EPIC patient portal adoption among vulnerable oncology patients in the era of oral anticancer medications.

593 Background: The use of the patient portal functionality in the electronic health record (EHR) has led to improved patient satisfaction and provides an alternative channel for patient-care team communication. However, the adoption of the patient portal is not equitable across age, race, ethnicity, and health literacy groups. Enhancements in the EHR mirror the recent evolution of cancer therapy delivery, such as the widespread use of oral anticancer medications (OAMs). Because of decreased direct clinical contact, patients on OAM benefit from enhanced communication provided by patient portal messaging. We characterized patient portal signup and messaging use among vulnerable oncology patients identified as having newly initiated an OAM during the study period, highlighting areas to improve patient portal adoption and thus patient communication with their oncology care teams. Methods: We conducted a retrospective analysis of patients newly initiated on an OAM at Tufts Medical Center between October 1, 2022 and March 31, 2024. Vulnerability was defined as meeting at least one of the following criteria: age≥75 years; non-English language; or subsidized insurance (Medicaid only or Medicare with Medicaid as a secondary insurance). Active portal use was defined as having at least one message in the portal; meaningful use was defined as patient-provider bidirectional messaging. Portal messaging proxy use was determined by message content screening. Fisher’s exact test evaluated the impact of vulnerability on portal signup rate. Logistic regressions were performed to identify factors associated with portal signup and meaningful use. Results: Among the study population of 280 patients who were newly initiated on OAM, 56% patients met the vulnerability criteria: 20% by age≥75 years, 26% by non-English language, and 30% by subsidized insurance. Among the non-English speakers, the most common language spoken was a Chinese dialect (75%). Medicaid-only was the more common insurance (57%), compared to Medicare with Medicaid as a secondary among patients with subsidized insurance. While the overall portal signup rate was 74%, it was 64% among vulnerable patients vs. 87% in non-vulnerable patients (P<0.0001). Non-English language was associated with lower rate of portal signup (P<0.0001), but none of the vulnerable characteristics was associated with decreased meaningful use once signup was accomplished. Messaging by proxy was found in 17% of vulnerable vs 2.8% of non-vulnerable patients who signed up for portal. OAM mention in portal content analysis was low at 31% among patients who signed up. Conclusions: While patient portal signup was lower among vulnerable patients, once adopted, vulnerable patients demonstrated comparable meaningful use and greater proxy engagement. Patient portal adoption requires a targeted approach with patient navigation and patient proxy, focusing on the signup stage.