Loyola University Chicago School of Law, JD 2024
In 2014, the Centers for Medicare and Medicaid Services and the Electronic Health Record Incentive Programs set guidelines requiring all eligible and participating hospitals and providers to offer certified technology that would give patients access to their electronic health information (EHI). By 2020, 57% of the population reported being offered access to their EHI via portal by their healthcare provider, which constitutes a 24% increase since it was first required. However, recent studies have found that there are disparities in who is being offered access to the EHI, specifically in the Black and Hispanic communities. These disparities must be addressed to promote improved health for the general population and health equity.
Why is access to EHI important?
There has been an increase in federal policy and regulations that promote patient access and engagement with EHI. This is a result of studies showing that such engagement has helped lead to better health outcomes by enabling patients to make informed decisions, facilitate communication, and increase adherence to medical treatments and drugs.
The ONC Study
The Office of the National Coordinator for Health IT (ONC) has supported CMS and EHR’s efforts since the 2014 guidelines. Most recently, they completed a study on the discrepancy in access and use between the Black and Hispanic populations in comparison with Caucasians. They found that Black and Hispanic people were 5.2% less likely to be offered access to their EHI via patient portals and 7.9% less likely to access the portals. These percentages were calculated after accounting for other external factors, including education level, health status, gender, and age. The racial and ethnic disparities continued to persist.
However, the study showed that when providers offered access to the Black and Hispanic communities, the disparities were no longer significant. According to the abstract in the Journal of the American Medical Informatics Association (JAMIA), “individuals offered a portal and encouraged to use it by their providers were 21 percentage points more likely to access it”. Furthermore, Black and Hispanic individuals were offered access were 12% more likely than whites to download or transmit information from there.
What role do providers pay in equitable EHI access?
The study’s findings indicated that a health care provider’s offer and encouragement to access EHI increased the likelihood of patient portal usage. If anything, a provider’s inconsistency in offering patients access to their portals is a limiting factor to broadening patient access and use of EHI. To increase access, it is critical to address access-related barriers and facilitating conversation around EHI. As mentioned, Black and Hispanic individuals who were offered and encouraged to use their portal were more likely to access their portals than those that were not encouraged. This essentially highlights the importance of patient-provider conversations regarding not just their health but access their health information remotely. However, many provider practices that are lower-resourced, smaller, or serve disadvantaged populations are less likely to have HER technology that allow for patient engagement. As a result, they are less likely to offer access to patients.
Addressing the disparity
First and foremost, CMS and EHR need to revise their guidelines to require providers to not only have the certified technology, but to offer and encourage all patients to use and access the EHI. Along with increasing patient access to health information, it will also ensure that the providers are equitable in their conversations with each patient. The guidelines can be accompanied by incentives for providers to encourage EHI usage. Specifics of the incentives would have to be analyzed to ensure they are in compliance with fraud and abuse laws. Additionally, health systems and physician offices can receive incentives as part of an EHI access incentive program.
Furthermore, policy efforts directed towards interventions that increase the availability and awareness of patient engagement with their EHI and portals needs to increase. Specifically, the efforts must be directed towards healthcare providers since they play the largest role in promoting access. Since the studies have shown that after being offered and encouraged access to the portals there was no disparity in usage, it is clear that stricter guidelines for providers to encourage usage as part of their patient visitation protocols will strengthen the policy efforts behind increasing patient engagement with EHI.