OBJECTIVE: The aim of this study was to identify racial and ethnic disparities in patient portal offers, access, and use and to examine the role of providers in facilitating access to electronic health information (EHI) by offering patient portals and encouraging their use. MATERIALS AND METHODS: Using nationally representative survey data from 2019 and 2020 (N = 8028), we examined disparities in patients being offered access to a portal by their provider and differences in subsequent access and use. Using multivariable models, we estimated the effect of race and ethnicity on the likelihood of being offered, accessing or using a portal. Among those offered, we examined the relationship between provider encouragement and portal access; and for those who did not access their portal, we explored reasons for nonuse. RESULTS: Black and Hispanic individuals were offered and accessed patient portals at significantly lower rates than White individuals. Compared to Whites, Black and Hispanic individuals were 5.2 percentage-points less likely to be offered a portal (P < .05) and, among those offered, 7.9 percentage-points less likely to access their portal (P < .05). Black and Hispanic individuals who were offered and accessed a portal were 12 percentage-points more likely than Whites to use it to download or transmit information (P < .01). Individuals who were offered a portal and encouraged to use it were 21 percentage-points more likely to access it. DISCUSSION: Differences in patient portal access and use are likely driven by disparities in which groups of patients reported being offered a portal. CONCLUSIONS: Providers play an important role in increasing access to EHI by facilitating access to patient portals.

BACKGROUND: Certified electronic health record (EHR) technology has been adopted by most hospitals and health care providers. In 2015, the Office of the National Coordinator for Health Information Technology (ONC) published new EHR certification requirements, known as the 2015 Edition. To date, no research has examined the impact of hospitals' adoption of the 2015 Edition on health care delivery. METHODS: We analyzed aggregated, longitudinal data drawn from a repository of deidentified health insurance claims collected by FAIR Health, the repository was estimated to represent about 75% of the privately insured in the United States. These data were linked with the American Hospital Association (AHA) Information Technology Supplement Survey to obtain hospitals' health information technology characteristics. A fixed effects specification was used to assess the incidence of duplicate testing and imaging in both inpatient and outpatient settings before and after the hospitals' adoption of the 2015 Edition. RESULTS: Hospitals with the 2015 Edition were less likely to perform duplicate imaging for inpatients by 5 percentage points (or 50% from baseline). Hospitals that adopted the 2015 Edition and actively engaged in interoperable data exchange were even less likely to perform duplicate lab tests. CONCLUSIONS: Adoption of the 2015 Edition certified EHR was negatively associated with the incidence of lab and imaging test duplication in both the outpatient and inpatient settings. However, the results were not robust across specifications. Given that multiple factors influence care delivery decisions, improvements in certification standards alone are unlikely to eliminate unneeded duplicate lab and imaging tests.

OBJECTIVE: This study: 1) characterized the app market by EHR app gallery and type of app; 2) tracked changes in the EHR app galleries from the end of 2019 through 2020; and 3) examined how apps connect to EHR data systems, and if the apps support the HL7 FHIR standard. MATERIALS AND METHODS: We developed a program that gathered data from the public app galleries hosted by Allscripts, athenahealth, Cerner Corporation, Epic Systems Corporation, and SMART. Data collection for this study began in December 2019 and ended December 2020. The program was run 11 times during this period, and the data collected were used to generate the findings and trends observed in this study. RESULTS: The total number of unique apps increased from 600 to 734 during the study period. The most common types of apps marketed were intended for administrative (42%) and clinical use (38%). About 1 in 5 apps (22%) described support for the FHIR standard. Support for FHIR varied by intended functionality and gallery. DISCUSSION: This study provides early insights into the number of third-party apps that are connecting to EHRs, what services they provide, and if these connections use standards-based application programming interfaces (APIs). CONCLUSION: It is a federal government priority to improve the access and use of electronic health information, including third-party apps that can introduce competition as well as best-of-breed functions and user experiences. This study shows that there is room for growth, and variation exists among some of the largest EHR developers.

OBJECTIVE: To understand hospitals' use of EHR audit-log-based measures to address burden associated with inpatient EHR use. MATERIALS AND METHODS: Using mixed methods, we analyzed 2018 American Hospital Association Information Technology Supplement Survey data (n = 2864 hospitals; 64% response rate) to characterize measures used and provided by EHR vendors to track clinician time spent documenting. We interviewed staff from the top 3 EHR vendors that provided these measures. Multivariable analyses identified variation in use of the measures among hospitals with these 3 vendors. RESULTS: 53% of hospitals reported using EHR data to track clinician time documenting, compared to 68% of the hospitals using the EHR from the top 3 vendors. Among hospitals with EHRs from these vendors, usage was significantly lower among rural hospitals and independent hospitals (P < .05). Two of these vendors provided measures of time spent doing specific tasks while the third measured an aggregate of auditable activities. Vendors varied in the underlying data used to create measures, measure specification, and data displays. DISCUSSION: Tools to track clinicians' documentation time are becoming more available. The measures provided differ across vendors and disparities in use exist across hospitals. Increasing the specificity of standards underlying the data would support a common set of core measures making these measures more widely available. CONCLUSION: Although half of US hospitals use measures of time spent in the EHR derived from EHR generated data, work remains to make such measures and analyses more broadly available to all hospitals and to increase its utility for national burden measurement.