Patients are not accessing their medical records online, according to recent research published in Health Affairs.

Hospitals that are part of a more extensive system saw their patients engage more with online records. That was also the case for teaching and public hospitals, the research says.

But the lowest access rates were for people at hospitals receiving the most in disproportionate share hospital payments and those with a high mix of dual-eligible Medicare and Medicaid patients.

Larger hospitals see an increase in use by patients, but those in areas with less access to computers and the internet were, predictably, least likely to see a positive change.

Despite these differences in populations served, most hospitals give the majority of patients access to their medical information online. Despite this, only 10% of patients access it.

Patient engagement efforts don't appear sufficient for this set of information contained within the record, perhaps because of the delivery system of the data.

These findings are backed up by a paper published by the Office of the National Coordinator for Health IT. It found that more than 70% of hospitals allowed patients to view, download, and transmit their health information online, but two-thirds of hospitals said fewer than a quarter of patients accessed their portals.

The Centers for Medicare and Medicaid Services (CMS) repeatedly highlights patient engagement and encourages patient access to information and ownership of their health issues. Early this year, the Department of Health and Human Services (HHS) released proposed rules to promote interoperability, curb information blocking, and mandate free patient access to electronic records.

"Overall, our findings suggest that policy efforts (by CMS) have failed to engage a large portion of patients in the electronic use of their data or to bridge the 'digital divide' that accompanies health care disparities," the researchers wrote.

The research suggests that an update to the Promoting Interoperability Program might be warranted. Previously known as Meaningful Use, the program decreases requirements for patient use and patient access over time in response to provider complaints, despite its original plan to gradually ramp up milestones.

In August 2019, CMS published the 2020 Medicare Hospital Inpatient Prospective Payment System (PPS) final rule. In the rule, CMS continued its focus on improving interoperability and patient access to health information.

"Our study suggests that a higher threshold for both measures might be more achievable than providers claim and that CMS may wish to reconsider this decision moving forward," the Health Affairs researchers wrote.