Results viewing according to A, test type; B, patient race; C, patient primary language; and D, number of results released and viewed.
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Pho K, Lu R, Gates S, Xie Y, Lee SJC, Gerber DE. Characteristics of Patients Using Patient Portals in Oncology. JAMA Oncol. 2018;4(3):416–418. doi:10.1001/jamaoncol.2017.5257
Nationwide, health care institutions have implemented electronic patient portals, providing patients real-time access to their health information and physicians. Portals have been studied extensively in primary care and certain specialty settings, but only recently has use in oncology been investigated. Longitudinal cancer care may be more intensive than many other specialties, resulting in increased portal data flow.1 However, little is known about how patients access incoming portal data. In this study, we analyzed the likelihood of accessing portal data according to patient characteristics and type of portal content.
This study was reviewed and approved by the University of Texas Southwestern Medical Center institutional review board and a waiver of written informed consent was granted. We identified patients with a cancer diagnosis treated at the Harold C. Simmons Comprehensive Cancer Center who enrolled in the patient portal (MyChart) and received at least 1 laboratory and/or imaging result between January 1, 2007, and December 31, 2016. As described previously,1 we extracted released results from Clarity databases, based on a MyChart timestamp by the data extraction cutoff (May 12, 2017). The primary endpoint was result viewing. Associations between patient characteristics and the odds of viewing results were tested using univariable and multivariable logistic regression models. Logistic regression models were run using the glm function in R statistical software (version 3.3.2, R Foundation).
From 2007 to 2016, we identified 19 434 patients with MyChart accounts from a total of 44 590 total patients (44%). Over time, the proportion of patients with MyChart accounts increased from 26% to 62%. Median age was 64 years (interquartile range [IQR], 54-72 years), 9790 (50%) were women, and 14 492 (75%) were white (Table). Radiology results were more likely to be viewed than were laboratory results (Figure, A). Rates of result viewing were consistently lower among black (OR, 0.50; 95% CI, 0.49-0.50) and Spanish-speaking (OR, 0.37; 95% CI, 0.36-0.39) patients (Figure, B and C). In recent years, there was a clear decrease in the proportion of results viewed (61% in 2012 vs 38% in 2015; decreasing trend P = .05; time coefficient standard error, 0.02) (Figure, D).
Among patients treated at a National Cancer Institute (NCI)-designated comprehensive cancer center, rate of portal enrollment more than doubled in recent years, radiology results were more likely to be viewed than laboratory results, and the likelihood of viewing test results was substantially lower among underrepresented minorities. These findings suggest the possibility of a growing digital divide, which may hinder access to health information.2,3 Although socioeconomic status may represent a confounding factor, our results are particularly noteworthy because our sample does not include underinsured individuals, who are cared for at our affiliated safety-net facility.
We also observed a recent decrease in the proportion of results viewed, which suggests that increasing reliance on electronic communication may not always promote the stated goal of increasing transparency in health care.4 Potential explanations for this trend include the enrollment of a broader population that might be less motivated to access the portal, the sheer volume of incoming data (which could result in information overload5), or other factors.
A limitation of the current study is the single-center setting. Patients who seek care at NCI-designated centers differ from the broader population in socioeconomic status and education level,6 factors with potential relevance to portal use. In addition, demographic variables—based on patient self report and entered by clinic staff—may be incompletely documented in the medical record.
Although increased access to and transparency of health care are key drivers for patient health portal implementation, actual use patterns suggest highly variable uptake. Specifically, traditionally medically underserved populations appear less likely to access available data. Furthermore, over time a smaller proportion of results are being viewed. Future research to explain and address these trends is needed. That portal use may exacerbate rather than ameliorate health care disparities highlights the importance of critically evaluating this technology to improve patient engagement and quality of care.
Corresponding Author: David E. Gerber, MD, Division of Hematology-Oncology, Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Mail Code 8852, Dallas, TX 75390-8852 (firstname.lastname@example.org).
Accepted for Publication: November 13, 2017.
Published Online: January 25, 2018. doi:10.1001/jamaoncol.2017.5257
Author Contributions: Dr Gerber had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design: Pho, Gates, Xie, Lee, Gerber.
Acquisition, analysis, or interpretation of data: Pho, Lu, Gates, Lee, Gerber.
Drafting of the manuscript: Pho, Lu, Gerber.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Lu, Gates, Xie.
Obtained funding: Lee, Gerber.
Administrative, technical, or material support: Pho, Lee, Gerber.
Study supervision: Xie, Lee, Gerber.
Conflict of Interest Disclosures: None reported.
Funding/Support: Supported by a National Cancer Institute (NCI) Midcareer Investigator Award in Patient-Oriented Research (K24CA201543-01) (D.E.G), an NIH National Institute of Diabetes and Digestive and Kidney Diseases Short-Term Institutional Research Training Grant (5 T35 DK 66141-10) (K.P.), and by the National Center for Advancing Translational Sciences UT Southwestern Center for Translational Medicine (U54 RFA-TR-12-006). Biostatistical support provided by the Biostatistics Shared Resource at the Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas, which is supported in part by NCI Cancer Center Support Grant 1P30 CA142543-01 and by the Cancer Prevention and Research Institute of Texas (CPRIT), RP150596.
Role of the Funder/Sponsor: The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Meeting Presentation: This work was presented in abstract form at the 17th annual ECOG-ACRIN Young Investigator Symposium; October 26, 2017; Orlando, Florida.