Office of the National Coordinator for Health Information Technology, Washington, DC.
JAMA Health Forum. 2023 Nov 3;4(11):e233883. doi: 10.1001/jamahealthforum.2023.3883.
Patient access to electronic health information (EHI) available via online medical records and through patient portals has been shown to help individuals make informed health decisions, which are associated with better health outcomes.
To assess progress in patient engagement with EHI and to identify racial or ethnic disparities in access to patient portals.
DESIGN, SETTING, AND PARTICIPANTS: This was a repeated cross-sectional study using data from the US Health Information National Trends Survey (HINTS), a nationally representative survey of US adults that tracks individuals' access and use of their health information. Six cycles of HINTS were included (2014, 2017-2020, 2022); data for the disparities analysis came from the 2022 HINTS. Data analyses were performed in April 2023.
Patient reports of (1) being offered portal access by a health care provider (HCP); (2) being encouraged by the HCP to use the portal; (3) accessing their portal; and (4) using the portal for various purposes. Additional key measures included methods used to access portals and self-reported ease of understanding information contained in the online medical records or portals.
The total study population included 22 266 individuals (mean [SE] age, 49.9 [0.15] years) of whom 13 348 (54%) were female; 909 (5%) self-identified as Asian, 3523 (12%) as Black, 3178 (14%) as Hispanic, 13 555 (66%) as White, and 785 (3%) as another or more than 1 race. Nationally, patient portal access increased each year from 2014 through 2022, with a 46% increase observed between 2020 (n = 3319) and 2022 (n = 5437). However, in 2022, Black and Hispanic individuals reported being offered access to a portal by their HCP at significantly lower rates compared with White individuals (73% vs 81%; χ21 = 22.24; P < .001; and 62% vs 81%; χ21 = 135.57; P < .001, respectively) as well as accessing a patient portal at lower rates (60% vs 70%; χ21 = 23.80; P < .001; and 57% vs 70%; χ21 = 49.02; P < .001, respectively).
The findings of this repeated cross-sectional study of US adult respondents to the HINTS suggest that access to and engagement with patient portals increased significantly from 2014 through 2022, but racial and ethnic disparities in patient access persisted in 2022. However, there were no significant differences in use or understanding of information available in the online medical records among those who accessed them, which suggests that efforts to promote equitable opportunities to access EHI would likely be associated with increased patient access.
患者可以通过在线病历和患者门户访问电子健康信息（EHI），这已被证明有助于个人做出明智的健康决策，从而改善健康结果。
评估患者对 EHI 的参与程度，并确定在获得患者门户方面是否存在种族或民族差异。
设计、地点和参与者：这是一项使用来自美国健康信息国家趋势调查（HINTS）的数据进行的重复横断面研究，该调查是一项针对美国成年人的全国代表性调查，跟踪个人获取和使用其健康信息的情况。共纳入了 HINTS 的六个周期（2014 年、2017-2020 年、2022 年）；差异分析的数据来自 2022 年 HINTS。数据分析于 2023 年 4 月进行。
患者报告（1）医疗保健提供者提供门户访问的情况；（2）医疗保健提供者鼓励使用门户的情况；（3）访问其门户的情况；以及（4）使用门户进行各种目的的情况。其他关键措施包括用于访问门户的方法以及自我报告对在线病历或门户中包含的信息的理解程度。
总研究人群包括 22266 名个体（平均[SE]年龄，49.9[0.15]岁），其中 13348 名（54%）为女性；909 名（5%）自我认定为亚洲人，3523 名（12%）为黑人，3178 名（14%）为西班牙裔，13555 名（66%）为白人，785 名（3%）为其他种族或多种族。从 2014 年到 2022 年，患者门户的访问量每年都在增加，2020 年（n=3319）和 2022 年（n=5437）之间的增长率为 46%。然而，在 2022 年，与白人相比，黑人（73%比 81%；χ21=22.24；P<0.001）和西班牙裔（62%比 81%；χ21=135.57；P<0.001）的个体报告获得 HCP 提供的门户访问的比例较低，并且访问患者门户的比例也较低（60%比 70%；χ21=23.80；P<0.001；和 57%比 70%；χ21=49.02；P<0.001）。
这项对 HINTS 美国成年受访者的重复横断面研究结果表明，从 2014 年到 2022 年，患者对门户的访问量和参与度显著增加，但在 2022 年，患者获取门户的机会仍然存在种族和民族差异。然而，在使用或理解在线病历中的信息方面，访问者之间没有显著差异，这表明促进公平获取 EHI 的努力可能与增加患者访问量有关。
