title: The digital divide in adoption and use of a personal health record.
abstract: BACKGROUND
  Personal health records (PHRs) offer the potential to improve the patient experience and the quality of patient care. However, the "digital divide," the population-level gap in Internet and computer access, may prevent certain groups from accessing the PHR.
  
  
  METHODS
  We conducted a cross-sectional analysis of a PHR within a northeastern health system. We compared adopters (ie, those activating a PHR account online) with nonadopters (ie, those who see a physician offering the PHR but do not activate an account). We further categorized adopters by intensity of PHR use, measured by number of log-ins and number of messages sent to physicians' practices.
  
  
  RESULTS
  As of September 30, 2009, among 75,056 patients, 43% had adopted the PHR since 2002. Blacks and Hispanics were less likely to adopt the PHR compared with whites (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.45-0.55; and 0.64; 0.57-0.73, respectively), and those with lower annual income were less likely to adopt the PHR than were those with higher income. Compared with nonadopters, adopters were more likely to have more than 2 comorbidities (OR, 1.27; 95% CI, 1.17-1.30). Use of an aggressive marketing strategy for PHR enrollment increased adoption nearly 3-fold (OR, 2.92; 95% CI, 1.58-5.40). Intensity of use was best predicted by increasing number of comorbidities, followed by race/ethnicity (whites more than blacks and Hispanics) and insurance status. We found no association between income and log-in frequency or secure messages sent.
  
  
  CONCLUSIONS
  Despite increasing Internet availability, racial/ethnic minority patients adopted a PHR less frequently than white patients, and patients with the lowest annual income adopted a PHR less often than those with higher incomes. Among adopters, however, income did not have an effect on PHR use.
authors: Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA 02120, USA.
authors: Cyrus K
authors: CK
authors: Yamin
authors: Srinivas
authors: S
authors: Emani
authors: Deborah H
authors: DH
authors: Williams
authors: Stuart R
authors: SR
authors: Lipsitz
authors: Andrew S
authors: AS
authors: Karson
authors: Jonathan S
authors: JS
authors: Wald
authors: David W
authors: DW
authors: Bates
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D057286:Electronic Health Records; D005260:Female; D018166:Health Care Reform; D055991:Health Records, Personal; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D033283:Patient Access to Records; D012959:Socioeconomic Factors; D014481:United States