Patient portal messaging patterns among Spanish-speaking patients in North Texas

Background: Patient portal messaging connects patients with their healthcare teams but is underused by Spanish-speaking patients. Objective: Evaluate content and use patterns of portal messaging among Spanish-speaking patients to inform future implementation strategies to increase portal messaging. Methods: We evaluated messaging use patterns among a random sample of adults with an EHR-designated Spanish language preference across three diverse healthcare systems in Texas: an academic medical center, a public safety-net institution, and a regional, integrated community health system. Eligible participants initiated ≥1 medical advice request conversation via the portal between April 5, 2021-April 4, 2022. We thematically coded messages to capture characteristics including message sender and receiver role, language, topic, conversation length, and concordance. Results: We analyzed 883 patient-initiated conversations from 297 patients including n=1,557 messages sent by patients and n=1,123 sent to patients. Most (77.3%, 1,204/1,557) messages from patient accounts were initiated in English, and 26.7% (414/1,557) were written by a self-identified care partner. Messages were most frequently about prescriptions (40.0%, 353/883), appointments (26.6%, 235/883), and symptoms (21.5%, 190/883). Most conversations were brief, with 56.4% consisting of one (21.4%) or two (35.0%) messages. Nearly all messages sent by patient accounts received language concordant responses (94.9%, 976/1,028), although some patients and care partners used automated translation tools. Discussion: Spanish-speaking patients who use the patient portal usually message in English, and more than a quarter of messages are written by care partners. Vendors and health systems could increase portal messaging use among Spanish speaking patients via Spanish language portal configuration and educational resources, especially for those without access to an English-speaking care partner. The most common messaging topics (appointment scheduling and medication refill requests) have existing, but underused, discrete portal functions. Generative artificial intelligence (AI) solutions in Spanish could facilitate portal messaging triage and language concordant responses to Spanish speakers.