Exploring the Digital Divide: Age and Race Disparities in Use of an Inpatient Portal

Abstract

Background: Age and race disparities in the use of new technologies-the digital divide-may be limiting the potential of patient-facing health information technology to improve health and health care. Objective: To investigate whether disparities exist in the use of patient portals designed specifically for the inpatient environment. Methods: Patients admitted to the six hospitals affiliated with a large, Midwestern academic medical center from July 2017 to July 2018 were provided with access to a tablet equipped with an inpatient portal and recruited to participate in the study (n = 842). Demographic characteristics of study enrollees were obtained from patients' electronic health records and surveys given to patients during their hospital stay. Log files from the inpatient portal were used to create a global measure of use and calculate use rates for specific portal features.Results: We found both age and race disparities in use of the inpatient portal. Patients aged 60-69 (45.3% difference, p < 0.001) and those over age 70 (36.7% difference, p = 0.04) used the inpatient portal less than patients aged 18-29. In addition, African American patients used the portal less than White patients (40.4% difference, p = 0.004).Discussion: These findings suggest that the availability of the technology alone may be insufficient to overcome barriers to use and that additional intervention may be needed to close the digital divide. Conclusions: We identified lower use of the inpatient portal among African American and older patients, relative to White and younger patients, respectively.

Keywords: disparities; e-health; inpatient portal; patient portal; telemedicine.

Fig. 1.

Use of four most frequently used MyChart^® Bedside features, by age category. Significance determined from analysis of variance with Bonferroni correction. ^a60–69 versus 30–39, p = 0.02; ^b≥70 versus 30–39, p = 0.02; ^c50–59 versus 18–29, p = 0.004; ^d50–59 versus 30–39, p < 0.001; ^e60–69 versus 18–29, p < 0.001; ^f60–69 versus 30–39, p < 0.001; ^g≥60–69 versus 40–49, p = 0.005; ^h≥70 versus 18–29, p = 0.02; ⁱ>70 versus 30–39, p = 0.02.

Fig. 2.

Use of the four most frequently used MyChart Bedside features, by race category. Significance determined from analysis of variance with Bonferroni correction. ^aWhites versus African Americans, p < 0.001; ^bWhites versus African Americans, p = 0.009.