Cancer outcome disparities are in large part attributable to impediments to access to care for minority populations and individuals of lower socio-economic status. The use of electronic personal health records (ePHR) such as myChart, which allow patients to directly interact with their health record and their healthcare providers, has been drastically increasing with cancer patients overall but disproportionately less so in the underserved. We need to better understand the factors that underlie disparities in usage of ePHR, particularly for prevention, in order to be better able to leverage on this technology to improve access to care.
In 2012 Cleveland Clinic implemented an opt out program where every patient is given a myChart activation code at check in. This has resulted in close to a million “newly active” patients and almost half a million activated MyChart users. All patients with an email address on file were invited to participate in a survey inquiring about patient knowledge, use and preferences for myChart. We used logistic regression to test for differences across ethnicity after controlling for factors that confound factors such as age and illness.
A total of 18,599 369 myChart users responded to the survey. 633 (3%) responders self-identified as Hispanic (His) and 1265 (7%) as African American (AA). Both His and AA tended to be younger and healthier (less chronic conditions) than non-Hispanic White (WHI) responders (AA OR=1.4, p = 0.001, His OR 2.0, p = 0.001). Despite this His and AA have higher frequencies of visits to their PCP and to the ER after controlling for chronic conditions and age. Although younger WHI responders were more likely to say that they would use myChart more if they visited their PCP more, this was not the case for His and AA. Instead we find that His and AA are more likely to say that they do not discuss preventative measures with their PCP (AA OR =1.3, p=0.01, His OR = 1.5, p = 0.002)
Conclusion: Our results suggest that adding functionality to ePHR that will more actively promote discussion and planning of prevention between primary care providers and His and AA may be a way to improve the impact of this technology on how minorities engage with prevention.
Citation Format: Paola Raska, Katherine Schneider, Jordan Zivoder, Scott Steele, Jame Abraham. Electronic personal health records, minorities and prevention. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C02.