Widespread use of online personal health records inhibited by ‘digital divide’

Yamin CK. Arch Intern Med. 2011;171:568-574.

Disparities in access to technology have inhibited adoption of Internet-based medical information, particularly among minority populations, according to recent findings published in the Archives of Internal Medicine.

“While a lot has been written about the ‘digital divide,’ few empiric data have been available to quantify it,” David W. Bates, MD, MSc, of the division of general internal medicine at Brigham and Women’s Hospital, said in an interview. “We measured how many patients adopted a patient portal within a large network and assessed the magnitude of the digital divide.”

In the cross-sectional analysis, Bates and colleagues pooled data on 75,056 patients who received health care from practices using personal health records (PHR) between 2007 and 2009. Demographic characteristics of those who activated a PHR account online (adopters) were then compared with those who visited a practice offering PHR but did not have a PHR account (nonadopters).

The intensity of use was based upon the number of log-ins and messages sent to physician offices; the presence of chronic disease was also examined for an association between adoption and intensity of use.

Overall, 32,274 patients adopted a PHR, which accounted for 290,662 log-ins during the study period. The largest group of adopters (51%) was classified as low users, whereas high users who logged into the PHR 10 times or more accounted for 27%.

Gender, age, ethnicity and insurance status significantly differed among adopters and nonadopters. Compared with patients aged 18 to 35 years, more patients aged older than 65 years adopted a PHR; 41% of high users were patients aged 51 to 65 years.

Compared with whites, blacks and Hispanics were 50% less likely to adopt PHRs (OR=0.50; 95% CI, 0.45-0.55). Blacks were 24% less likely to be included in the high-user group vs. whites (intensity ratio=0.76; 95% CI, 0.71-0.82). Although patients in the lowest-income households were 14% less likely to adopt PHRs compared with those in the highest-income households, this had a minimal effect on PHR adoption, according to the researchers.

Patients with chronic disease were 25% more likely to adopt a PHR compared with those without a chronic disease. Specifically, those with one chronic disease were 1.21 times more likely to send messages through a PHR (95% CI, 1.16-1.26), and those with two chronic diseases were 1.42 times more likely to send messages (95% CI, 1.33-1.52).

“We found that minorities and patients of lower socioeconomic status were less likely to adopt the portal,” Bates said. “However, among those who did adopt, levels of use were similar, suggesting that the key to overcoming it may be getting patients to adopt. Physicians should encourage all patients to use PHRs, especially those who have chronic diseases, are minorities, or with lower socioeconomic status.” – by Ashley DeNyse

Disclosure: Dr. Bates reports no relevant financial disclosures.

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