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J Am Med Inform Assoc. 2009 Sep-Oct;16(5):683-9. doi: 10.1197/jamia.M3169. Epub 2009 Jun 30.

Disparities in use of a personal health record in a managed care organization.

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  • 1Center for Health Research/Southeast, Kaiser Permanente Georgia, Atlanta, GA, USA.



Personal health records (PHRs) can increase patient access to health care information. However, use of PHRs may be unequal by race/ethnicity.


The authors conducted a 2-year cohort study (2005-2007) assessing differences in rates of registration with, a component of the Kaiser Permanente electronic health record (EHR).


At baseline, 1,777 25-59 year old Kaiser Permanente Georgia enrollees, who had not registered with, responded to a mixed mode (written or Internet) survey. Baseline, EHR, and data were linked. Time to registration by race from 10/1/05 (with censoring for disenrollment from Kaiser Permanente) was adjusted for baseline education, comorbidity, patient activation, and completion of the baseline survey online vs. by paper using Cox proportional hazards.


Of 1,777, 34.7% (616) registered with between Oct 2005 and Nov 2007. Median time to registering a account was 409 days. Among African Americans, 30.1% registered, compared with 41.7% of whites (p < 0.01). In the hazards model, African Americans were again less likely to register than whites (hazard ratio [HR] = 0.652, 95% CI: 0.549-0.776) despite adjustment. Those with baseline Internet access were more likely to register (HR = 1.629, 95% CI: 1.294-2.050), and a significant educational gradient was also observed (more likely registration with higher educational levels).


Differences in education, income, and Internet access did not account for the disparities in PHR registration by race. In the short-term, attempts to improve patient access to health care with PHRs may not ameliorate prevailing disparities between African Americans and whites.

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