Thursday, December 18, 2014

How Can Non-English Speaking Patients 'Meaningfully Use' Patient Portals?

By Neda Ratanawongsa, MD, MPH

 “For Spanish press 1, for Cantonese press 2, for Mandarin press 3, for Taishanese press 4, for Vietnamese press 5 …” 

My exam room phone doesn’t have enough buttons for all the languages I need to serve my patients.   In a typical clinic session, I use an interpreter for half of my clinic visits and phone calls to patients.   It is this amazing linguistic and cultural diversity that drew me to be a primary care provider at the General Medicine Clinic.

But as Chief Medical Informatics Officer for the outpatient electronic health record, I desperately need your help. We are rolling out our patient portal – MYSFHEALTH – to all of SFHN’s primary care, specialty care, and hospital patients.  Patient portals offer tremendous benefits to patients, improving access to their own health information, promoting engagement in their health, and facilitating adherence to medications.  Diverse patients want to use health information technology to access their health records and communicate with their health care teams. However, multiple studies have found disparities in portal enrollment or use by race/ethnicity, age, gender, educational attainment, and health literacy.  (Many thanks to GIM colleagues Urmimala Sarkar and Courtney Lyles for their work in this area!)

Surprisingly, there is a dearth of resources or research about how to make portals more accessible to non-English speaking patients. In San Francisco, 45% of households speak a primary language other than English: 19% Cantonese or Mandarin, 12% Spanish, 3% Tagalog, and the remainder a mix of Russian, French, Vietnamese, Korean, and other languages.  Because it is so crucial to offer health care in a patients’ preferred language, SFHN prioritizes providing both health care and health education across our populations’ key languages. 

Unfortunately, across the U.S, patient portals are not available to most patients who are non-English speaking; to my knowledge, there are only a handful of patient portals in Spanish and only one offering Chinese languages.  This will prove an enormous barrier to engaging a large proportion of SFHN patients, even though many of these patients do use the Internet via computers and/or mobile devices. 

The Centers for Medicare & Medicaid Services (CMS) defines the goals for achieving “Meaningful Use” with electronic health records. For clinic providers and hospitals to meet Stage 2 criteria, we need to enroll 50% of our patients with the patient portal and have 5% actually log in to the portal. 

But most importantly, I want to reduce disparities in patient portal access and engagement for our patients.  When health information technology is designed to be linguistically and culturally concordant, it has tremendous potential to engage non-English speaking patients to promote self-care and quality of life.   Patient portals could be powerful tools to improve the health and health care of all safety net patients.

Given the realities of the English-language portal we now have, we are working to allow patients to designate proxies to help access their patient portal records. This requires detailed education and consent to ensure that patients truly understand what sensitive information may be contained in their online health records.

Please let me know what you think would help engage diverse patient populations on our patient portal and portals in other safety net health systems.  Whether you are a patient, a loved one, or part of a health care team, I would love to hear your thoughts!  Post comments below or tweet me @ratanawongsa or @BlogHealthEquit 


  1. We have a large Native American patient population in Northern Arizona. There are not a lot of patients with computers and internet access on the reservation where they live. One of the strategies that our heart and vascular clinic came up with was having a volunteer from the hospital right there in the outpatient clinic waiting room to sign up patients for the portal and have the patient send a portal message to their provider. The next time the patient comes in, the volunteer assists the patient with their portal if they want to use it again.

    Wouldn't a patient portal Kiosk be a great idea? I mean they exist for check ins...why not the portal?

    I think this will really benefit those patients when the ACO portal comes along. We will be able to assist them with all their needs throughout the community and hopefully improve their health and minimize the risk of inpatient admissions.

    1. Thanks for the feedback, Kandice. Yes, we are also thinking about volunteer help and kiosks at SFGH - but would love to hear what works best for you in terms of long-term but cost-effective patient engagement in the coming months.

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