• Ilana Graetz, Jie Huang, Richard J Brand, John Hsu, Cyrus K Yamin, and Mary E Reed.
• University of Tennessee Health Science Center, 66 N Pauline St, Ste 620, Memphis, TN 38163. Email: igraetz@uthsc.edu.
• Am J Manag Care. 2018 Jan 1; 24 (1): 434843-48.

ObjectivesSome patients lack regular computer access and experience a digital divide that causes them to miss internet-based health innovations. The diffusion of smartphones has increased internet access across the socioeconomic spectrum, and increasing the channels through which patients can access their personal health records (PHRs) could help bridge the divide in PHR use. We examined PHR use through a computer-based Web browser or mobile device.Study DesignCross-sectional historical cohort analysis.MethodsAmong adult patients in the diabetes registry of an integrated healthcare delivery system, we studied the devices used to access their PHR during 2016.ResultsAmong 267,208 patients with diabetes, 68.1% used the PHR in 2016; 60.6% of all log-ins were via computer and 39.4% were via mobile device. Overall, 63.9% used it from both a computer and mobile device, 29.6% used only a computer, and 6.5% used only a mobile device. After adjustment, patients who were black, Hispanic, or Asian; lived in lower socioeconomic status (SES) neighborhoods; or had lower engagement were all significantly more likely to use the PHR only from a mobile device (P <.05). Patients using the PHR only via mobile device used it less frequently.ConclusionsMobile-ready PHRs may increase access among patients facing a digital divide in computer use, disproportionately reaching racial/ethnic minorities and lower SES patients. Nonetheless, even with a mobile-optimized and app-accessible PHR, differences in PHR use by race/ethnicity and SES remain. Continued efforts are needed to increase equitable access to PHRs among patients with chronic conditions.

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