Patient Portal Enrollment before and during the COVID-19 Pandemic

The COVID-19 pandemic accelerated the adoption of digital health solutions, including patient portals, which offer secure access to medical records, communication with providers, and appointment management. Despite their benefits, disparities in adoption persist across demographic and socioeconomic groups. This observational cohort study examined patient portal enrollment trends before and during the pandemic at Johns Hopkins Medicine, analyzing differences by race and socioeconomic status. We categorized patients as prior enrollees, new enrollees, or non-enrollees across three periods: pre-pandemic (March 2019 - March 2020), first-year pandemic (March 2020 - March 2021), and second-year pandemic (March 2021 - March 2022).Using electronic health record data, we assessed enrollment rates and applied logistic regression to evaluate associations with demographic and social determinants of health. The cohort included 68,738 patients, observed throughout all study periods. Analysis revealed an increase in patient portal enrollment incidence rates from 22.9 per 100 patients eligible to enroll pre-pandemic to 35.2 per 100 in the first year of the pandemic, followed by a decreased enrollment incidence rate to 13.0 per 100 in the second year of the pandemic. This trend suggests an association between the onset of the COVID-19 pandemic and the initial surge in patient portal enrollment. Comparisons between the pre-pandemic and second year of the pandemic showed statistically significant differences in enrollment rates across most demographic subgroups.Higher odds of enrollment were observed among patients aged 18-44, White, and non-Hispanic individuals, while Black, Hispanic, male, and socioeconomically disadvantaged patients exhibited lower enrollment rates. These findings highlight disparities in digital health engagement and underscore the need for targeted strategies to promote equitable access to patient portals.