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Disparities in Patient Portal Activation and Use in a Pediatric Emergency Department
Mary Beth Howard1,2, Keith Kleinman1, Philip J Spevak3
1Department of Pediatrics, Division of Pediatric Emergency Medicine.
Insights
Patient portal use in pediatric emergency departments (EDs) is high, but disparities exist. Targeted interventions are needed to ensure equitable access for all young patients to their health information.
Area of Science:
- Health Informatics
- Pediatric Emergency Medicine
- Digital Health Equity
Background:
- Patient portals improve engagement and outcomes but are understudied in pediatric emergency departments (EDs).
- This study addresses the gap in understanding patient portal activation and proxy use within a pediatric ED setting.
Purpose of the Study:
- To evaluate patient portal activation and proxy use in a pediatric ED.
- To examine demographic and clinical factors associated with patient portal utilization.
- To assess proxy use patterns among adolescent patients.
Main Methods:
- Retrospective analysis of electronic health record data from a single urban pediatric ED (July 2022-June 2023).
- Categorization of patient portal use: active, nonactive, and nonuser.
- Multivariable analyses to identify factors associated with portal use and proxy access in adolescents.
Main Results:
- Over 18,000 patients (27,000+ visits) showed 58.1% active portal use.
- Active users were younger, privately insured, and less likely to be non-Hispanic Black.
- Adolescent patient-only portal access significantly increased with age (1.9% at 12 to 82.0% at 17).
Conclusions:
- High overall patient portal use in pediatric EDs, yet demographic disparities persist.
- Targeted interventions are crucial for equitable portal adoption and access to medical records.
- Findings align with the Cures Act Final Rule's goals for patient data access.
Introduction:
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.
Methods:
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.
Results:
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.
Conclusions:
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.
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