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Disparities in Individuals' Access and Use of Health Information Technology in 2014

ONC Data Brief 34 | February, 2016

Vaishali Patel, PhD MPH, Wesley Barker, MS, Erin Siminerio, MPH

Findings from nationally representative surveys show that individuals' use of information technology (IT) for health needs increased significantly between 2013 and 2014 (1). The percentage of individuals offered online access to their medical record also grew by over one-third to nearly 4 in 10 individuals in 2014 (2). Prior analysis revealed that disparities in online access of medical records and use of IT for health-related needs existed by certain socio-demographic characteristics and geographic settings in 2013 (3). This data brief examines 2014 data to identify disparities in online access of medical records and use of IT for health needs.

Individuals whose provider had an EHR were offered online access to their medical record at three times the rate of those whose provider does not

Figure 1: Percent of individuals who have been offered access to an online medical record and use certain types of IT for health related needs by whether or not the individual's provider has an EHR, 2014

This is bar chart that visualizes the percent of individuals who have certain access and use of health IT by whether or not the individuals provider has an EHR.

NOTE: *Significant differences among individuals whose provider has an EHR versus does not have an EHR (p<0.05), comparisons within same year.

SOURCE: 2012 - 2014 Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic Health Records and Health Information Exchange

Individuals with lower incomes and less education had significantly lower rates of being offered online access to their health information

Figure 2: Percentage of individuals offered online access to a medical record by a health insurer or health care provider by annual household income and education, 2014

This is a bar chart that shows the percent of individuals by category of annual income and education that have been offered electronic access to their medical record.

NOTE: *Significantly different from reference category (p<0.05). No significant differences were found by age, setting (e.g., rural vs. urban), chronic health condition, or disability. See Appendix Table 1 for variation in being offered online access to medical record.

SOURCE: 2012 - 2014 Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic Health Records and Health Information Exchange

Individuals who had difficulty speaking English were offered online access to their medical records at significantly lower rates

Figure 3: Percentage of individuals who were offered online access to their medical record by a health insurer or health care provider by language and race/ethnicity, 2014

This is a bar chart that shows the percent of individuals by category of language, english proficiency, and race/ethnicity that have been offered electronic access to their medical record.

NOTE: *Significantly different from reference category (p<.05). See Appendix Table 1 for variation in being offered online access to medical record.

SOURCE: 2012 - 2014 Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic Health Records and Health Information Exchange

Among individuals offered online access to their medical record, those with higher incomes and more education were more likely to view their record

Figure 4: Among individuals who were offered online access to their medical record by a health care provider or health insurer, the percentage who viewed their online medical record at least once within the last year by annual household income and education, 2014

This is a bar chart that shows the percent of individuals by category of annual income and education that viewed their data from an online medical record at least once in the past year.

NOTES: *Significantly different compared to reference category (p<0.001). No significant differences were found by demographic characteristics (e.g., age, gender), race, language, setting (e.g., rural vs. urban), chronic health condition, or disability. See Appendix Table 1 for variation in rates of viewing online medical record

SOURCE: 2012 - 2014 Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic Health Records and Health Information Exchange

Individuals with more education and higher income use certain types of IT for health-related needs at significantly higher rates

Figure 5: Percentage of individuals who have ever used certain types of IT for health-related needs by various characteristics (significant differences shaded dark)

This figure has multiple bar charts across four information technology categories. It shows the percent of individuals across information technology and socio-demographic categories who used those information technologies. The technologies are: emailed health care provider, looked at test results online, text messaged health care provider, and used a smart phone/mobile health application. The socio-demographic categories are age, race, income, education, language, geographic setting, and whether or not the individual has a disability.

NOTES: Significant differences among respondent categories reflect unadjusted comparisons to reference category, indicated by parentheses ( ). See Appendix Table 2 for values. Measurement of disability is based upon a composite measure (see Definitions).

SOURCE: 2012 - 2014 Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic Health Records and Health Information Exchange

Summary

Although rates of individuals offered online access and use of certain types of information technology grew significantly between 2013 and 2014, disparities remain. This data brief's findings suggest that individuals' access to their online medical record and their use of IT to address their health care needs varies significantly across socio-demographic characteristics and by geographic setting in 2014.

Individuals with less income or education had lower rates of access to and use of their online medical record. These individuals also had lower rates of using certain types of IT to address their health care needs, such as emailing or text messaging their health care provider and using a smart phone health application.

Findings from this data brief also suggest that language barriers may impede access to online medical records and use of health IT. Individuals who did not speak English well or took the survey in Spanish were significantly less likely to be offered access to their online medical record. Individuals who took the survey in Spanish also had significantly lower rates of emailing their health care provider or looking up test results online.

There were no differences in rates of access to or the viewing of an online medical record by age. However, individuals 50 to 59 years of age had significantly higher rates of emailing or text-messaging health care providers, looking up test results online, and using smartphone health applications compared to individuals 70 years or older.

Individuals' electronic access their personal health information and use of IT for health differed by whether their provider had an EHR. In both 2013 and 2014, individuals whose health care providers used EHRs had significantly higher rates of being offered online access to their medical record and using IT for health-related needs compared to those who did not. Hospitals' and physicians' adoption of computerized functionality to support individuals' online access to medical records also grew significantly over this same time period, and this may be reflected in the consumer data (4, 5). Increased use of these online capabilities by providers may also drive increased use by consumers.

ONC intends to continue monitoring patient access to their electronic health information. ONC is collaborating with the National Cancer Institute and the National Partnership for Women and Families on future rounds of Health Information National Trends Survey, a nationally representative survey of individuals to monitor health IT access and use (6). This will allow ONC to continue examining variation in health IT access and use to identify disparities and factors that enable greater access and use of health IT.

Definitions

Online medical record: The survey defined this as: "Some patients can access information from their medical records online-that is, through the Internet-on secure websites set up for this purpose. By going to the secure website, patients can view parts of their own medical record, download the information, or send it somewhere else."

Disability: Individuals who responded "yes" to one or more of the following items: Are you deaf or do you have serious difficulty hearing? Are you blind or do you have serious difficulty seeing, even when wearing glasses? Because of a physical, mental, or emotional condition, do you have serious difficulty concentrating, remembering, or making decisions?

Data Source and Methods

Data are from The Office of the National Coordinator for Health Information Technology's (ONC) Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic Health Records and Health Information Exchange. The survey was conducted by NORC at the University of Chicago with MITRE.

The respondent universe for the survey was the civilian, non-institutionalized population ages 18 years old and older within the 50 states and the District of Columbia. This survey utilized a dual random digit dialing (RDD) frame of landline phone numbers and wireless/mobile phone numbers developed by Survey Sampling International (SSI). In order to reduce sampling variability and to represent the nation, NORC stratified the landline RDD frame by Census Region. The 2013 survey oversampled Hispanic, Asian and Black populations, and the 2012 and 2014 oversampled for Hispanic and Black populations. A total of 2,123 were completed in 2014; 2,107 surveys were completed in 2013; and 2,050 surveys were completed in 2012. Data presented in this data brief are weighted national estimates. Bivariate, unadjusted analyses were conducted across groups.

New survey data will not be available in 2015. ONC is collaborating with the National Cancer Institute on future rounds of their nationally representative Health Information Trends Survey to monitor health IT access and use. For more information regarding HINTS please go to http://hints.cancer.gov/about.aspx.

References

1. Office of the National Coordinator for Health Information Technology. 'Trends in Individuals Use of Health IT: 2012 - 2014,' Health IT Quick-Stat #46. http://dashboard.healthit.gov/quickstats/pages/FIG-Individuals-Health-IT-Use.php. June 2015.

2. Patel V., Barker W. & Siminerio E. (October 2015). Trends in Consumer Access and Use of Electronic Health. ONC Data Brief, no.30. Office of the National Coordinator for Health Information Technology: Washington DC. http://dashboard.healthit.gov/evaluations/data-briefs/trends-consumer-access-use-electronic-health-information.php.

3. Patel V., Barker W. & Siminerio E. (June, 2015). Disparities in Individuals' Access and Use of Health IT in 2013. ONC Data Brief, no.26. Office of the National Coordinator for Health Information Technology: Washington DC. http://www.healthit.gov/sites/default/files/briefs/oncdatabrief26june2015consumerhealthit.pdf.

4. Charles, D., Gabriel, M., Henry, J. (October 2015) Electronic Capabilities for Patients among U.S. Non-Federal Acute Care Hospitals: 2008-2014. ONC Data Brief, no.29. Office of the National Coordinator for Health Information Technology: Washington DC. http://dashboard.healthit.gov/evaluations/data-briefs/hospitals-patient-engagement-electronic-capabilities.php.

5. Heisey-Grove, D., Patel, V., Searcy, T. (September 2015) Physician electronic exchange of patient health information, 2014. ONC Data Brief, no. 31. Office of the National Coordinator for Health Information Technology: Washington DC. http://dashboard.healthit.gov/evaluations/data-briefs/physician-electronic-exchange-patient-health-information.php.

6. HINTS: Health Information National Trends Survey. http://hints.cancer.gov/about.aspx.

About the Authors

The authors are with the Office of the National Coordinator for Health Information Technology, Office of Planning, Evaluation, and Analysis and the Consumer e-Health Division.

Acknowledgements

MITRE and NORC at the University of Chicago contributed to the development of the survey instrument, survey administration, and data analysis.

Suggested Citation

Patel V., Barker W. & Siminerio E. (February 2016). Disparities in Individuals' Access and Use of Health IT in 2014. ONC Data Brief, no.34. Office of the National Coordinator for Health Information Technology: Washington DC.

Appendix

See Appendix tables 1 and 2 in the PDF of this data brief for more information.

Appendix Table 1: Individuals' Use of Certain Types of IT for Health-Related Needs by Selected Characteristics, 2014

Emailed Provider (weighted %) Looked at test results online (weighted %) Text messaged healthcare provider (weighted %) Used smartphone/ mobile health application (weighted %)
National Estimate 31% 22% 18% 17%
Demographics
Sex
(Male) 31% 19% 17% 16%
Female 31% 24% 18% 18%
Age
18-29 27% 20% 16% 19%*
30-39 35%* 24% 16% 20%*
40-49 32% 22% 21%* 24%*
50-59 35%* 27%* 25%* 21%*
60-69 32% 21% 15% 12%*
(70+) 22% 14% 10% 3%
Race/Ethnicity
Hispanic 22%* 13%* 18% 18%
Non-Hispanic, Asian 27% 22% 22% 20%
Non-Hispanic, black 24% 20% 14% 8%*
(Non-Hispanic, white) 34% 24% 18% 19%
Non-Hispanic, others/multi-racial 31% 11% 20% 18%
Education
Not a high school graduate 8%* 5%* 7%* 10%*
High school graduate or GED 18%* 9%* 15%* 8%*
Some college or 2-yr degree 28%* 20%* 17%* 13%*
4-yr college graduate 39%* 30% 18%* 26%
(More than 4-yr college degree) 54% 40% 30% 29%
(Less than $25,000) 12% 7% 8% 11%
Annual Income
$25,000-$49,999 27%* 19%* 20%* 13%
$50,000-$99,999 42%* 29%* 22%* 22%*
$100,000 or greater 54%* 42%* 26%* 35%*
Language
(Speak Engligh: very well or well) 32% 23% 18% 18%
Speak English: not well 9%* 4%* 10% 12%
Speak English: not at all 0% 0% 0% 12%
(Took survey in English) 32% 23% 18% 18%
Took survey in Spanish 8%* 6%* 14% 13%
Geographic setting
Urban 35% 26% 16% 21%
(Suburban) 33% 23% 20% 18%
Rural 19%* 14%* 13% 11%
Health and Functional Status
Disability composite
(Yes to any disability) 23% 17% 14% 11%
No to all disabilities 33%* 23% 19% 19%*
Chronic health condition
(Yes) 31% 21% 17% 16%
No 31% 22% 18% 18%

Notes: Weighted percentages. () denotes reference category, and * denotes significant difference from reference category (p<0.05)

Source: 2014 Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic Health Records and Health Information Exchange

Appendix Table 2: Rates of Access and Use of Online Medical Records by Select Characteristics, 2014

Offered electronic access to your health information by health insurer/provider Viewed medical record at least once within last year (among those who were offered access)
National Estimate 38% 55%
Demographics
Sex
(Male) 32% 53%
Female 43%* 56%
Age
18-29 34% 58%
30-39 43% 57%
40-49 40% 57%
50-59 39% 62%
60-69 40% 48%
(70+) 34% 40%
Race/Ethnicity
Hispanic 22%* 54%
Non-Hispanic, Asian 31% 84%
Non-Hispanic, black 35% 61%
(Non-Hispanic, white) 43% 53%
Non-Hispanic, others/multi-racial 34% 34%
Education
Not a high school graduate 19%* 26%*
High school graduate or GED 26%* 35%*
Some college or 2-yr degree 37%* 54%
4-yr college graduate 49% 61%
(More than 4-yr college degree) 52% 68%
(Less than $25,000) 27% 36%
Annual Income
$25,000-$49,999 36% 53%
$50,000-$99,999 45%* 60%*
$100,000 or greater 53%* 66%*
Language
(Speak Engligh: very well or well) 39% 56%
Speak English: not well 15%* 14%
Speak English: not at all 5%* 0%
(Took survey in English) 40% 55%
Took survey in Spanish 11%* 35%*
Geographic setting
Urban 41% 61%
(Suburban) 39% 54%
Rural 30% 48%
Health and Functional Status
Disability composite
(Yes to any disability) 38% 52%
No to all disabilities 38% 56%
Chronic health condition
(Yes) 39% 49%
No 37% 59%

Notes: Weighted percentages. () denotes reference category, and * denotes significant difference from reference category (p<0.05)

Source: 2014 Consumer Survey of Attitudes Toward the Privacy and Security Aspects of Electronic Health Records and Health Information Exchange