Disparities in Patient Portal Activation and Use in a Pediatric Emergency Department

Patient portals enhance patient engagement and health care outcomes, yet their use in pediatric emergency departments (EDs) remains understudied. This study evaluated patient portal activation and proxy use in a pediatric ED, examining associations with demographic and clinical factors.

We conducted a retrospective analysis of electronic health record patient portal use from a single urban pediatric ED from July 1, 2022, to June 30, 2023. Patient portal use was categorized as active, nonactive, and nonuser. We assessed demographic and clinical characteristics associated with portal use and examined proxy use among adolescents.

Among 18,964 unique patients (27,454 visits), 58.1% were active portal users, 11.0% were nonactive, and 31.0% were nonusers. Multivariable analyses showed that active users were significantly more likely to be younger [odds ratio (OR): 2.9, 95% CI: 2.6-3.1] and covered by private insurance (OR: 1.6, 95% CI: 1.5-1.7), and less likely to be non-Hispanic black (OR: 0.80, 95% CI: 0.74-0.86). Discharged patients had lower odds of active use (0.51, 95% CI: 0.46-0.56). Among adolescents, patient-only access increased with age, from 1.9% at age 12 to 82.0% at age 17.

While overall portal use was high, demographic disparities persist. These findings highlight the need for targeted interventions to enhance equitable portal adoption, ensuring all pediatric ED patients benefit from improved access to their medical records, consistent with the Cures Act Final Rule.