A single-center study showed that certain cancer patients were less likely to enroll in a patient portal that allows them to access their electronic health records (EHRs). The study was published in JAMA Oncology.1

The data showed that Black patients were 44% less likely to enroll than White patients, and patients in their 80s were 36% less likely to enroll than patients aged 18 to 29 years.

The researchers tracked 266,917 patients who first visited the University of California, San Francisco (UCSF) cancer center from 2012, when the center adopted the patient portal, to 2020. The researchers analyzed patients’ self-reported demographic information, along with rates of patient sign-up and the number of days from their initial visit to portal registration.

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“[Enrollment] is one of the first natural steps to look at,” in terms of understanding how patients interact with EHRs, said study author Julian C. Hong, MD, MS, assistant professor in the Department of Radiation Oncology and Bakar Computational Health Sciences Institute at UCSF.

The researchers found that certain groups, particularly men and patients aged 18 to 29 years, had lower enrollment rates initially, but those rates eventually caught up with the higher enrollment rates observed in women and patients aged 30 to 39 years.

The groups older than 39 years took longer to enroll and never caught up with the younger groups, and enrollment decreased with increasing age, especially for patients 80 years of age and older, Dr Hong noted.

There were lower enrollment rates initially among Black patients and patients for whom English was not their primary language, when compared with White patients and native English speakers, respectively. These differences persisted throughout the study. 

Other studies have described age and racial disparities in using EHRs in various patient populations, and research suggests that disparities may be more pronounced at the level of enrollment.2

An analysis of patients with cancer at an academic medical center in the southern United States showed that younger patients and White patients were more likely than other age and racial groups to engage with the portal, mostly to view test results and respond to clinic messages.3

However, a study that observed racial and age disparities among those who enrolled in the patient portal showed no racial disparities in portal use among the individuals who did enroll.4

This research suggests that enrollment “might be a critical step in getting patients access to their information,” said Sumi Sinha, MD, a resident at UCSF and lead author of the JAMA Oncology study.

Although the study did not explore the barriers that kept patients from enrolling, Dr Hong noted that many of their patients do not have computers and smart phones, and they generally may not feel comfortable using the technology. The researchers are currently trying to ease enrollment by allowing patients, or their care proxy, to enroll during the visit. The researchers are also working on translating the portal into more languages.

The findings do not come as a surprise, but they do highlight the need to reduce barriers, according to Traber Davis Giardina, PhD, MSW, assistant professor of medicine at Baylor College of Medicine and researcher at the Michael E. DeBakey VA Medical Center in Houston, who was not involved in the UCSF study.

Dr Giardina said research suggests that interventions designed to train patients on portal use, either in person or online, may be effective.2

“It makes me sad to think that we have this technology that has the possibility [to give patients more knowledge] and that Black patients and older patients are getting left behind,” said Dr Giardina, whose research focuses on whether patient portal use may reduce diagnostic errors and improve patient safety.

There has been very little research exploring whether patient portal use is associated with better clinical outcomes for patients with cancer, particularly because it is difficult to know exactly which outcomes to assess, Dr Hong explained. However, a 2018 study suggested that the types and frequency of messages that breast cancer patients send their providers through the portal may predict their risk of discontinuing hormonal therapy.5

Dr Giardina said there is evidence that using the portal — for reasons such as viewing their provider’s notes from the visit — may make patients feel more involved in their care in general.6

“It is encouraging that you could leverage health IT to help people feel more engaged in their care,” she added.


  1. Sinha S, Garriga M, Naik N, et al. Disparities in electronic health record patient portal enrollment among oncology patients. JAMA Oncol. Published online April 8, 2021. doi:10.1001/jamaoncol.2021.0540
  2. Grossman LV, Masterson Creber RM, Benda NC, Wright D, Vawdrey DK, Ancker JS. Interventions to increase patient portal use in vulnerable populations: a systematic review. J Am Med Inform Assoc. 2019;26(8-9):855-870. doi:10.1093/jamia/ocz023
  3. Gerber DE, Laccetti AL, Chen B, et al. Predictors and intensity of online access to electronic medical records among patients with cancer. J Oncol Pract. 2014;10(5):e307-312.  doi:10.1200/JOP.2013.001347
  4. Goel MS, Brown TL, Williams A, Hasnain-Wynia R, Thompon JA, Baker DW. Disparities in enrollment and use of an electronic patient portal. J Gen Intern Med. 2011;26(10):1112-1116. doi:10.1007/s11606-011-1728-3
  5. Yin Z, Harrell M, Warner JL, et al. The therapy is making me sick: how online portal communications between breast cancer patients and physicians indicate medication discontinuation. J Am Med Inform Assoc. 2018;25(11):1444-1451. doi:10.1093/jamia/ocy118
  6. Gerard M, Chimowitz H, Fossa A, et al. The importance of visit notes on patient portals for engaging less educated or nonwhite patients: Survey study. J Med Internet Res. 2018;20(5):e191. doi:10.2196/jmir.9196

This article originally appeared on Cancer Therapy Advisor