Mind the Gap: Racial and Ethnic Disparities in Electronic Patient Portal Activation and Use During Pregnancy at an Academic Medical Center [ID 1238]

INTRODUCTION: Patient-facing electronic medical record portals (EMR-PP) increase access to health information and facilitate patient–provider communication. Studies suggest sociodemographic disparities in portal enrollment and use. Associations between patient characteristics and portal activation in obstetrics are limited. We characterized the association between EMR-PP activation and utilization at delivery according to race/ethnicity and other sociodemographic variables. METHODS: A retrospective evaluation of obstetric patients at an academic teaching hospital from 2018 to 2021 was performed. Records were reviewed for patient demographics, pregnancy outcomes, and EMR-PP status at first prenatal visit and at delivery. Subjects were categorized into three groups at delivery: remained active, became active (converter), and never active. RESULTS: Of the 13,360 subjects included, 6,303 (51%) had active EMR-PP status at first obstetric visit. Seventy-three percent of subjects were EMR-PP active at delivery, representing an increase of 22%. Among subjects with either chronic hypertension or gestational diabetes mellitus (N=1,748), non-Hispanic ethnicity (odds ratio [OR] 7.30 [95% CI, 5.6–9.5], P <.001) and education beyond high school (OR 7.69 [95% CI, 3.8–17.1], P <.001) increased the odds of portal activation at delivery. Government insurance and/or Spanish language were also associated with decreased EMR-PP conversion. Preliminary data showed that those utilizing the EMR-PP for staff messaging were at least two times more likely to be non-Hispanic White and use English as primary language. CONCLUSIONS/IMPLICATIONS: Our findings demonstrate strong associations between patient language, ethnicity, and education with active EMR-PP at delivery. Future equity initiatives targeting vulnerable populations should consider EMR-PP status as a patient access quality metric. Further study is needed to link EMR-PP utilization to pregnancy outcomes.