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71% of safety net patients want email, texts, and portals

By Jennifer Bresnick

- A large majority of low income, underserved, and safety net patients want to communicate with their providers using email, text messaging, and online patient portals, according to a new study published in the Journal of General Internal Medicine, but fewer than 20% actually do. “A significant majority of safety net patients currently use email, text messaging, and the internet, and they expressed an interest in using these tools for electronic communication with their medical providers,” wrote the authors. “This interest is currently unmet within safety net clinics that do not offer a patient portal or secure messaging.”

More than four hundred patients in the San Francisco area were surveyed about their internet habits, with the population encompassing uninsured and publically insured patients from racially diverse, low income backgrounds.  While only 17% said they email their providers informally, 78% expressed interest in electronic communications with healthcare services.  Despite perceptions that lower income populations lack access to reliable internet connections, 60% reported using email regularly, 54% said they obtained general research information from the internet.

“Patients were largely in favor of using email technology for health and agreed it would likely improve overall clinical communication and efficiency,” said lead author Adam Schickedanz, MD, a medical resident in the UCSF Department of Pediatrics. “Our work makes it clear that lower income patients from a wide variety of backgrounds want to be part of the health information technology revolution.  The question is whether they will be afforded the opportunities to take part in the same way as their middle and higher-income peers.”

But many clinics in the area are not yet equipped with patient portals and mature broadband infrastructures.  “Ninety percent of the time or more the patient will have to call,” Nina Vaccaro, executive director of the Southside Coalition of Community Health Clinics told Southern California Public Radio. “Either they leave a message with the physician’s assistant or they have some other process set up in the clinic where, say, a nurse manager takes all incoming calls and relays them to the primary care provider it relates to.”

This unmet interest in electronic communication is good news for providers looking to meet the patient engagement requirements involved with Stage 2 of meaningful use.  The 5% patient engagement mandate has been an ongoing concern for providers who can’t control whether or not their patients take advantage of online offerings, but interest among populations traditionally considered to have low technical literacy is encouraging, even if it may require some adjustments.  “Tools such as email encounters and electronic patient portals should be implemented and supported to a greater extent in resource-poor settings,” the study concludes, “but this will require tailoring these tools to patients’ language, literacy level, and experience with communication technology.”

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