Identifying contributors to disparities in patient access of online medical records: examining the role of clinician encouragement

Abstract Objective The aim of this study was to understand the influence of clinician encouragement and sociodemographic factors on whether patients access online electronic medical records (EMR). Materials and Methods We analyzed 3279 responses from the Health Information National Trends Survey 5 cycle 4 survey, a cross-sectional, nationally representative survey administered by the National Cancer Institute. Frequencies and weighted proportions were calculated to compare clinical encouragement and access to their online EMR. Using multivariate logistic regression, we identified factors associated with online EMR use and clinician encouragement. Results In 2020, an estimated 42% of US adults accessed their online EMR and 51% were encouraged by clinicians to access their online EMR. In multivariate regression, respondents who accessed EMR were more likely to have received clinician encouragement (odds ratio [OR], 10.3; 95% confidence interval [CI], 7.7–14.0), college education or higher (OR, 1.9; 95% CI, 1.4–2.7), history of cancer (OR, 1.5; 95% CI, 1.0–2.3), and history of chronic disease (OR, 2.3; 95% CI, 1.7–3.2). Male and Hispanic respondents were less likely to have accessed EMR than female and non-Hispanic White respondents (OR, 0.6; 95% CI, 0.5–0.8, and OR, 0.5; 95% CI, 0.3–0.8, respectively). Respondents receiving encouragement from clinicians were more likely to be female (OR, 1.7; 95% CI, 1.3–2.3), have college education (OR, 1.5; 95% CI, 1.1–2.0), history of cancer (OR, 1.8; 95% CI, 1.3–2.5), and greater income levels (OR, 1.8–3.6). Discussion Clinician encouragement of patient EMR use is strongly associated with patients accessing EMR, and there are disparities in who receives clinician encouragement related to education, income, sex, and ethnicity. Conclusions Clinicians have an important role to ensure that all patients benefit from online EMR use. Lay Summary Online medical records are a widely available tool that might help to improve communication and help patients to better take care of their health. But past studies have shown that certain types of patients are less likely to use their online records, especially patients from racial and ethnic minorities and patients with lower income or less education. None of these studies tried to figure out the clinicians’ role in encouraging patients to use these online medical records. In this study, we wanted to understand whether clinicians encouraging patients to use online medical records seeme