Factors such as age and ethnicity may make some patients less likely to use an online portal for self-scheduling mammograms. These findings have important implications regarding how technology can unintentionally increase health care inequalities, according to Patricia Balthazar, MD, assistant professor, abdominal radiology & imaging informatics at Emory University in Atlanta.
Balthazar
“As an imaging informaticist, I am interested in using technology solutions to improve patient quality and safety, and efficiency of health care delivery,” Dr. Balthazar said. “However, as a health services researcher, I understand digital health interventions can widen the digital divide and may add to health inequities.”
This retrospective cohort study, performed at an urban quaternary care academic medical center with patient portal access to electronic medical records, included a total of 46,268 female patients who had screening mammograms from Jan. 1, 2018, to Dec. 31, 2019. The investigators obtained data from the institutional data warehouse on the following patient variables:
- Scheduling pathway (online self-scheduled mammogram versus traditional phone call scheduling method)
- Age
- Language
- Race
- Health insurance provider
- Zip code
The researchers obtained census data based on the patient’s zip code, including internet access, education level and median household income. Then they used multivariable logistic regression to determine which independent factors were linked to using online self-scheduling for screening mammograms.
Linking Patient Variables to Online Portal Use
Only 302 patients (0.7%) scheduled their mammograms using the online patient portal. Those who scheduled their screenings online were more likely to be younger and have private insurance. They also had higher odds of being white and English-speaking, and residing in zip codes with greater access to broadband internet service.
These bar graphs illustrate how patient age, ethnicity, English proficiency and insurance status correlated with whether patients opted to use the online self-scheduling tool for mammogram screenings or the traditional, over-the-phone scheduling method.
The researchers did not find any significant links between use of the online self-scheduling tool and education level, having any type of internet access or living in an area with a higher median household income.
“These results underscore emerging health disparities in accessing patient portals and telehealth applications among underserved patient populations, and the contribution of health information technology and digital health interventions in widening the digital divide,” Dr. Balthazar said.
Without “tailored, intentional digital care,” said Dr. Balthazar, telehealth and mobile health interventions can become an additional barrier to care and lead to intervention-generated inequities.
To avoid these problems, new health care technologies should be designed and implemented with equity in mind, Dr. Balthazar asserted. One way to help accomplish this, she said, is to include a digital health navigator as part of the health care team. Community outreach campaigns can also be useful, as can multilingual resources and digital tools written at inclusive health literacy levels.
“Although we have good intentions, if we don’t use a health equity lens to evaluate new digital health technologies at the design stage, we may inadvertently cause some harm,” she said. “We cannot assume that all patients will benefit equally from an intervention if they are coming from diverse backgrounds.”
The poster presentation, “Online Patient Portals Widen Health Disparities In Radiology: Analysis Of Patient Characteristics Of Self-scheduled Online Patient Portal Screening Mammography,” (NPM03-A2) will take place on Tuesday, Nov. 30 at 12:15 p.m. Visit the Learning Center or access the poster at Meeting.RSNA.org.
