Epic Patient Portal Adoption Among Vulnerable Oncology Patients in the Era of Oral Anticancer Medications

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Abstract
PURPOSE: We characterized patient portal signup in the electronic health record and messaging use among vulnerable oncology patients identified as having newly initiated an oral anticancer medication (OAM), evaluating opportunities to improve patient portal adoption and thus patient communication with their oncology care teams. PATIENTS AND METHODS: We conducted a retrospective analysis of patients who newly initiated an OAM at Tufts Medical Center between October 1, 2022, and March 31, 2024. Vulnerability was defined as meeting at least one of the following criteria: age ≥75 years; non-English language; or subsidized insurance (Medicaid only or Medicare with Medicaid as a secondary insurance). Active portal use was defined as having at least one message in the portal; meaningful use was defined as patient-provider bidirectional messaging. Portal messaging proxy use was determined by message content screening. Fisher's exact test evaluated the impact of vulnerability on portal signup rate. Logistic regression was performed to identify factors associated with portal signup and meaningful use. RESULTS: Among the study population (N = 280), 56% met the criteria of vulnerability. Although the overall portal signup rate was 74%, it was 64% among vulnerable patients and 87% in nonvulnerable patients ( P < .0001). Non-English language was associated with lower rate of portal signup ( P < .0001), but none of the vulnerable characteristics were associated with decreased meaningful use. Messaging by proxy was used by 17% of vulnerable versus 2.8% of nonvulnerable patients who signed up for portal. Among patients who signed up, 31% used the portal to communicate about OAM. CONCLUSION: Although patient portal signup was lower among vulnerable patients, once adopted, vulnerable patients demonstrated comparable meaningful use and greater proxy engagement. Fostering patient portal adoption requires a targeted approach with patient navigation and patient proxy engagement.

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