Abstract

US Federal bodies have adopted policies and programs (e.g., Centers for Medicare and Medicaid Services’ (CMS) Electronic Health Record (EHR) Incentive Programs launched in 2014) to promote patient access to electronic health information (EHI) or expand provider capabilities to enable access to EHI for patients. One of the routes, which expand access, is through patient portals. As of early 2020, about 57% patients reported to have been offered access to portals by their healthcare providers and 40% accessed their medical records via portals once or more in the past year (Richwine et. al., 2023). Despite some progress in portal access, concerns about digital divides in the access and use of patient portals abound, especially considering the enactment of policies/incentives targeted to increase access or the existence of multiple access modalities (e.g., using health apps via smartphones). Social influence (SI) is a key construct in adoption. Reviewing studies that used UTAUT, Dwivedi et al. (2019) note SI affects usage through multiple paths. The World Health Organization (WHO) Global Strategy on Digital Health 2020-2025 aims to strengthen/improve “public trust in digital health technologies." Providers are instrumental to building trust. However, the role that providers play alone or in tandem with patient-related factors is not fully understood. Enormous societal changes inflicted by the COVID pandemic warrant revisiting influences of patient and provider factors on digital tool utilization. To assess the role of providers in patient access to EHI, we pose the following questions. 1) How does the relation between provider encouragement (SI) and continuance/use behavior evolve over time from pre-COVID to COVID and to post-COVID? 2) How does SI relate to usage behavior reflecting patient engagement outcomes? 3) How do health literacy and self-efficacy affect the relationship? This research uses data from three cycles of the Health Information National Trends Survey (HINTS), nationally representative population-wide surveys of civilian, noninstitutionalized adults conducted by the National Cancer Institute in 2017 (pre-COVID), 2020 (during COVID), and 2022 (post-COVID). About 14000 patients were available and about 88% reported using health services in the past 12 months. Provider encouragement saw a slow increase from 42% in 2017 to 66% in 2022. We run regression analysis and provide weighted estimates that are applicable to the US population. Our research is in progress and going to shed light on important and effective mechanisms to ameliorate disparities. Also, the results hold theoretical implications for continuance of digital tools.

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