The Impact of the COVID-19 Pandemic on Internet Use and the Use of Digital Health Tools: Secondary Analysis of the 2020 Health Information National Trends Survey.

backgroundThe COVID-19 pandemic increased the use of digital tools in health care (eg, patient portal, telemedicine, and web-based scheduling). Studies have shown that older individuals, racial/ethnic minority groups, or populations with lower educational attainment or income have lower rates of using digital health tools. Digitalization of health care may exacerbate already existing access barriers in these populations.

objectiveThis study evaluated how use of digital tools to asynchronously communicate with clinicians, schedule appointments, and view medical records changed near the beginning of the pandemic.

methodsUsing 2020 Health Information National Trends Survey (HINTS) data, we examined internet use and 7 digital health technology use outcomes (electronic communication with a provider, electronic appointment scheduling, electronic test result viewing, patient portal access, portal use to download health records, portal use for patient-provider communication, and portal use to view test results). The HINTS surveyors designated surveys received after March 11, 2020, as postpandemic responses. Using weighted logistic regression, we investigated the impact of the pandemic after adjusting for sociodemographic traits (age, race/ethnicity, income, education, and gender), digital access (having ever used the internet and smartphone/tablet ownership), and health-related factors (insurance coverage, caregiver status, having a regular provider, and chronic diseases). To explore differences in changes in outcomes among key sociodemographic groups, we tested for significant interaction terms between the pandemic variable and race/ethnicity, age, income, and educational attainment.

resultsThere were 3865 respondents (1437 prepandemic and 2428 postpandemic). Of the 8 outcomes investigated, the pandemic was only significantly associated with higher odds (adjusted odds ratio 1.99, 95% CI 1.18-3.35) of using electronic communication with a provider. There were significant interactions between the pandemic variable and 2 key sociodemographic traits. Relative to the lowest income group (<US $20,000), the highest income group (≥US $75,000) had increased growth in the odds of ever having used the internet in postpandemic responses. Compared to the most educated group (postbaccalaureates), groups with lower educational attainment (high school graduates and bachelor's degree) had lower growth in the odds of using electronic communication with a provider in postpandemic responses. However, individuals with less than a high school degree had similar growth to the postbaccalaureate group in using electronic communication with a provider.

conclusionsOur study did not show a widespread increase in use of digital health tools or increase in disparities in using these tools among less advantaged populations in the early months of the COVID-19 pandemic. Although some advantaged populations reported a greater increase in using the internet or electronic communication with a provider, there were signs that some less advantaged populations also adapted to an increasingly digital health care ecosystem. Future studies are needed to see if these differences remain beyond the initial months of the pandemic.