured participants with a mean [SE] age of 49.9 years [0.15] years) of whom 13,348 (54%) were female; 909 (5%) self-identified as Asian, 3523 (12%) as Black, 3178 (14%) as Hispanic, 13,555 (66%) as White, and 785 (3%) as another or more than one race. Patient portal access increased nationally each year from 2014-2022, with a 46% increase observed between 2020 (n = 3319) and 2022 (n = 5437). However, in 2022, Black and Hispanic individuals reported being offered access to a portal by their healthcare provider (HCP) at significantly lower rates compared with White individuals (73% vs 81%; χ21 = 22.24; P < .001; and 62% vs 81%; χ21 = 135.57; P < .001, respectively) as well as accessing a patient portal at lower rates (60% vs 70%; χ21 = 23.80; P < .001; and 57% vs 70%; χ21 = 49.02; P < .001, respectively).

Data for this repeated cross-sectional study came from the Health Information National Trends Survey (HINTS), a nationally representative survey of US adults that tracks individuals’ access and use of their health information. The sample was limited to respondents who had a health care visit in the past 12 months, and had a reason to access their online medical record.

Access to these digital patient portals was propelled in 2020 when the Office of the National Coordinator for Health Information Technology published the Cures Act Final Rule (Cures Rule),1 which called on health information technology developers to adopt secure, standards-based application programming interfaces that could enable patients to access their EHI using health apps via a smartphone or other methods, and prohibited health care professionals, developers, and other relevant actors from interfering with an individual’s right to access their own records.2,3 These anti-information blocking regulations play an important role in affirming patient access to EHI, which is central to meeting patient demand for getting timely access to test results and clinical notes.4,5

Study authors noted that “the overarching goal of this study was to assess progress toward equitable patient access to EHI two years after the start of the COVID-19 pandemic, and to identify persistent racial and ethnic disparities.”

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Findings suggested that patient access to EHI has improved; in fact, the share of individuals across the country who were offered and accessed their online medical record has more than doubled in the past eight years. Specifically, patient access increased during the pandemic from 46% in 2020 to 68% in 2022, but more efforts are needed to provide reasonable opportunities by encouraging all patients to access and use their portals.

References

1. Office of the National Coordinator for Health Information Technology. 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program. 2020. Accessed October 6, 2023. https://www.federalregister.gov/documents/2020/05/01/2020-07419/21st-century-cures-act-interoperability-information-blocking-and-the-onc-health-it-certification

2. US Department of Health and Human Services. Your Rights Under HIPAA. Accessed May 3, 2023. https://www.hhs.gov/hipaa/for-individuals/guidance-materials-for-consumers/index.html

3. Office of the National Coordinator for Health Information Technology. What Is Information Blocking and to Whom Does It Apply? Accessed May 3, 2023. https://www.healthit.gov/topic/information-blocking

4. Everson, J. New Study Shows Patients Prefer Immediate Access to Test Results and have Unmet Information Needs blog. March 2023. Accessed October 6, 2023. https://www.healthit.gov/buzz-blog/information-blocking/new-study-shows-patients-prefer-immediate-access-to-test-results-and-have-unmet-information-needs

5. Steitz, BD; Turer, RW; Lin, CT, et al. Perspectives of patients about immediate access to test results through an online patient portal. JAMA Netw Open. 2023;6(3):e233572. doi: 10.1001/jamanetworkopen.2023.3572