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Socioeconomic Disparities in Adoption of Personal Health Records Over Time
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Socioeconomic Disparities in Adoption of Personal Health Records Over Time

Jessica S. Ancker, PhD, MPH; Baria Hafeez, MS; and Rainu Kaushal, MD, MPH
Over 4 years, rates of personal health record use increased rapidly across the board, but a digital divide remained evident.
The weighted proportion of New Yorkers who reported using a PHR rose from 11% in 2012 to 27.1% in 2015 (P <.01 for 4-year trend) (Figure). Black individuals were initially substantially less likely to use portals/PHRs than whites, but the proportion of black respondents using these technologies rose sharply (4.3% in 2012, 7.5% in 2013, 14.3% in 2014, and 23.9% in 2015; P <.001 for trend). By 2015, the proportion of blacks who used portals/PHRs was not significantly different from the proportion of other races (23.9% vs 28.1%; P = .25).
A different trend was seen among individuals of Hispanic ethnicity. In 2012, the PHR adoption rate among Hispanics was not significantly lower than the rate among non-Hispanics (9% vs 11.1%; P = .52). By 2015, despite an increase, the adoption rate lagged significantly behind the rate for non-Hispanics (15.8% vs 29.3%; P = .001). Also, the portal/PHR adoption rate among low-income respondents (household income <$50,000) also rose, but remained about half the rate reported by higher-income respondents (7.2% vs 13.5% in 2012, P = .007; 18.2% vs 32.6% in 2015, P <.001).
As previously reported, the use of portals/PHRs was also more common among patients who used the Internet more frequently, those with higher education, and those using prescription medications.9

During a 4-year period in which federal policies incentivized medical organizations to give medical record access to patients through PHRs and electronic portals, the proportion of New Yorkers who used these technologies more than doubled. Racial disparities in technology adoption largely disappeared during this time. However, disparities on the basis of income and Hispanic ethnicity did not narrow. Despite large and rapid across-the-board increases in the use of consumer health IT, a digital divide remains evident, linked to lower income and Hispanic origin rather than race.
Electronic patient portals and PHRs are anticipated to be an important tool for patient engagement in healthcare, and it is therefore important to determine whether they are reaching all patient populations. Our analysis of statewide polling data shows that the use of portals and PHRs has increased sharply in recent years. Although both black and white patients are now equally likely to use the technology overall, low-income and Hispanic patients remain somewhat less likely to use it. Healthcare organizations seeking to use these tools to engage patients should examine their efforts to reach all patient groups. Measures that should be investigated include making these technologies accessible in multiple languages, designing for usability by individuals with low levels of computer expertise, and ensuring access via mobile phone and Web browsers.

Author Affiliations: Department of Healthcare Policy and Research, Weill Cornell Medical College (JSA, BH, RK), New York, NY.

Source of Funding: The survey was supported by the New York eHealth Collaborative. JSA is supported by an AHRQ grant: K01 HS021531.

Author Disclosures: The authors report no relationship or financial interest with any entity that would pose a conflict of interest with the subject matter of this article.

Authorship Information: Concept and design (JSA, RK); analysis and interpretation of data (JSA, BH); drafting of the manuscript (JSA, BH); critical revision of the manuscript for important intellectual content (JSA, BH, RK); statistical analysis (JSA); obtaining funding (JSA); and supervision (JSA, BH, RK).

Address Correspondence to: Jessica S. Ancker, PhD, MPH, Weill Cornell Medical College, 425 E 61 St, Ste 301, New York, NY 10065. E-mail:

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