Unlocking digital health: inequalities in the adoption of a patient portal

OBJECTIVE: Digital health apps and patient portals are proposed as part of the drive from 'analogue to digital' care for the National Health Service (NHS) 10-Year Plan. Without mitigation strategies, digital inequalities could arise as a result, and more evidence is needed to understand how to mitigate this. METHODS: As part of an equality impact assessment, a retrospective cross-sectional analysis was conducted examining patient portal activation among patients invited to outpatient appointments at two large south-east London Hospital Trusts between 1 May and 1 November 2024. RESULTS: Of the 503 688 patients invited to attend outpatient clinics during the study period, 52.7% had activated the patient portal. Availability of email contact details was the strongest determinant of onboarding likelihood (OR 10.86). Multivariate logistic regression models showed that the following groups were less likely to activate the patient portal: men (OR 0.84), individuals at the extremes of age (71-80 or 11-20 years), those of mixed or undefined ethnicity (OR 0.58), those of black ethnicity (OR 0.62) and those with the highest degree of socioeconomic deprivation (Index of Multiple Deprivation group 1; OR 0.68). CONCLUSION: This large-scale roll-out of a digital health portal provides empirical evidence of factors that drive digital inequalities for patients of two major London NHS Trusts. The observed disparities across demographic and socioeconomic dimensions and simple reliable digital contact mechanisms highlight the risk that digital healthcare initiatives may inadvertently produce new types of inequalities.