P4A096: Characteristics of Inpatient Pediatric Patients Viewing Shared Notes

Background: One of the mandates of the 21st Century Cures Act was that patients have immediate electronic access to clinician notes. This has led to increased note sharing among providers. This has however not translated to increased access as studies show that only 3-7% of patients actually view their shared notes. The aim of this study was identify specific socio-demographic and clinical characteristics associated with increased note viewing in the pediatric inpatient setting.

Methods: This was a retrospective chart review of hospitalized pediatric patients discharged from the Pediatric Hospital Medicine service of a single health system between January 1 and December 31, 2022. The electronic patient portal used was MyChart (EPIC). Each patient’s discharge summary was used as a proxy for MyChart utilization. Patients had to have MyChart downloaded prior to the hospitalization, as such, infants in the newborn nurseries were excluded. The characteristics compared amongst the two groups were: Age, gender, race, primary language spoken, observation or inpatient admission status, whether the patient spent time in the ICU during hospitalization, insurance status, primary diagnosis, LOS, and discharge location (which of the three hospitals). Continuous and ordinal data was compared using Wilcoxon rank sum tests and categorical characteristics were compared using Chi-square or Fisher’s exact tests.

Results: A total of 3,724 patient charts met inclusion criteria. Of those, 18 (0.5%) of the notes were blocked and 3,706 (99.6%) were shared. Of the 3,706 shared notes, 519 (14%) were viewed and 3,187 (86%) were not viewed. Compared to patients without viewed notes, those with notes viewed were significantly more likely to be younger (median age 22 months vs. 35 months), white (17% vs. 8.3% of black patients and 11% for other race), English speaking (14% vs. 4% of non-English), privately insured (18% vs. 9.7% of publicly insured), and had a primary discharge diagnosis group of common newborn issues (20% vs. 14% for infectious diagnoses, 15% for non-infectious diagnoses, and 3.9 for a primary psych, developmental or eating disorder). Gender, admission status, whether or not patient required ICU-level care, and LOS were all found to have no significant differences.

Conclusion: This was the first study to describe differences in characteristics and demographics among hospitalized pediatric patients’ utilizing, or not utilizing, the electronic patient portal. Despite all patients in this study having the same level of access to MyChart, our findings show disparities continue to exist for patients of minority groups and those with lower socioeconomic status. Future studies are needed to determine causes for disparities in healthcare, as well as strategies to close the gap.