Appl Clin Inform 2019; 10(01): 040-050
DOI: 10.1055/s-0038-1676971
Research Article
Georg Thieme Verlag KG Stuttgart · New York

Technology Access, Technical Assistance, and Disparities in Inpatient Portal Use

Lisa V. Grossman
1  Department of Biomedical Informatics, Columbia University, New York, New York, United States
,
Ruth M. Masterson Creber
2  Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
,
Jessica S. Ancker
2  Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York, United States
,
Beatriz Ryan
3  Value Institute, New York-Presbyterian Hospital, New York, New York, United States
,
Fernanda Polubriaginof
3  Value Institute, New York-Presbyterian Hospital, New York, New York, United States
,
Min Qian
4  Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, United States
,
Irma Alarcon
1  Department of Biomedical Informatics, Columbia University, New York, New York, United States
,
Susan Restaino
5  Department of Medicine, New York-Presbyterian Hospital, New York, New York, United States
,
Suzanne Bakken
1  Department of Biomedical Informatics, Columbia University, New York, New York, United States
,
George Hripcsak
1  Department of Biomedical Informatics, Columbia University, New York, New York, United States
,
David K. Vawdrey
1  Department of Biomedical Informatics, Columbia University, New York, New York, United States
3  Value Institute, New York-Presbyterian Hospital, New York, New York, United States
› Author Affiliations
Funding This work was supported by the Agency for Healthcare Research and Quality (R01HS21816, PI: Vawdrey), the National Library of Medicine (T15LM007079), and the National Institute of Nursing Research (K99NR016275, PI: Masterson Creber).
Further Information

Publication History

17 August 2018

22 November 2018

Publication Date:
16 January 2019 (online)

Abstract

Background Disadvantaged populations, including minorities and the elderly, use patient portals less often than relatively more advantaged populations. Limited access to and experience with technology contribute to these disparities. Free access to devices, the Internet, and technical assistance may eliminate disparities in portal use.

Objective To examine predictors of frequent versus infrequent portal use among hospitalized patients who received free access to an iPad, the Internet, and technical assistance.

Materials and Methods This subgroup analysis includes 146 intervention-arm participants from a pragmatic randomized controlled trial of an inpatient portal. The participants received free access to an iPad and inpatient portal while hospitalized on medical and surgical cardiac units, together with hands-on help using them. We used logistic regression to identify characteristics predictive of frequent use.

Results More technology experience (adjusted odds ratio [OR] = 5.39, p = 0.049), less severe illness (adjusted OR = 2.07, p = 0.077), and private insurance (adjusted OR = 2.25, p = 0.043) predicted frequent use, with a predictive performance (area under the curve) of 65.6%. No significant differences in age, gender, race, ethnicity, level of education, employment status, or patient activation existed between the frequent and infrequent users in bivariate analyses. Significantly more frequent users noticed medical errors during their hospital stay.

Discussion and Conclusion Portal use was not associated with several sociodemographic characteristics previously found to limit use in the inpatient setting. However, limited technology experience and high illness severity were still barriers to frequent use. Future work should explore additional strategies, such as enrolling health care proxies and improving usability, to reduce potential disparities in portal use.

Protection of Human and Animal Subjects

This 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 by the Columbia University Medical Center Institutional Review Board.


Supplementary Material