Electronic medical records will let patients access their health information over the Internet, but a new study suggests some of the most vulnerable older Americans may be left behind.
While Internet use doubled among seniors in general over the past decade, researchers found, there was little growth among people with physical impairments - suggesting a new digital divide could be forming.
Functional impairments, including physical disabilities such as the loss of a sense or the ability to walk, make it difficult for people to live in their community, take care of personal finances and coordinate transportation.
“If you look at the subgroup of people functionally impaired, there was also a doubling (of Internet use) there but it was still remarkably low,” said the study's lead author, Dr. S. Ryan Greysen, from the University of California, San Francisco.
The Centers for Medicare and Medicaid Services (CMS), which oversees those two U.S. government-run health insurance programs, wants doctors to go digital.
CMS runs a $30 million incentive program that pays individual doctors to use electronic medical records (EMRs) – also known as EHRs for electronic health records. The agency will also begin penalizing doctors who don't adopt EMRs by 2015.
Greysen and his colleagues point out in their report in JAMA Internal Medicine that part of the program requires that patients be able to access their own medical information through online portals.
“What I think has gotten lost in this is yes, we need the electronic medical records to be accessible, but who are the groups that will have difficulty getting to those portals?” Greysen said.
For the new study, he and his colleagues analyzed responses from a national survey of about 19,000 Americans who were at least 65 years old and did not live in nursing homes.
Overall, the proportion of respondents who reported using the Internet in any way doubled from 21 percent in 2002 to 42 percent in 2010. But that increase varied depending on the characteristics and health of some groups.
Those who started with very low rates of Internet use saw some of the sharpest increases. For example, among non-white seniors, rates of Internet use rose from 7 percent to 21 percent.
After adjusting the numbers for factors that are known to influence Internet access - such as sex, race, education and wealth, the researchers found only those who were 75 years old and older, not white or considered themselves to be in poor or fair health significantly increased their Internet use over the study period.
Those with functional impairments ended the study period more or less where the larger group began, however. Just 10 percent of people with a functional impairment used the Internet in 2002 and that rose to 23 percent in 2010.
If people with functional impairments don’t start increasing their use of the Internet, Greysen and his colleagues suggest, they may be left behind as the management of healthcare becomes digital.
To address this gap, the authors suggest strategies to help those with functional limitations to access the Internet. For example, people can use special software on their computers to have the text of a website read to them or to operate a computer with voice commands instead of a mouse and keyboard.
Greysen added that his team is currently trying to teach older patients how to access their own information through the portals.
“We show them how the patient portal works and how to navigate it,” he said.
“For those who have more severe functional impairment, showing them isn’t going to be enough,” Greysen said. But teaching younger, unimpaired caregivers about the portals may be another possibility for expanding access.