Patient Portal Use Among Admitted Surgical Patients Following the 21st Century Cures Act.

Abstract

Admitted surgical patients increasingly use patient portals for real-time result and note viewing in the wake of the 21st Century Cures Act. As patient data accessibility expands, understanding patient portal use in the inpatient setting can inform surgeon-patient communication and new strategies for patient engagement. To examine the proportion of surgical patients who logged into, viewed results in, or viewed notes in the patient portal while admitted, and secondarily to compare patient characteristics associated with portal use. Retrospective cross-sectional study of hospitalized adult patients (aged ≥18 years) who underwent a surgical operation during their admission between April 5, 2019, and April 4, 2024, at a single large academic quaternary care referral center. Data analysis was performed from November 5, 2024, to March 25, 2025. Immediate note release, starting November 16, 2020, and immediate result release, starting April 5, 2021, to the patient portal. Weekly proportion of admitted patients who accessed the patient portal, defined by logging in, viewing results, or viewing notes. During the study period, there were 58 801 surgical admissions, representing 36 416 unique patients (median [IQR] age, 62 [49-71] years; 31 965 admissions [54%] of men). For 45 000 patient admissions (77%), MyChart was activated prior to admission. Patients logged into MyChart during 28 616 admissions (49%), viewed at least 1 test result in 14 008 admissions (23%), and viewed at least 1 clinical note in 5718 admissions (10%). Immediate result and note release was associated with a 17% (95% credible interval [CrI], 14%-20%) increase in logging in (P = .001), a 35% (95% CrI, 34%-36%) increase in viewing results (P = .001), and a 13% (95% CrI, 13%-14%) increase in viewing notes (P = .001). Models revealed decreased portal use associated with increasing age, Spanish speakers, noncommercial insurance, and self-reported Black and Hispanic race and ethnicity. A substantial and sustained proportion of admitted surgical patients used a patient portal for real-time result and note viewing in the wake of the 21st Century Cures Act, and sociodemographic disparities in portal access mirrored those found in the broader patient portal literature. By understanding patients' portal use, surgeons can leverage data accessibility for better communication of care; further work is needed to investigate patient perceptions around inpatient portal use and to address disparities.