This research suggests that enrollment “might be a critical step in getting patients access to their information,” said Sumi Sinha, MD, a resident at UCSF and lead author of the JAMA Oncology study.

Although the study did not explore the barriers that kept patients from enrolling, Dr Hong noted that many of their patients do not have computers and smart phones, and they generally may not feel comfortable using the technology. The researchers are currently trying to ease enrollment by allowing patients, or their care proxy, to enroll during the visit. The researchers are also working on translating the portal into more languages.

The findings do not come as a surprise, but they do highlight the need to reduce barriers, according to Traber Davis Giardina, PhD, MSW, assistant professor of medicine at Baylor College of Medicine and researcher at the Michael E. DeBakey VA Medical Center in Houston, who was not involved in the UCSF study.

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Dr Giardina said research suggests that interventions designed to train patients on portal use, either in person or online, may be effective.2

“It makes me sad to think that we have this technology that has the possibility [to give patients more knowledge] and that Black patients and older patients are getting left behind,” said Dr Giardina, whose research focuses on whether patient portal use may reduce diagnostic errors and improve patient safety.

There has been very little research exploring whether patient portal use is associated with better clinical outcomes for patients with cancer, particularly because it is difficult to know exactly which outcomes to assess, Dr Hong explained. However, a 2018 study suggested that the types and frequency of messages that breast cancer patients send their providers through the portal may predict their risk of discontinuing hormonal therapy.5

Dr Giardina said there is evidence that using the portal — for reasons such as viewing their provider’s notes from the visit — may make patients feel more involved in their care in general.6

“It is encouraging that you could leverage health IT to help people feel more engaged in their care,” she added.


  1. Sinha S, Garriga M, Naik N, et al. Disparities in electronic health record patient portal enrollment among oncology patients. JAMA Oncol. Published online April 8, 2021. doi:10.1001/jamaoncol.2021.0540
  2. Grossman LV, Masterson Creber RM, Benda NC, Wright D, Vawdrey DK, Ancker JS. Interventions to increase patient portal use in vulnerable populations: a systematic review. J Am Med Inform Assoc. 2019;26(8-9):855-870. doi:10.1093/jamia/ocz023
  3. Gerber DE, Laccetti AL, Chen B, et al. Predictors and intensity of online access to electronic medical records among patients with cancer. J Oncol Pract. 2014;10(5):e307-312.  doi:10.1200/JOP.2013.001347
  4. Goel MS, Brown TL, Williams A, Hasnain-Wynia R, Thompon JA, Baker DW. Disparities in enrollment and use of an electronic patient portal. J Gen Intern Med. 2011;26(10):1112-1116. doi:10.1007/s11606-011-1728-3
  5. Yin Z, Harrell M, Warner JL, et al. The therapy is making me sick: how online portal communications between breast cancer patients and physicians indicate medication discontinuation. J Am Med Inform Assoc. 2018;25(11):1444-1451. doi:10.1093/jamia/ocy118
  6. Gerard M, Chimowitz H, Fossa A, et al. The importance of visit notes on patient portals for engaging less educated or nonwhite patients: Survey study. J Med Internet Res. 2018;20(5):e191. doi:10.2196/jmir.9196