Use of Electronic Health Records by Older Adults, 85 Years and Older, and Their Caregivers

Abstract

Background: Healthcare providers may not offer patient portal (PP) access to electronic health records (EHRs) to their patients older than 85 years, due to the false impression that they do not utilize technology. It is imperative that older adults be given equal opportunity to use technology in regard to their healthcare.

Objective: To characterize the content and frequency of use of PP messaging tethered to EHRs by older adults, aged 85 years and older, and their caregivers.

Design, setting, and participants: User-initiated communications from electronic PPs (MyChart) tethered to an EHR (Epic) for patients who were 85 years and older, receiving care at outpatient internal medicine and geriatric clinics at an academic health center from July 1, 2016, to December 31, 2016, were reviewed retrospectively and analyzed with mixed methods.

Results: A total of 1254 user-initiated messages, sent by 62 patients aged 85 years and older (mean age = 87.9 years; n = 576 messages; mean = 9.9 messages per person) and 82 caregivers (n = 678 messages; mean = 7.8 messages per person), were analyzed. Qualitative analysis revealed 12 main themes: clinical issues, medication/vaccine questions, medication refills, laboratory orders/results, therapy/durable medical equipment, care coordination, care transitions, scheduling, appreciation/thank you, administrative/billing, telephone requests, and death notification. Caregivers significantly initiated messages more for care transitions (P < .001). Patients significantly initiated messages more for scheduling (P = .04) and medication refills (P = .04). Patients who had heart failure, coronary artery disease, or Alzheimer's disease were significantly more likely to have caregivers using the PP as their proxy (30.7% vs 21.6%; P = .01).

Conclusions: Adults, aged 85 years and older, and their caregivers utilize PPs tethered to EHRs. Healthcare providers should ensure inclusivity and offer access to EHRs to older adult populations, especially those aged 85 years and older. J Am Geriatr Soc 68:1078-1082, 2020.

Keywords: caregivers; electronic health records; older adults.