Real-Time Electronic Patient Portal Use Among Emergency Department Patients

Author:

Turer Robert W.12,McDonald Samuel A.12,Lehmann Christoph U.23,Thakur Bhaskar1,Dutta Sayon45,Taylor Richard A.67,Rose Christian C.8,Frisch Adam9,Feterik Kristian9,Norquist Craig10,Baker Carrie K.11,Nielson Jeffrey A.11,Cha David11,Kwan Brian12,Dameff Christian12,Killeen James P.12,Hall Michael K.13,Doerning Robert C.13,Rosenbloom S. Trent14,Distaso Casey1415,Steitz Bryan D.15

Affiliation:

1. Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas

2. Clinical Informatics Center, University of Texas Southwestern Medical Center, Dallas

3. Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas

4. Department of Emergency Medicine, Mass General Brigham, Boston, Massachusetts

5. Mass General Brigham Digital, Boston, Massachusetts

6. Department of Emergency Medicine and Section for Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut

7. Department of Biostatistics, Yale School of Public Heath, New Haven, Connecticut

8. Department of Emergency Medicine, Stanford University School of Medicine, Stanford, California

9. Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

10. Department of Emergency Medicine, HonorHealth, Phoenix, Arizona

11. Department of Emergency Medicine, Kettering Health, and Wright State University Boonshoft School of Medicine, Dayton, Ohio

12. Department of Emergency Medicine, School of Medicine, University of California, San Diego

13. Department of Emergency Medicine, University of Washington, Seattle

14. Departments of Internal Medicine and Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee

15. Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee

Abstract

ImportancePatients with inequitable access to patient portals frequently present to emergency departments (EDs) for care. Little is known about portal use patterns among ED patients.ObjectivesTo describe real-time patient portal usage trends among ED patients and compare demographic and clinical characteristics between portal users and nonusers.Design, Setting, and ParticipantsIn this cross-sectional study of 12 teaching and 24 academic-affiliated EDs from 8 health systems in California, Connecticut, Massachusetts, Ohio, Tennessee, Texas, and Washington, patient portal access and usage data were evaluated for all ED patients 18 years or older between April 5, 2021, and April 4, 2022.ExposureUse of the patient portal during ED visit.Main Outcomes and MeasuresThe primary outcomes were the weekly proportions of ED patients who logged into the portal, viewed test results, and viewed clinical notes in real time. Pooled random-effects models were used to evaluate temporal trends and demographic and clinical characteristics associated with real-time portal use.ResultsThe study included 1 280 924 unique patient encounters (53.5% female; 0.6% American Indian or Alaska Native, 3.7% Asian, 18.0% Black, 10.7% Hispanic, 0.4% Native Hawaiian or Pacific Islander, 66.5% White, 10.0% other race, and 4.0% with missing race or ethnicity; 91.2% English-speaking patients; mean [SD] age, 51.9 [19.2] years). During the study, 17.4% of patients logged into the portal while in the ED, whereas 14.1% viewed test results and 2.5% viewed clinical notes. The odds of accessing the portal (odds ratio [OR], 1.36; 95% CI, 1.19-1.56), viewing test results (OR, 1.63; 95% CI, 1.30-2.04), and viewing clinical notes (OR, 1.60; 95% CI, 1.19-2.15) were higher at the end of the study vs the beginning. Patients with active portal accounts at ED arrival had a higher odds of logging into the portal (OR, 17.73; 95% CI, 9.37-33.56), viewing test results (OR, 18.50; 95% CI, 9.62-35.57), and viewing clinical notes (OR, 18.40; 95% CI, 10.31-32.86). Patients who were male, Black, or without commercial insurance had lower odds of logging into the portal, viewing results, and viewing clinical notes.Conclusions and RelevanceThese findings suggest that real-time patient portal use during ED encounters has increased over time, but disparities exist in portal access that mirror trends in portal usage more generally. Given emergency medicine’s role in caring for medically underserved patients, there are opportunities for EDs to enroll and train patients in using patient portals to promote engagement during and after their visits.

Publisher

American Medical Association (AMA)

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