OAKLAND, Calif., March 3, 2016 – Despite widespread access to online health-care tools among U.S. seniors, a new Kaiser Permanente study found that digital access and usage preferences among seniors significantly differs by race/ethnicity and age. The study was published online today in the Journal of Medical Internet Research.
The study is believed to be the first to document these racial/ethnic group differences in real-world usage patterns and to link these patterns to differences in access and preferences for online health care tools in a large cohort of seniors enrolled in a large integrated health care delivery system.
“Since seniors are such high consumers of health care and health info, it’s important to identify their ability to communicate with and get information from their health care providers,” said Nancy P. Gordon, ScD, lead author of the study and research scientist with the Kaiser Permanente Northern California Division of Research.
All Kaiser Permanente members can register on the kp.org website for HealthConnect, a secure patient portal launched in 2005 that provides a range of online services including email communication with health care providers, appointment scheduling, pharmacy services, laboratory results, and preventative care information. In 2014, Kaiser Permanente members exchanged more than 20 million secure emails with their health care providers.
The researchers analyzed the online usage patterns in 2013 of a racially/ethnically diverse cohort of more than 231,000 English-speaking seniors ages 65 to 79 years old, all members of Kaiser Permanente’s Northern California region. A random sample of approximately 2,600 members also completed a mailed survey regarding their online access, habits and preferences.
More than three-quarters of all seniors studied (77.1 percent) were registered to use the patient portal by the end of 2013. The study found that adults ages 65 to 69 (82.2 percent) were significantly more likely to have registered to use the patient portal than those 70 to 74 years old (78.6 percent) and 75 to 79 years old (71.5 percent) and to be using its secure features.
Significant race/ethnic disparities in usage were also identified. Non-Hispanic white (81.1 percent) and Chinese (81.4 percent) seniors were significantly more likely to have registered to use the portal than black (54.1 percent), Latino (62.5 percent) and Filipino (60.5 percent) seniors. Non-Hispanic white and Chinese seniors were also significantly more likely than black, Latino, and Filipino seniors to use the portal to send messages to their doctor, view lab test results, and order prescription refills. These same age group and race/ethnic differences were also seen among members who were registered to use the portal.
The survey explored seniors’ preferences for using digital technologies for health care-related tasks (eHealth). Overall, nearly 60 percent of those surveyed were using the portal to send secure messages to their doctors, about the same percentage as communicated by phone. Two-thirds (67 percent) used the portal to view lab results when they received a secure email. However, many fewer seniors were using the portal to refill prescriptions (21 percent) or get appointment reminders (24 percent). The same age group and race/ethnic disparities seen with the larger study population were also found in the survey sample. However, the survey results suggested that these disparities were not solely due to lack of ability to use the Internet – they were also due to differences in preferences.
Gordon noted that the findings serve as a caution to Kaiser Permanente and other government agencies and health organizations serving seniors, as they invest in improving web-based access to health and health care-related information and communication channels, and ask seniors to complete and submit questionnaires and forms online.
“Among our fairly well-educated population of seniors, we found that certain groups were less likely to have the tools, abilities, and preferences to use web-based tools that are being made available to them,” Gordon said. “These tend to be segments of our membership that have the greatest need for easy access to benefits and health information, two-way communication with their clinical care team, and discounted medications and medical equipment. Further, many seniors who do not currently use the patient portal and websites say they do not want to use them.”
Co-author Mark C. Hornbrook, PhD, of Kaiser Permanente’s Center for Health Research based in Portland, Ore., noted that by monitoring trends in seniors’ use of digital and non-digital channels by race/ethnicity and age group, “we can gain better insight into member communication preferences. This will enable us as an organization and society to ensure that those who can’t or don’t want to make the transition to eHealth will continue to have easy access to the more traditional modalities of health-related communication and information.
“We need to make sure that everyone knows that these more traditional modalities are still available to them so that they won’t feel that their health care access is being limited,” Hornbrook said.
The survey results also suggest ways that Kaiser Permanente and other organizations can improve seniors’ engagement with portals and websites. Approximately one-third of survey participants indicated interest in learning how to use the patient portal and website. Nearly 63 percent (and 75 percent of those aged 75 and over) wanted a hard-copy instructional handbook (as compared with 21 percent wanting a downloadable PDF and 34 percent an online handbook), and over 40 percent wanted to be able to call a help-desk person when they needed help (as compared to 16 percent who wanted live online chat support).
While Kaiser Permanente has long offered an online portal to its members, usage of such tools has recently become more widespread nationally under the federal Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, which promoted the use of electronic health records nationally and began penalizing medical practices that did not use them in 2015.
“Health care providers and government agencies can learn from the online usage patterns among senior members of a large health-care system with a mature patient portal,” Gordon said.
This study was funded by the Kaiser Permanente Northern California Community Benefit Program.
About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 550-plus staff is working on more than 400 epidemiological and health services research projects. For more information, visit www.dor.kaiser.org or follow us @KPDOR.
About the Kaiser Permanente Center for Health Research
The Kaiser Permanente Center for Health Research, founded in 1964, is a nonprofit research institution dedicated to advancing knowledge to improve health. It has research sites in Portland, Oregon, and Honolulu, Hawaii. Visit kpchr.org for more information.