With Kara Gavin
In recent years, Americans have grown accustomed to logging into a patient portal via their smartphone or computer to make telehealth appointments with their doctors and health care teams, view prescriptions and lab test results, text their providers and more.
However, one study shows that integrating this technology into many aspects of patient care can have created an unintended barrier to health care access for more than 25 million patients with limited English proficiency.
The study finds that the patient portal login page for many hospitals is not accessible in at least two languages, which may limit access to these important tools for a vulnerable patient population.
The University of Michigan study finds that 29% of hospitals offer access to their patient portal in English only, and another 60% offer it in both English and Spanish. Only 11% offer patient portal access in English, Spanish and another language.
Less than 5% of hospitals offered login prompts on their patient portal in the most common language spoken in their region other than English or Spanish.
The study, published in JAMA Network Open by a team led by Debbie W. Chen, MD, of the UM School of Medicine, also shows that hospitals where new doctors can be trained — called teaching hospitals — were more likely to translate portal login messages into at least one language.
Chen notes that federal policies and legislation, such as Section 1557 of the Affordable Care Act, have been enacted to support meaningful access to health care services for patients with limited English proficiency in hospitals, health systems, clinics and other health care sites that receive federal funding such as Medicare.
This is why translation services are usually offered in such settings, through medical translators in person or digitally connected.
“Many patient portals, and the policies around them, were created long before the COVID-19 pandemic spurred the use of patient portal platforms as essential tools for physicians and other providers to deliver care through virtual visits and secure messaging,” Chen explained.
“My own experience as an endocrinologist using these tools to communicate with my patients, including those with limited English proficiency, inspired this study.”
Chen and her colleagues analyzed the websites of 511 hospitals in 51 counties in 17 states, where census data showed at least 300,000 residents had limited English proficiency. They looked at the language accessibility of patient portal login pages.
“We could only look at the linguistic accessibility of this ‘front door’ to digital health technology in every hospital,” said Chen, who is a clinical assistant professor of internal medicine.
“This study raises an important question: If a patient can’t log into the patient portal, what healthcare services, such as virtual visits and secure messaging with their doctor, are they missing out on, and how might that affect their health?”
He added, “While assessing patients’ ability to log into the portal is an important first step, additional next steps include investigating how user-friendly these platforms are in different languages beyond the login page.”
Even if hospitals haven’t intentionally neglected to offer their patient portal login pages in the languages used by their patient populations, Chen hopes the new study will prompt all hospitals to consider this thorny issue.
“Our findings highlight that there is a need, even if the fix is not straightforward,” he said.
“The number of people in this country who have limited English proficiency is increasing. For many hospitals, patient portals are an important tool through which doctors provide care between appointments, so it’s important to make the portal accessible to all patients.”
He notes that hospitals contracting with Epic MyChart and Cerner for their patient portals were significantly more likely than hospitals using other vendors to offer login commands to their patient portal in two or more languages.
This suggests there is an opportunity for hospitals to work with existing portal vendors to improve non-English language options.
Patients with limited English proficiency face barriers not only when accessing patient portals, but also when seeking care through traditional methods.
Chen’s previous work examined language barriers to accessing cancer care at the hospital operator leveland when trying to schedule a clinic appointment for the first time specialized cancer treatment.
Additional authors: In addition to Chen, study authors are Maya Watanabe, MS. Steven Xie, MD; Hattie H. Huston-Paterson, MD, MSHPM; Mousumi Banerjee, PhD; and Megan R. Haymart, MD. Chen, Banerjee and Haymart are its members UM Institute for Healthcare Policy and Innovation. Chen and Haymart are its members Rogel Cancer Center.
Funding/Disclosures: The study was funded by the National Cancer Institute (K08-CA273047).
Document referred to: “Language barriers and access to US hospital patient portals”, JAMA Network Open. DOI: 10.1001/jamanetworkopen.2025.37864
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Previously Posted at michiganmedicine.org with Creative Commons license
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