EHR portal use and telehealth readiness among patients in a national network of community-based health centers: An observational study (Preprint)

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BACKGROUND Lack of telehealth engagement could exacerbate inequities among low-income persons with chronic conditions. As patient portal accounts are the primary access point for telehealth services, understanding portal use patterns and other elements of telehealth readiness in socioeconomically vulnerable populations is necessary. OBJECTIVE To add knowledge on community health center patients’ ‘telehealth readiness’ defined as access to and ability to use relevant technologies, and their portal use patterns. METHODS Using EHR data from a national network of over 2,000 community-based health centers, we compared patients who ever vs. never used the EHR’s portal, and patterns of portal use. We also conducted a survey on telehealth readiness among portal-using patients in four health centers. We compared survey respondents vs. non-respondents, and associations between the respondent characteristics and their survey answers. All data are from 2023. RESULTS The 41% of patients who ever used the portal differed from those who did not. Users were younger, more likely female, white, English speaking, and with higher income; they were less likely Hispanic or to have diabetes / hypertension. They did not differ by rural-urban location. Patients who used the portal >10 times / year were more likely female, white, or with diabetes / hypertension, and less likely Black, Hispanic, or primarily Spanish speaking. The survey response rate was 5.6% (567/10,158). Most respondents had access to a smartphone (98%), computer (85%), and the internet (96%); >20% always or often limited their internet use due to cost or poor connectivity. Respondents were less likely to limit internet use because of cost if they were white and more likely if they were Hispanic. Respondents used technological devices to track a health-related goal (71%), find information about a condition (88%), communicate with their provider (95%), make appointments or look up test results (94%), and share biometric data with their care team (60%). Respondents whose primary language was Spanish were less likely to report that their device helped them locate health information or share data with their care team. White respondents and those with diabetes were more likely to use technology to track health information. Hispanic respondents were less likely to access the portal six or more times annually. Respondents with chronic diseases who were portal users used it more frequently than others, suggesting that once initial barriers are bridged, such individuals will engage with the portal. CONCLUSIONS Health center patients with portal accounts have high telehealth readiness. They face few technology-related barriers to engaging in telehealth, but some barriers exist, including cost, connection quality, and language. It is necessary to ensure that portals can be accessed in multiple languages, and to identify interventions that support portal adoption in diverse patient groups as a means to improve health equity.

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