Patient portals could widen health disparities

Websites that offer secure access to one’s medical record, often referred to as patient portals, are increasingly important for physician or and patient communication and routine access to health care information. However, patient portals could widen the gap in health disparities among the most vulnerable patients, according to research from Northwestern University Feinberg School of Medicine.

The study found that patients with low health literacy, less education and who are African American were less likely to use patient portals compared with white patients and those who were more health literate.

Michael S. Wolf


“Patient portals that offer access to electronic medical records could help individuals better manage their health care and personal needs, but people with less access to and comfort with computers are at risk of not receiving these benefits and will eventually be left behind,” Michael S. Wolf, PhD, MPH, corresponding study author and a professor of medicine at Northwestern University Feinberg School of Medicine, stated in a press release. “It is a big concern as the patients that already are, perhaps, less engaged in their health and experiencing worse health outcomes may be further marginalized.”

The study showed white patients were 2.5 times more likely to be registered as portal users than African American patients. Patients with good health literacy skills were 3.5 times more likely to be registered with the portal than those who did not have those skills.

“If we now further complicate what it means to be a patient by asking people to be engaged outside the doctor’s office – on the web or by mobile phone – and if these same groups of patients are not as capable or ready to assume these new roles, we may further exacerbate the disparities that already exist,” Sam Smith, Sc, MSc, PhD, CPsychol, cancer research UK postdoctoral fellow at Queen Mary University of London and co-author who worked on the study when he was a postdoctoral fellow student at Feinberg, stated in the release. Smith added that these patients may experience delays in getting information and instructions about their health care, and their physicians may be less informed about their conditions.

Underserved populations may need greater support in using online patient portals for patient care, the authors said. Patients may need simple instructions on how to register for an account, as well as support in how to use the available functions.

For the study, researchers linked existing cohort data from a National Institutes of Health (NIH) funded study to routinely collected patient-level data at Northwestern Memorial Hospital.


Wolf M, et al. J Am Med Inform Assoc. 2014;doi:10.1093/jamia/ocv025.

Disclosure: The authors report no relevant financial disclosures.

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