‘Digital Divide’ Appears To Exist in Adoption of Online Personal Health Records

Despite increasing Internet availability, the ‘digital divide’ (disparities in access to technology) appears to exist among primary care patients adopting an online personal health record, according to a report in the March 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

“The personal health record (PHR) is an Internet-based set of tools that allows people to access and coordinate their lifelong health information,” the authors write as background information in the article. PHRs aim to increase patient access to personal health information, however wide use of PHRs will be difficult to achieve if patients cannot access this information because of a lack of Internet or computer access.

Cyrus K. Yamin, B.S., of Brigham and Women’s Hospital, Harvard Medical School, Boston, and colleagues conducted a cross-sectional analysis of personal health record use within a health system in the Northeast United States. Patients were categorized as adopters (those who activated a PHR account online) and nonadopters (patients who had visited a clinician at a practice offering PHR but did not have a PHR account). A total of 75,056 patients were included, 43 percent of whom had adopted a PHR.

When compared with white patients, the likelihood of using a PHR was lower among all racial and ethnic minorities, with blacks and Hispanics half as likely as whites to adopt a PHR. Patients living in the highest income-earning households were 14 percent more likely to adopt a PHR than those living in the lowest income-earning households. Among adopters, however, income was not associated with PHR use.

Of the 32,274 adopters, the authors recorded 290,662 log-ins to the personal health record system, and classified 51 percent of users as very low users, logging into the PHR one time or less in the previous two years. The second-largest group identified were categorized as high users (27 percent) and logged into the system ten or more times. Patients between the ages of 51 and 65 years composed the majority of the high users group at 41 percent. Additionally, the authors found that patients older than 65 adopted a PHR to a greater extent than patients between 18 and 35 years of age.

“In this study, we found the presence of a digital divide in a diverse population. Specifically, racial/ethnic minorities and patients with lower socioeconomic status were less likely to adopt a PHR. However, both of these groups used the PHR as much as other groups if they were able to adopt it. Whether the digital divide was caused by barriers in access to technology or reflects long-standing disparities in health-seeking behavior is less clear. Further studies are needed to better understand and promote use of PHRs among adopters and to design interventions to increase PHR uptake among populations likely to benefit most,” the authors conclude.

Arch Intern Med. 2011;171[6]:568-574.