Identifying contributors to disparities in patient access of online medical records: examining the role of clinician encouragement

Bryan A Sisk; Sunny Lin; Joyce Joy E Balls-Berry; Argentina E Servin; Jennifer W Mack

doi:10.1093/jamiaopen/ooad049

Identifying contributors to disparities in patient access of online medical records: examining the role of clinician encouragement

JAMIA Open. 2023 Jul 7;6(3):ooad049. doi: 10.1093/jamiaopen/ooad049. eCollection 2023 Oct.

Authors

Bryan A Sisk^{1

2}, Sunny Lin², Joyce Joy E Balls-Berry³, Argentina E Servin⁴, Jennifer W Mack^{5

6}

Affiliations

¹ Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA.
² General Medical Sciences, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
³ Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA.
⁴ Department of Medicine, University of California San Diego, San Diego, California, USA.
⁵ Department of Pediatric Oncology and Division of Population Sciences, Dana-Farber Cancer Institute, Boston, Massachusetts, USA.
⁶ Division of Pediatric Hematology/Oncology, Boston Children's Hospital, Boston, Massachusetts, USA.

Abstract

Objective: The aim of this study was to understand the influence of clinician encouragement and sociodemographic factors on whether patients access online electronic medical records (EMR).

Materials and methods: We analyzed 3279 responses from the Health Information National Trends Survey 5 cycle 4 survey, a cross-sectional, nationally representative survey administered by the National Cancer Institute. Frequencies and weighted proportions were calculated to compare clinical encouragement and access to their online EMR. Using multivariate logistic regression, we identified factors associated with online EMR use and clinician encouragement.

Results: In 2020, an estimated 42% of US adults accessed their online EMR and 51% were encouraged by clinicians to access their online EMR. In multivariate regression, respondents who accessed EMR were more likely to have received clinician encouragement (odds ratio [OR], 10.3; 95% confidence interval [CI], 7.7-14.0), college education or higher (OR, 1.9; 95% CI, 1.4-2.7), history of cancer (OR, 1.5; 95% CI, 1.0-2.3), and history of chronic disease (OR, 2.3; 95% CI, 1.7-3.2). Male and Hispanic respondents were less likely to have accessed EMR than female and non-Hispanic White respondents (OR, 0.6; 95% CI, 0.5-0.8, and OR, 0.5; 95% CI, 0.3-0.8, respectively). Respondents receiving encouragement from clinicians were more likely to be female (OR, 1.7; 95% CI, 1.3-2.3), have college education (OR, 1.5; 95% CI, 1.1-2.0), history of cancer (OR, 1.8; 95% CI, 1.3-2.5), and greater income levels (OR, 1.8-3.6).

Discussion: Clinician encouragement of patient EMR use is strongly associated with patients accessing EMR, and there are disparities in who receives clinician encouragement related to education, income, sex, and ethnicity.

Conclusions: Clinicians have an important role to ensure that all patients benefit from online EMR use.

Keywords: Electronic medical record; communication; healthcare disparities; online patient portals; physician–patient relationship.