Patient portals’ digital divide

By Ben Leonard, Erin Schumaker and Ruth Reader

Patient portals help patients keep track of their care, but not everyone has access. | Getty Images

Black and Hispanic patients were less likely than white patients to be offered and use online patient portals, a new study from HHS’ Office of the National Coordinator for Health IT found.

The disparities persisted even when adjusting for age, education and other factors in the data for 2019 and 2020.

The key findings:

— White patients were about 10 percentage points more likely to be offered and access patient portals that provide test results and other medical information than Black and Hispanic patients.

— About a third of Black and Hispanic patients accessed portals compared with about half of white patients.

— Roughly 6 in 10 people were offered portal access in 2020, up from 42 percent in 2014, a tally found in previous research.

— When the researchers looked at use among patients who were offered access, those disparities narrowed. About six in 10 Black and Hispanic patients accessed portals when offered compared with about 70 percent of white patients.

“Differences in access were likely driven by disparities in being offered a portal,” ONC economist Chelsea Richwine wrote in a blog post Thursday. “Our findings point to the important role of health care providers in increasing access to [electronic health information] by offering portals and encouraging their use.”

Why it matters: Health care organizations are adopting digital health records to provide patients with easier access to their data. The sector hopes to avoid a digital divide as health care undergoes its digital transformation.

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Today on our Pulse Check podcast, Katherine Ellen Foley talks with Megan Messerly about the future of the drug Lequembi now that the FDA has granted it accelerated approval to treat Alzheimer's disease. The drug targets amyloid proteins in the brain, which are thought to cause progressive dementia.

The FDA is now allowing retail pharmacies to dispense the abortion pill mifepristone. | AP Photo/Jeff Roberson

The FDA’s decision to allow brick-and-mortar pharmacies to dispense the abortion pill mifepristone has again presented America’s biggest companies with a thorny choice. It’s just the latest example of how businesses increasingly can’t avoid the culture war that’s engulfed public health.

CVS and Walgreens were quick to say they’d dispense the pill in states where it’s legal. But Walmart, Kroger, Costco and Albertsons didn’t respond to POLITICO's request for comment on their plans.

Companies are weighing business, legal, political and moral considerations in deciding what to do. And whether to dispense the abortion pill is just the latest in a series of business decisions with public health implications that national retailers have grappled with.

Here’s a timeline of some of them:

— Walmart lagged behind CVS and Walgreens in stocking the Plan B emergency contraception pill, only doing so in 2006 following government pressure and a lawsuit against the company. Now, as the result of a 2013 FDA decision, all three retailers sell the "morning-after" pill over the counter.

— CVS eliminated tobacco products from its stores in 2014, sacrificing $2 billion in annual revenue, its then-CEO Larry Merlo said at the time, because “cigarettes have no place in an environment where health care is being delivered.”

— In 2018, after the Parkland, Fla., school shooting, Walmart, the nation’s biggest gun seller, decided to stop selling firearms to people under 21. Walmart had previously stopped selling the AR-15 rifle that multiple mass shooters have used, and the company said it took seriously its obligation to be a “responsible seller.”

— In 2019, concerns about e-cigarette safety and use among teenagers prompted Walgreens, Kroger and Walmart to stop selling them.

Pharmacies have faced a legal thicket since Roe v. Wade fell in June. As POLITICO’s Alice Miranda Ollstein and Daniel Payne have reported, state and federal laws have long allowed individual pharmacists to refuse to dispense medication and contraception that clashed with their religious beliefs — as long as they directed patients to someone else who would fill their prescription.

Some pharmacists have refused to dispense the abortion pill misoprostol, used to treat miscarriages, because their states ban abortion.

In October, the Department of Health and Human Services opened an investigation into whether CVS and Walgreens policies allowed pharmacists to refuse to fill prescriptions for drugs they suspected might harm a pregnancy.

If major chain pharmacies opt to distribute mifepristone, it would expand access to abortion for patients in most states but not help people seeking to end pregnancies in states with abortion bans.

Graham Felstead works the computer with the Stentrode brain-computer interface. | Business Wire

Synchron, a New York City-based medical device maker, launched the first safety trial of its brain-computer interface with the aim of answering two questions: Is inserting the company’s device into a vein in the brain safe and will it enable paralyzed patients to use a computer without using their hands?

Its new report in JAMA Neurology says yes to both.

How does it work?

— Synchron’s brain-computer interface is a small, round mesh tube, or stent, inserted into a blood vessel in the brain. The stent, called the Stentrode, is connected to a receiver transmitter implanted beneath the skin in the chest, which sends signals to an external receiver and, ultimately, to a computer.

— The procedure is done using a catheter threaded through the jugular vein to the brain and is less invasive than other methods that could involve drilling a hole into the skull.

— Synchron uses eye-tracking technology to help train patients to control a cursor with their gaze and then “click” on the screen using their thoughts. One patient was able to navigate the computer without eye tracking.

— Patients could shop, check email, text and review their finances online without assistance.

The small, 12-month safety study, conducted in Australia, began in 2019.

While the four patients experienced headaches and bruising around the incision site, they had no serious adverse effects.

Synchron began enrolling patients earlier this year in an FDA-authorized clinical trial for patients with severe paralysis.

The company competes with Elon Musk’s brain-computer interface business Neuralink, which last year announced intentions to apply to the FDA for a human trial.

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