Electronic Health Record Patient Portal Use in Radiotherapy Treated Patients in the Era of COVID-19; Who's Getting Left Behind?

PURPOSE/OBJECTIVE(S): COVID-19 has accelerated the utility of electronic health record (EHR) patient portal (PP) as a method for patients to communicate with oncology teams and improve the quality of care. This study examines the relationship between several sociodemographic characteristics with activation and use of PP system at an academic center by patients who underwent radiotherapy (RT). Use of PP among patients for up-to-date information on their care and to enhance their ability to manage their healthcare are linked with more favorable outcomes and quality of life. With the rapid integration of PP in oncologic management, differences in sociodemographic could account for disparities seen in PP use highlighting patients that should be receiving targeted efforts. MATERIALS/METHODS: EHR data were retrospectively analyzed regarding PP activation and use in all patients who underwent RT between the start of COVID-19 (March 2020) until February 2022 at an academic center. Summary statistics and odds ratios were used to examine the study cohort demographic characteristics regarding the outcome of PP activation. RESULTS: There was a 10.4% increase in RT treated patients’ activation of PP from 69.8% before the COVID-19 pandemic (November 2017-March 2020) to 80.2% after the start of the pandemic. Concurrently, telemedicine use (requiring PP activation) among patients increased from 0.8% pre-pandemic to 40.2%. During the study period of interest, PP activation rate was 84.3% among White patients, 67.8% in Black/African American, 76.5% in Asians; 82.9% activation rate in Hispanics compared to 76.2% in non-Hispanics. Non-Hispanic White female was the group most likely to activate PP (OR 2.2; 95% CI 1.7-2.8), whereas non-Hispanic Black male was the least likely (OR 0.5; 95% CI 0.3-0.7). English speakers were significantly more likely to activate their PP (OR 3.7; 95% CI 2.1-6.5) compared to non-English speakers (OR 0.3; 95% CI 0.1-0.5). The highest activated PP by age range was amongst 20-30 years old (89.6%). PP activation was slightly lower in ages 30-40 (80.7%), and then recovered to 85.9% in 40-50 years old, after which there was a gradual decrease each subsequent decade reaching a low of 75.8% in ≥ 80 years. Breast cancer had the highest activation rate (92.7%) followed by head and neck (84%), prostate (81.3%), and lung cancer (66.5%). Married or divorced patients in comparison to single or widowed were more likely to activate PP. There was no correlation with having activated PP with a “no show” status for RT treatment. CONCLUSION: Overall, activation of PP has increased in RT treated patients since the start of the pandemic. There are disparities in respect to race, speaking English, sex, and age. At the time of this study, the PP system was only available in English. The lower rate of activation identified in specific sex, race and age should prompt exploration of creative opportunities to increase patient activation and engagement in populations facing health disparities.