Adoption of a patient portal at a cancer center: Changes over 5 years.
Authors: Redelman-Sidi Yael , Spiegelhoff Zoe , White Charlie , Polubriaginof Fernanda C. G. , Lipitz-Snyderman Allison , Chimonas Susan , Kuperman Gilad 
Published: October 2023

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Background: Patient portals increasingly are essential tools in oncology. Understanding their patterns of adoption and use is important to enable optimal care coordination and communication between providers, staff, and patients. Our goal was to identify trends in patient portal adoption in a large cancer center in NY, between 2017 and 2022. Specifically, we sought to understand when in their clinical journey patients start to engage with the portal, and how often they use it while receiving care. Methods: MSK offers a patient portal via a mobile app or browsers. We identified newly registered patients in January 2017 (2017 group) and January 2022 (2022 group) with two or more completed appointments for that year. We followed each group for one year and determined: (i) the proportion of patients who created and used portal accounts (ii) the timing of the creation of the portal account as compared with completion of the registration process (note: patients can create portal accounts before registration is complete) (iii) the proportion of patients who logged into the portal more than once (“ever-users”) (iv) the ratio (“usage ratio”) between the number of days a patient logged into the portal (“log-in days”) and the number of days a patient had an encounter at the center (“encounter days”) We captured demographics for both groups. This study was approved by the MSK Institutional Review Board. Results: A total of 2772 patients were in the 2017 group, and 3006 were in the 2022 group. Age, sex, race, ethnicity, and preferred language were comparable across groups. In the 2017 group, 57.1% (1584) opened an account, compared with 74.2% (2231) in 2022 (p<.00001). Of those who opened an account in 2017, 17% (265) opened it prior to registration, 68% (1083) opened it within 2 months of registration, and 15% (236) opened it by year’s end. In the 2022 group, 30% (678) opened it prior to registration, 62% (1383) opened it within 2 months from registration, and 8% (170) opened by year’s end. (p <.00001). In the 2017 group, 49.8% (1380) became ever-users, compared with 62.5% (1879) in the 2022 group. Median login-days for ever-users increased from 30 in 2017 to 47 in 2022, while the median of encounters decreased from 12 to 11. The median usage ratio of ever-users increased from 2.23 (IQR 1.23,3.88) in 2017 to 3.53 (IQR 2.18, 5.2) in 2022 (p<.001). The proportion of ever-users whose log-in days were less than their encounter days dropped from 17% to 5.1% (p<.001); the proportion of ever-users with log-in days more than 8 times per encounter days increased from 5.1% to 7.7% (p=0.03). Conclusions: From 2017 to 2022 patients created portal accounts more often and used them earlier and more often in their cancer journey. However, an important fraction of non-users persists. Oncology care increasingly will be dependent on digital capabilities. Future work should focus on closing the digital gap and assuring that disparities are understood and addressed.