A pioneering EMR-embedded digital health literacy tool reveals healthcare disparities for diverse older adults

Julie Rousseau; Lisa Gibbs; Carlos Garcia-Cabrera; Ava Runge; Christina Palmer; Jigar Haria; Matthew Eichinger; Jung-Ah Lee

doi:10.1111/jgs.18935

A pioneering EMR-embedded digital health literacy tool reveals healthcare disparities for diverse older adults

J Am Geriatr Soc. 2024 Apr 29. doi: 10.1111/jgs.18935. Online ahead of print.

Authors

Julie Rousseau¹, Lisa Gibbs¹, Carlos Garcia-Cabrera², Ava Runge³, Christina Palmer⁴, Jigar Haria⁵, Matthew Eichinger⁵, Jung-Ah Lee⁴

Affiliations

¹ Division of Geriatric Medicine and Gerontology, School of Medicine, University of California, Irvine, Irvine, California, USA.
² Program in Medical Education (PRIME), School of Medicine, University of California, San Diego, San Diego, California, USA.
³ Department of Internal Medicine, School of Medicine, University of California, San Francisco, San Diego, California, USA.
⁴ Sue and Bill Gross School of Nursing, University of California, Irvine, Irvine, California, USA.
⁵ Irvine Health, Information Systems Application, University of California, Irvine, California, USA.

PMID: 38682826
DOI: 10.1111/jgs.18935

Abstract

Background: The COVID-19 pandemic transformed healthcare delivery with the rapid adoption of telehealth and digital technologies to access healthcare. Interventions are needed to ensure that older people in underserved communities do not face new technology-driven healthcare disparities. This article describes pioneering electronic medical record (EMR) embedded tools to assess and support each diverse patient's digital health literacy.

Methods: We designed and validated a rapid EMR-embedded Digital Health Engagement Tool (DHET) to assess each patient's digital literacy in English and Spanish. We built a separate, EMR-generated auto-scoring function to assess patient use of telehealth and healthcare navigation as recorded within the EMR. Combined, the tools created a complete digital literacy assessment for each patient. We then deployed the tools to conduct a pilot study to elucidate disparities.

Results: A total of 112 ethnic/racial diverse older patients were enrolled (mean age was 78, ranging from 57 to 96) years (SD = 8.04). The female participants were 72.3%. Among the participants, non-Hispanic Whites were 47.3%; Hispanic 25.0%; non-Hispanic Asian 19.6%; non-Hispanic others (including multi-race and non-Hispanic Black/African Americans) 8.0%. Digital literacy disparities were revealed for older adults, particularly those over 70 years old, female gender, and those reporting relying on a helper.

Conclusion: New EMR-embedded tools enable healthcare systems to assess the ability of patients to navigate and utilize EMR capabilities, such as video telehealth appointments, messaging providers, reviewing labs/radiology reports, and requesting prescriptions. The study identified significant challenges for older patients in navigating EMRs and calls for healthcare systems to better support patient learning.

Keywords: digital health literacy; electronic medical records; intersectional disparities; older adults.

Grants and funding

U1QHP28724/HRSA/HRSA HHS/United States