Changes in Pediatric Portal Use Among Caregivers Before, During, and After the Coronavirus Disease 2019 Pandemic: A Longitudinal Study

Abstract

Background

Patient portals are increasingly used to support digital health engagement, but little is known about how caregivers used patient portals before, during, and after the coronavirus disease 2019 (COVID-19) pandemic.

Objectives

This study aimed to examine longitudinal changes in caregiver engagement with pediatric patient portals, focusing on logins, session duration, messaging behaviors, and provider response times across prepandemic, pandemic, and postpandemic periods.

Methods

We conducted a retrospective cohort study using deidentified MyChart data from caregivers of children aged 0 through 11 who received care at four pediatric primary care clinics in the Southeastern United States between March 2018 and March 2023. Generalized linear models were used to compare portal engagement across prepandemic, pandemic, and postpandemic periods. Outcomes included login frequency, session duration, message volume, message types and recipients, and provider response times, all normalized per user per year.

Results

Among 478 caregivers, portal logins and session duration increased significantly during and postpandemic, with 16-fold increases postpandemic compared with prepandemic (p < 0.001). Message volume declined substantially during the pandemic (p < 0.001) but returned to baseline levels. Provider response times shortened during the pandemic and remained lower than prepandemic levels (p = 0.032). Messaging to primary care declined and did not recover fully, while specialty care messaging increased across all periods. Appointment and medical advice messages declined during the pandemic, with only the latter rebounding. Customer service inquiries rose significantly and remained elevated, and medication renewal messages increased markedly postpandemic.

Conclusion

The COVID-19 pandemic initiated lasting changes in caregivers' engagement with pediatric patient portals, including deeper engagement, quicker provider responses, and shifts in messaging patterns. Findings can be used to guide and optimize caregiver-centered digital health strategies in pediatrics. Future work should explore potential provider burnout from increased portal workload, incorporate multicenter studies, and link portal use to clinical characteristics to better inform digital health interventions.

Keywords

patient portal - MyChart - electronic medical record - pediatrics - caregiver - COVID-19 - telemedicine and telehealth - digital health

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed and approved by the University of Florida Institutional Review Board.

Publikationsverlauf

Eingereicht: 04. Juni 2025

Angenommen: 16. September 2025

Accepted Manuscript online:
19. September 2025

Artikel online veröffentlicht:
28. Oktober 2025

• References

• 1 What is a patient portal? | HealthIT.gov. Accessed April 23, 2025 at: https://www.healthit.gov/faq/what-patient-portal
• 2 Steitz BD, Wong JIS, Cobb JG, Carlson B, Smith G, Rosenbloom ST. Policies and procedures governing patient portal use at an academic medical center. JAMIA Open 2019; 2 (04) 479-488
• 3 You JGT, Potter JE, Mishuris RG. Electronic health record adolescent confidentiality in a safety net setting. Appl Clin Inform 2023; 14 (05) 878-882
• 4 Dendere R, Slade C, Burton-Jones A, Sullivan C, Staib A, Janda M. Patient portals facilitating engagement with inpatient electronic medical records: a systematic review. J Med Internet Res 2019; 21 (04) e12779
• 5 Lee JA, Holland-Hall C. Patient portals for the adolescent and young adult population: benefits, risks and guidance for use. Curr Probl Pediatr Adolesc Health Care 2021; 51 (11) 101101
• 6 Bush RA, Connelly CD, Fuller M, Pérez A. Implementation of the integrated electronic patient portal in the pediatric population: a systematic review. Telemed J E Health 2016; 22 (02) 144-152
• 7 Sisk BA, Bereitschaft C, Enloe M, Schulz G, Mack J, DuBois J. Oncology clinicians' perspectives on online patient portal use in pediatric and adolescent cancer. JCO Clin Cancer Inform 2023; 7: e2300124
• 8 Sisk BA, Chen S, Bereitschaft C. et al. Benefits, problems, and motivations for using the online patient portal in adolescent oncology: interviews with adolescents and parents. JCO Clin Cancer Inform 2025; 9: e2500038
• 9 Sarabu C, Lee T, Hogan A, Pageler N. The value of OpenNotes for pediatric patients, their families and impact on the patient–physician relationship. Appl Clin Inform 2021; 12 (01) 76-81
• 10 Ginting K, Stolfi A, Wright J, Omoloja A. Patient portal, patient-generated images, and medical decision-making in a pediatric ambulatory setting. Appl Clin Inform 2020; 11 (05) 764-768
• 11 Sisk BA, Antes A, Bereitschaft C, Bourgeois F, DuBois J. Parental access to adolescent online healthcare portals: benefits, problems, and barriers. Appl Clin Inform 2025
• 12 Kafashzadeh D, Hall K, Pirani C, Szilagyi PG, Chen L, Ross MK. Electronic patient portal activation and outcomes among pediatric patients with asthma. J Allergy Clin Immunol Pract 2023; 11 (06) 1950-1953.e2
• 13 Steitz B, Cronin RM, Davis SE, Yan E, Jackson GP. Long-term patterns of patient portal use for pediatric patients at an academic medical center. Appl Clin Inform 2017; 8 (03) 779-793
• 14 Wood KE, Greene HR, Krasowski MD. Patient portal activation and use in hospitalized children at an academic medical center. Hosp Pediatr 2021; 11 (06) 587-594
• 15 Szilagyi PG, Valderrama R, Vangala S. et al. Pediatric patient portal use in one health system. J Am Med Inform Assoc 2020; 27 (03) 444-448
• 16 Bush RA, Vemulakonda VM, Richardson AC, Deakyne Davies SJ, Chiang GJ. Providing access: differences in pediatric portal activation begin at patient check-in. Appl Clin Inform 2019; 10 (04) 670-678
• 17 Byczkowski TL, Munafo JK, Britto MT. Family perceptions of the usability and value of chronic disease web-based patient portals. Health Informatics J 2014; 20 (02) 151-162
• 18 Masterman M, Cronin RM, Davis SE, Shenson JA, Jackson GP. Adoption of secure messaging in a patient portal across pediatric specialties. Vol 2016. 2017: 1930
• 19 LeLaurin JH, Nguyen OT, Thompson LA. et al. Disparities in pediatric patient portal activation and feature use. JAMIA Open 2021; 4 (03) ooab086
• 20 Stanimirovic D. eHealth Patient Portal–becoming an indispensable public health tool in the time of COVID-19. In: Public Health and Informatics. IOS Press; 2021: 880-884
• 21 Portz JD, Brungardt A, Shanbhag P. et al. Advance care planning among users of a patient portal during the COVID-19 pandemic: retrospective observational study. J Med Internet Res 2020; 22 (08) e21385
• 22 Quiles J, López R, Rosón B. Quantitative study of a regional patient portal usage in the pandemic period. In: Caring is Sharing–Exploiting the Value in Data for Health and Innovation. IOS Press; 2023: 490-491
• 23 Ahmed N, Sanghavi K, Mathur S, McCullers A. Patient portal use: persistent disparities from pre- to post-onset of the COVID-19 pandemic. Int J Med Inform 2023; 178: 105204
• 24 Yoon E, Hur S, Opsasnick L. et al. Disparities in patient portal use among adults with chronic conditions. JAMA Netw Open 2024; 7 (02) e240680-e240680
• 25 Zeng B, Rivadeneira NA, Wen A, Sarkar U, Khoong EC. The impact of the COVID-19 pandemic on internet use and the use of digital health tools: secondary analysis of the 2020 health information national trends survey. J Med Internet Res 2022; 24 (09) e35828
• 26 Lo B, Charow R, Laberge S, Bakas V, Williams L, Wiljer D. Why are patient portals important in the age of COVID-19? Reflecting on patient and team experiences from a Toronto hospital network. J Patient Exp 2022;9:23743735221112216
• 27 Patel PD, Cobb J, Wright D. et al. Rapid development of telehealth capabilities within pediatric patient portal infrastructure for COVID-19 care: barriers, solutions, results. J Am Med Inform Assoc 2020; 27 (07) 1116-1120
• 28 Singh S, Polavarapu M, Arsene C. Changes in patient portal adoption due to the emergence of COVID-19 pandemic. Inform Health Soc Care 2023; 48 (02) 125-138
• 29 Mai F, Ko DG, Shan Z, Zhang D. The impact of accelerated digitization on patient portal use by underprivileged racial minority groups during COVID-19: longitudinal study. J Med Internet Res 2023; 25: e44981
• 30 Alpert JM, Campbell-Salome G, Gao C. et al. Secure messaging and COVID-19: a content analysis of patient–clinician communication during the pandemic. Telemed J E Health 2022; 28 (07) 1028-1034
• 31 Huang M, Khurana A, Mastorakos G. et al. Patient portal messaging for asynchronous virtual care during the COVID-19 pandemic: retrospective analysis. JMIR Hum Factors 2022; 9 (02) e35187
• 32 Thompson LA, Martinko T, Budd P, Mercado R, Schentrup AM. Meaningful use of a confidential adolescent patient portal. J Adolesc Health 2016; 58 (02) 134-140
• 33 Apter AJ, Bryant-Stephens T, Perez L. et al. Patient portal usage and outcomes among adult patients with uncontrolled asthma. J Allergy Clin Immunol Pract 2020; 8 (03) 965-970.e4
• 34 Lieu TA, Altschuler A, Weiner JZ. et al. Primary care physicians' experiences with and strategies for managing electronic messages. JAMA Netw Open 2019; 2 (12) e1918287-e1918287
• 35 Riera KM, Robinson JR, Van Arendonk KJ, Jackson GP. Care delivered by pediatric surgical specialties through patient portal messaging. J Surg Res 2019; 234: 231-239
• 36 Xu H, Intrator O, Bowblis JR. Shortages of staff in nursing homes during the COVID-19 pandemic: what are the driving factors?. J Am Med Dir Assoc 2020; 21 (10) 1371-1377
• 37 Lehmann J, Buhl P, Giesinger JM. et al. Using the computer-based health evaluation system (CHES) to support self-management of symptoms and functional health: evaluation of hematological patient use of a web-based patient portal. J Med Internet Res 2021; 23 (06) e26022
• 38 Di Tosto G, McAlearney AS, Fareed N, Huerta TR. Metrics for outpatient portal use based on log file analysis: algorithm development. J Med Internet Res 2020; 22 (06) e16849
• 39 Maini I, Gilotra K, Sadigh G. Patient factors associated with the use of online portal health information in the postpandemic era: cross-sectional analysis of a national survey. J Med Internet Res 2025; 27: e60472
• 40 Koonin LM, Hoots B, Tsang CA. et al. Trends in the use of telehealth during the emergence of the COVID-19 pandemic—United States, January–March 2020. MMWR Morb Mortal Wkly Rep 2020; 69 (43) 1595-1599
• 41 Hoopes AJ, Cushing-Haugen KL, Coley RY. et al. Characteristics of adolescents who use secure messaging on a health system's patient portal. Pediatrics 2023; 152 (01) e2022060271
• 42 Jhamb M, Cavanaugh KL, Bian A. et al. Disparities in electronic health record patient portal use in nephrology clinics. Clin J Am Soc Nephrol 2015; 10 (11) 2013-2022
• 43 Singh J, Keely E, Guglani S, Garber G, Liddy C. The utilization of an electronic consultation service during the coronavirus disease 2019 pandemic. Telemed J E Health 2022; 28 (07) 994-1000
• 44 Hansen MA, Chen R, Hirth J, Langabeer J, Zoorob R. Impact of COVID-19 lockdown on patient-provider electronic communications. J Telemed Telecare 2024; 30 (08) 1285-1292
• 45 Deml MJ, Minnema J, Dubois J. et al. The impact of the COVID-19 pandemic on the continuity of care for at-risk patients in Swiss primary care settings: a mixed-methods study. Soc Sci Med 2022; 298: 114858
• 46 Alpert JM, Dyer KE, Lafata JE. Patient-centered communication in digital medical encounters. Patient Educ Couns 2017; 100 (10) 1852-1858
• 47 Expanded Patient Self-Scheduling in MyChart | The University Of Kansas Health System. Accessed May 9, 2025 at: https://www.kansashealthsystem.com/news-room/news/2020/08/mychart-expanded-self-scheduling
• 48 Sulieman L, Gilmore D, French C. et al. Classifying patient portal messages using convolutional neural networks. J Biomed Inform 2017; 74: 59-70
• 49 Gerber DE, Laccetti AL, Chen B. et al. Predictors and intensity of online access to electronic medical records among patients with cancer. J Oncol Pract 2014; 10 (05) e307-e312
• 50 Kelly MM, Dean SM, Carayon P, Wetterneck TB, Hoonakker PL. Healthcare team perceptions of a portal for parents of hospitalized children before and after implementation. Appl Clin Inform 2017; 8 (01) 265-278
• 51 Gregory ME, Russo E, Singh H. Electronic health record alert-related workload as a predictor of burnout in primary care providers. Appl Clin Inform 2017; 8 (03) 686-697
• 52 Xie J, Hogan A, McPherson T, Pageler N, Lee T, Carlson J. Creating a guardrail system to ensure appropriate activation of adolescent portal accounts. Appl Clin Inform 2023; 14 (02) 258-262