Language Barriers and Access to Hospital Patient Portals in the US

Importance Although patient portals are becoming important tools in health care delivery, there is a lack of published data on the language accessibility of these digital platforms. Objective To examine the language accessibility of hospitals’ patient portals. Design, Setting, and Participants This cross-sectional study identified 51 counties in the 17 US states (5 western states, 2 midwestern, 4 northeastern, and 6 southern) with at least 300 000 residents with limited English proficiency. From eligible hospitals with public-facing patient portal platforms, the following data were obtained between September and December 2024: the URL (uniform resource locator) and language accessibility of the patient portal (ie, of the login prompts), portal vendor, and whether the availability of secure portal messaging was explicitly described. Main Outcomes and Measures The primary outcome was language accessibility of the portal login page (binary variable: only English vs in at least 2 languages). Multivariable logistic regression analysis was performed to determine factors associated with accessibility of the portal login page in at least 2 languages. Results Among 514 eligible hospitals (194 38.0% in West census region), 511 (99.4%) had public-facing patient portal platforms and were thus included in the analytic cohort; 429 (84.0%) were nonteaching hospitals. Patient portals were accessible in only English at 150 hospitals (29.4%); in English and Spanish only at 305 hospitals (59.7%); and in English, Spanish, and at least 1 additional language at 56 hospitals (10.9%). Only 24 of the 511 hospitals (4.7%) offered portal access in the most common non-English, non-Spanish language of their respective counties. In multivariable logistic regression analysis, teaching hospitals had higher odds of offering portals with multilingual accessibility (odds ratio OR, 2.21; 95% CI, 1.66-2.95) compared with nonteaching hospitals, while hospitals that used vendors other than Epic MyChart or Cerner had lower odds (OR 0.34; 95% CI, 0.24-0.48 vs Epic). Conclusions and Relevance In this cross-sectional study of hospitals in 17 states, only a small proportion offered patient portals that were accessible in a non-English, non-Spanish language. As digital health care continues to evolve, prioritizing language accessibility in its design is essential to ensure inclusivity for all patients.