Background: Sharing electronic health records with patients has been shown to improve patient safety and quality of care, and patient portals represent a powerful and convenient tool to enhance patient access to their own healthcare data. However, the success of patient portals will only be possible through sustained adoption by its end-users: the patients. A better understanding of the characteristics of users and non-users is critical to understand which groups remain underserved or excluded from using such tools.

Objective: To identify the determinants of usage of the Care Information Exchange (CIE), a shared patient portal program in the United Kingdom.

Methods: A cross-sectional study was conducted, using an online questionnaire. Information collected included age, gender, ethnicity, educational level, health status, postcode and digital literacy. Registered individuals were defined as having had an account created in the portal, independent of their actual use of the platform; users were defined as having ever used the portal. Multivariate logistic regression was used to model the probability of being a user. Statistical analysis was performed in R, and Tableau ® was used to create maps of the proportion of CIE users by postcode area.

Results: A total of 1,083 subjects replied to the survey (+186% of the estimated minimum target sample). The proportion of users was 61.6% (n=667), and within these, the majority (57.7%, n=385) used the portal at least once a month. To characterise the users and non-users of the system, we performed a sub-analysis of the sample, including only participants that had provided at least information regarding gender and age category. The sub-analysis included 650 individuals (59.8% women, 84.8% over 40 years). The majority of the subjects were white (76.6%, n=498), resident in London (64.7%, n=651), and lived in North West London (55.9%, n=363). Individuals with a higher educational degree (undergraduate/professional or postgraduate/higher) had higher odds of being a portal user (adjusted OR = 1.58 (95%CI [1.04 - 2.39]), and 2.38 (95%CI [1.42 - 4.02], respectively), compared to those with a secondary degree or below. Higher digital literacy scores ((≥30) were also associated with higher odds of being a user (adjusted OR = 2.96 (95%CI [2.02 - 4.35]). Those with a good overall health status had lower odds of being a user (adjusted OR = 0.58 (95%CI [0.37 - 0.91]).

Conclusion: This work adds to the growing body of evidence highlighting the importance of educational aspects (educational level and digital literacy) in the adoption of patient portals. It is critical that further research not only describes, but also systematically addresses these inequalities through patient-centred interventions aiming to reduce the digital divide. Healthcare providers and policymakers must partner in investing and delivering strategic programs that improve access to technology and digital literacy, in an effort to improve digital inclusion and reduce inequities in delivery of care.