Validating the Effectiveness of the Patient-Centered Cancer Care Framework by Assessing the Impact of Work System Factors on Patient-Centered Care and Quality of Care: Interview Study With Newly Diagnosed Cancer Patients.

BACKGROUND: Patients with cancer who have recently been diagnosed have distinct requirements compared to cancer survivors. It is crucial to take into account their unique needs to ensure that they make informed decisions and are receptive to the care provided. OBJECTIVE: This study suggested a framework titled Effectiveness of Patient-Centered Cancer Care that considers the needs of newly diagnosed patients with cancer and related work system factors. This study investigated how work system factors influence the perceptions of patient-centered care, quality of care, and associated outcomes among newly diagnosed patients with cancer. Patient-centered care is defined in terms of workload and communication considerations, whereas the quality of care is assessed through indicators such as trust in physicians, satisfaction with care, and perceptions of technology. METHODS: This study used qualitative data collected through interviews with newly diagnosed patients with cancer (N=20) right after their first visits with their physicians. Thematic analysis was conducted to validate the 5 hypotheses of the framework, mapping the interactions among quality of care, patient-centered care, and work system factors. RESULTS: We found that workload and patient-centered communication impact the quality of care and that the work system elements impact the patient-centeredness (workload and communication) and the quality of care (trust in physicians, satisfaction with care, and perception of technology use). CONCLUSIONS: Qualitatively validating the proposed Effectiveness of Patient-Centered Cancer Care framework, this study demonstrated its efficacy in elucidating the interplay of various factors. The framework holds promise for informing interventions geared toward enhancing patients' experiences during their initial visits after diagnosis. There is a pressing need for heightened attention to the organizational design, patient processes, and collaborative efforts among diverse stakeholders and providers to optimize the overall patient experience.

Corrigendum: Acceptance, initial trust formation, and human biases in artificial intelligence: focus on clinicians.

[This corrects the article DOI: 10.3389/fdgth.2022.966174.].

Exploring factors influencing user perspective of ChatGPT as a technology that assists in healthcare decision making: A cross sectional survey study.

As ChatGPT emerges as a potential ally in healthcare decision-making, it is imperative to investigate how users leverage and perceive it. The repurposing of technology is innovative but brings risks, especially since AI's effectiveness depends on the data it's fed. In healthcare, ChatGPT might provide sound advice based on current medical knowledge, which could turn into misinformation if its data sources later include erroneous information. Our study assesses user perceptions of ChatGPT, particularly of those who used ChatGPT for healthcare-related queries. By examining factors such as competence, reliability, transparency, trustworthiness, security, and persuasiveness of ChatGPT, the research aimed to understand how users rely on ChatGPT for health-related decision-making. A web-based survey was distributed to U.S. adults using ChatGPT at least once a month. Bayesian Linear Regression was used to understand how much ChatGPT aids in informed decision-making. This analysis was conducted on subsets of respondents, both those who used ChatGPT for healthcare decisions and those who did not. Qualitative data from open-ended questions were analyzed using content analysis, with thematic coding to extract public opinions on urban environmental policies. Six hundred and seven individuals responded to the survey. Respondents were distributed across 306 US cities of which 20 participants were from rural cities. Of all the respondents, 44 used ChatGPT for health-related queries and decision-making. In the healthcare context, the most effective model highlights 'Competent + Trustworthy + ChatGPT for healthcare queries', underscoring the critical importance of perceived competence and trustworthiness specifically in the realm of healthcare applications of ChatGPT. On the other hand, the non-healthcare context reveals a broader spectrum of influential factors in its best model, which includes 'Trustworthy + Secure + Benefits outweigh risks + Satisfaction + Willing to take decisions + Intent to use + Persuasive'. In conclusion our study findings suggest a clear demarcation in user expectations and requirements from AI systems based on the context of their use. We advocate for a balanced approach where technological advancement and user readiness are harmonized.

Health Information Technology Supporting Adherence Memory Disorder Patients: A Systematic Literature Review.

BACKGROUND: People with memory disorders have difficulty adhering to treatments. With technological advances, it remains important to investigate the potential of health information technology (HIT) in supporting medication adherence among them. OBJECTIVES: This review investigates the role of HIT in supporting adherence to medication and therapies among patients with memory issues. It also captures the factors that impact technology adherence interventions. METHODS: We searched the literature for relevant publications published until March 15, 2023, using technology to support adherence among patients with memory issues (dementia, Alzheimer's, amnesia, mild cognitive impairment, memory loss, etc.). The review was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We conducted a quality assessment of the papers following the Mixed Methods Appraisal Tool. RESULTS: Fifteen studies were included after carefully reviewing the 3,773 articles in the search. Methodological quality, as appraised, ranged from 80 to 100% with eight studies rated 100%. The studies overall did not have a high risk of bias. Thus, all of the 15 studies were included. Technologies investigated were classified into four groups based on their impact: therapeutic patient education, simplifying treatment regimens, early follow-up visits and short-term treatment goals, and reminder programs. Different technologies were used (automatic drug dispensers or boxes, mobile health-based interventions, game-based interventions, e-health-based interventions, patient portals, and virtual reality). The factors impacting patients' adherence to technology-based treatment and medication were clustered into human-computer interaction and integration challenges. CONCLUSION: This study contributes to the literature by classifying the technologies that supported medication adherence among patients with memory issues in four groups. It also explores and presents the possible limitations of existing solutions to drive future research in supporting care for people with memory disorders.

The health information technology preferences and perceptions of newly diagnosed patients with cancer.

BACKGROUND & GOALS: Patients with new cancer diagnoses have unique needs. In this study, we explored the technological needs and preferences of new cancer patients and the challenges to technology use among these patients. METHODS: We used qualitative data from semi-structured interviews to identify the new cancer patients' technology preferences. Interviews were recorded and then transcribed verbatim. A thematic analysis was conducted to identify the technology perceptions of new cancer patients, their technology needs, and the challenges of technology. RESULTS: Most of the patients preferred mhealth technologies over other types of technologies to be used in their care management. The primary needs related to potential features in these technologies include access to information just in time, convenience, access to home care, self-management, privacy, interaction, and personalization. Patients also reported challenges of current technologies they utilized, including usability, impersonality, interoperability, and cost-effectiveness. CONCLUSION: Addressing patients' needs to increase uptake and efficient use of technologies in cancer care is critical. Growing clinical and consumer informatics technologies can potentially help cancer management if designed by employing user-centered approaches.

Supporting patients' workload through wearable devices and mobile health applications, a systematic literature review.

Patients face a challenging workload in their course of care. In this study, we investigate the impact of using mobile health technologies in supporting this workload and identify the system challenges of its application through a systematic review of the literature published in the last two decades following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Reviews and Meta-Analysis guidelines PRISMA guidelines. Twenty-two studies that satisfied the inclusion criteria were included. The review revealed various mobile health and wearable devices used to support mental demand, physical demand, frustration, and performance. Better outcomes were related to mobile health use in healthcare for patients in different settings. There were no applications of health that supported the temporal demand of patients. Some populations, such as cancer patients, need more than only physical demand. Mhealth devices are important in supporting the patients' workload in their daily activities and clinical settings.Practitioner summary: This review study shows the importance of mHealth and wearables in supporting patients' workload (physical, mental, emotional) but not the temporal load.

Perceived Patient Workload and Its Impact on Outcomes During New Cancer Patient Visits: Analysis of a Convenience Sample.

BACKGROUND: Studies exploring the workload in health care focus on the doctors' perspectives. The ecology of the health care environment is critical and different for doctors and patients. OBJECTIVE: In this study, we explore the patient workload among newly diagnosed patients with cancer during their first visit and its impact on the patient's perceptions of the quality of care (their trust in their doctors, their satisfaction with the care visits, their perception of technology use). METHODS: We collected data from the Hackensack Meridian Health, John Theurer Cancer Center between February 2021 and May 2022. The technology use considered during the visit is related to doctors' use of electronic health records. A total of 135 participants were included in the study. Most participants were 50-64 years old (n=91, 67.41%). A majority (n=81, 60%) of them were White, and only (n=16, 11.85%) went to graduate schools. RESULTS: The findings captured the significant effect of overall workload on trust in doctors and perception of health IT use within the visits. On the other hand, the overall workload did not impact patients' satisfaction during the visit. A total of 80% (n=108) of patients experienced an overall high level of workload. Despite almost 55% (n=75) of them experiencing a high mental load, 71.1% (n=96) reported low levels of effort, 89% (n=120) experienced low time pressure, 85.2% (n=115) experienced low frustration levels, and 69.6% (n=94) experienced low physical activity. The more overall workload patients felt, the less they trusted their doctors (odds ratio [OR] 0.059, 95% CI 0.001-2.34; P=.007). Low trust was also associated with the demanding mental tasks in the visits (OR 0.055, 95% CI 0.002-2.64; P<.001), the physical load (OR 0.194, 95% CI 0.004-4.23; P<.001), the time load (OR 0.183, 95% CI 0.02-2.35; P=.046) the effort needed to cope with the environment (OR 0.163, 95% CI 0.05-1.69; P<.001), and the frustration levels (OR 0.323, 95% CI 0.04-2.55; P=.03). The patients' perceptions of electronic health record use during the visit were negatively impacted by the overall workload experienced by the patients (OR 0.315, 95% CI 0.08-6.35; P=.01) and the high frustration level experienced (OR 0.111, 95% CI 0.015-3.75; P<.001). CONCLUSIONS: The study's findings established pathways for future research and have implications for cancer patients' workload. Better technology design and use can minimize perceived workload, which might contribute to the trust relationship between doctors and patients in this critical environment. Future human factors work needs to explore the workload and driving factors in longitudinal studies and assess whether these workloads might contribute to unintended patient outcomes and medical errors.

The role of digital health in supporting cancer patients' mental health and psychological well-being for a better quality of life: A systematic literature review.

BACKGROUND: This work aims to evaluate the role of digital health in supporting the mental and psychological well-being of patients with cancer and identify the associated challenges of use and implementation. METHODS: Eligibility criteria: We included peer-reviewed studies (quantitative/qualitative) published between January 2011 and July 2022, that are written in English using technology to support cancer patients' mental health. We excluded opinion papers, editorials, and commentaries. INFORMATION SOURCES: The systematic review was conducted across ProQuest CENTRAL, Scopus, PubMed, PsycInfo, Web Of Science, and IEEE Xplore. The study selection followed the Preferred Reporting Items for Systematic Reviews, meta-Analysis Reviews, and meta-Analysis guidelines (PRISMA). Risk of bias: All screening steps followed a consensus between the authors to minimize bias or discrepancy. Synthesis of the results: Data were extracted following the Six-factor Model of Psychological Well-being (SMPW). The technology challenges are summarized following the Systems Engineering Initiative for Patient Safety model (SEIPS), focusing on design, impact on processes, and outcomes. RESULTS: We included 25 studies satisfying our inclusion criteria. The studies had little interest in minorities and sociodemographic factors' assessment within their results. The review showed that mental health and psychological well-being tools cover many applications. In addition to allowing personal growth, digital health can help cancer patients gain more autonomy and self-acceptance. Moreover, these health technologies can aid in mastering the environment, shaping social relationships, and pursuing life goals. Many challenges were identified related to the environment, organization, users, and tasks. DISCUSSION: Digital health applications for cancer care cover a broad spectrum of mental health interventions. Challenges warrant analyzing the needs and usability. Lessons learned during COVID-19 may help refine technology interventions for mental health in cancer care. More interest in minorities is needed when designing technologies for patients to ensure more access to equitable care.

The Impact of Patient-Centered Care on Cancer Patients' QOC, Self-Efficacy, and Trust Towards Doctors: Analysis of a National Survey.

Patient-centered approaches impact cancer patients' perceptions and outcomes in different ways. This study explores the impact of patient-centered care practices on cancer patients' quality-of-care (QOC), self-efficacy, and trust in their doctors. We utilized cross-sectional national survey data from the National Cancer Institute collected between 2017 and 2020. All estimates were weighted using the jackknife method. We used multivariable logistic regression to test our hypotheses adjusted for the demographics of the 1932 cancer patients that responded to the survey. Findings indicate that patient-centered communication resulted in better QOC, self-efficacy, and trust in doctors. In addition, engagement in their care improved patients' trust in cancer-related information received from doctors. QOC and patients' trust in doctors were significantly improved with the patients' understanding of the next steps, addressing feelings, clear explanation of the problems, spending enough time with the clinicians, addressing uncertainty, and involvement in decisions. Patients who were given a chance to ask questions were significantly more likely to trust their doctors. Technology use did not impact any of these interactions. Patient-centered strategies should consider the needs of the patients in the cancer settings to improve overall outcomes. Organizations should also build strategies that are goal-oriented and centered around the patients' needs, as standard strategies cannot induce the wanted results.

Exploring Predictors of Social Media Use for Health and Wellness during COVID-19 among Adults in the US: A Social Cognitive Theory Application.

During COVID-19, SM media was relied upon for health-related information-seeking and activity support. This study uses the social cognitive theory (SCT) and a representative dataset of the population in the US to explore the factors influencing patients' perceptions of SM for health-related activities. As per SCT, consolidated factors comprised personal factors (sociodemographic, health perception, self-efficacy) and environmental factors (social isolation, purpose in life). Multivariate logistic regression analysis was conducted. Among the 6252 respondents, 95.15% rarely use SM to share personal health-related information, and 90.44% rarely use it to share general health-related information. Older individuals and Whites are less likely to consider SM for healthcare decisions. Education levels influence SM's perceived reliability. Those with positive health perceptions find SM more suitable for healthcare discussions. Socially-isolated individuals are less likely to use SM for healthcare. Those with a strong sense of purpose are less inclined to trust it for health decisions and may question its accuracy. SM-based interventions should address sociodemographic differences. Our findings contribute to the literature by SCT relevance validation in identifying the antecedents of SM use in healthcare. Our results also help to understand the challenges to its adoption. This can help enhance SM-based communication strategies and interventions.

Digital Twins for Managing Health Care Systems: Rapid Literature Review.

BACKGROUND: Although most digital twin (DT) applications for health care have emerged in precision medicine, DTs can potentially support the overall health care process. DTs (twinned systems, processes, and products) can be used to optimize flows, improve performance, improve health outcomes, and improve the experiences of patients, doctors, and other stakeholders with minimal risk. OBJECTIVE: This paper aims to review applications of DT systems, products, and processes as well as analyze the potential of these applications for improving health care management and the challenges associated with this emerging technology. METHODS: We performed a rapid review of the literature and reported available studies on DTs and their applications in health care management. We searched 5 databases for studies published between January 2002 and January 2022 and included peer-reviewed studies written in English. We excluded studies reporting DT usage to support health care practice (organ transplant, precision medicine, etc). Studies were analyzed based on their contribution toward DT technology to improve user experience in health care from human factors and systems engineering perspectives, accounting for the type of impact (product, process, or performance/system level). Challenges related to the adoption of DTs were also summarized. RESULTS: The DT-related studies aimed at managing health care systems have been growing over time from 0 studies in 2002 to 17 in 2022, with 7 published in 2021 (N=17 studies). The findings reported on applications categorized by DT type (system: n=8; process: n=5; product: n=4) and their contributions or functions. We identified 4 main functions of DTs in health care management including safety management (n=3), information management (n=2), health management and well-being promotion (n=3), and operational control (n=9). DTs used in health care systems management have the potential to avoid unintended or unexpected harm to people during the provision of health care processes. They also can help identify crisis-related threats to a system and control the impacts. In addition, DTs ensure privacy, security, and real-time information access to all stakeholders. Furthermore, they are beneficial in empowering self-care abilities by enabling health management practices and providing high system efficiency levels by ensuring that health care facilities run smoothly and offer high-quality care to every patient. CONCLUSIONS: The use of DTs for health care systems management is an emerging topic. This can be seen in the limited literature supporting this technology. However, DTs are increasingly being used to ensure patient safety and well-being in an organized system. Thus, further studies aiming to address the challenges of health care systems challenges and improve their performance should investigate the potential of DT technology. In addition, such technologies should embed human factors and ergonomics principles to ensure better design and more successful impact on patient and doctor experiences.

Predictors of Healthcare Professionals' Work Difficulty Perception during the COVID-19 Pandemic: Study of Work Environment in a Pandemic Hospital.

COVID-19 has dramatically changed the work environment in healthcare, which is creating an additional burden for healthcare professionals. In this study, we investigate the factors that trigger professionals to have negative perceptions of their jobs during the pandemic. A cross-sectional survey is used for this study. The respondents are selected based on convenience random sampling. We use 345 questionaries for the analysis. Respondents are health care professionals (nurses, doctors, midwives, technicians, etc.) working in a pandemic hospital in Turkey. We run a multivariable logistic regression model to analyze the predictors of work difficulty perception. The model is adjusted for the respondents' demographical characteristics and emotional wellbeing. We found that depression and burnout are significantly correlated with the perception of job difficulty (OR Severe PHQ-9 = 10.8, p = 0.004; OR Severe Burnout = 7.83, p < 0.001). The professionals who are changed from one department to another are also more likely to perceive the job as difficult (OR Department Change = 1.60, p = 0.045). However, the professionals that received sufficient applause from society are more likely to think that they did not face any difficulties doing their job during the pandemic (OR Applause = 0.56, p < 0.016). Anxiety, monetary motivation, religious beliefs, and information availability did not contribute to the perceived difficulty in their jobs. Thus, efforts need to be made to give them more social support and smooth their changes in departments and functions to facilitate their jobs.

Anxiety, Burnout and Depression, Psychological Well-Being as Predictor of Healthcare Professionals' Turnover during the COVID-19 Pandemic: Study in a Pandemic Hospital.

Turnover of healthcare professionals' is a rapidly growing human resource issue that affects healthcare systems. During the COVID-19 pandemic, healthcare professionals have faced stressful situations that have negatively impacted their psychological health. In this study, we explored impacts of the emotional wellbeing of healthcare professionals on their intention to quit their jobs. A cross-sectional survey design was used for this study. The respondents were selected based on simple random sampling. In total, 345 questionaries were returned and used for the analysis. Respondents were healthcare professionals (nurses, doctors, midwives, technicians, etc.) working in a pandemic hospital in Turkey. A multivariable logistic regression model was used to predict the emotions that encouraged the respondents to intend to quit their jobs. Emotions including anxiety, burnout, and depression were measured using validated scales. We found that the COVID-19 situation increased the turnover intention, especially among doctors and nurses (ORnurse/midwife = 22.28 (2.78-41.25), p = 0.01; ORdoctors = 18.13 (2.22-2.27), p = 0.01) mediating the emotional pressure it was putting them under. Anxiety related to work-pressure and burnout especially were the main emotional predictors of turnover intention. The more severe the anxiety was, the more the professional considered quitting (ORmoderate = 18.96 (6.75-137.69), p = 0.005; ORsevere = 37.94 (2.46-107.40), p = 0.016). Only severe burnout, however, engendered such an intention among them (ORsevere = 13.05 (1.10-33.48), p = 0.000).

Impact of Health Perception and Knowledge on Genetic Testing Decisions Using the Health Belief Model.

PURPOSE: Early detection of cancer risk is essential as it is associated with a higher chance of survival, more successful treatment, and improved quality of life. Genetic testing helps at-risk patients estimate the likelihood of developing cancer in a lifetime. This study aims to indentify the factors (perceived susceptibility, severity, benefits, and self-efficacy) that impact one's decision to take the genetic test. METHODS: We examined the impacts of different factors of the health belief model on the engagement of patients in genetic testing using data from the National Cancer Institute's 2020 cross-sectional nationally representative data published in 2021. Complete surveys were answered by 3,865 participants (weighted population size = 253,815,197). All estimates were weighted to be nationally representative of the US population using the jackknife weighting method for parameter estimation. We used multivariable logistic regression to test our hypotheses for patients who have taken the genetic test for cancer risk detection. We adjusted the multivariate model for age, education, income, race, sex, cancer history, familial cancer history, and education. RESULTS: We tested five hypotheses using the health belief model. Respondents who had genetic testing were more likely to rely on their health care providers and genetic counselors to make their decisions. Respondents who had genetic tests also reported less reliability on other sources than doctors: for the internet and social media (odds ratio = 0.33; P < .001) and for journals and magazines (odds ratio = 0.48; P = .007). CONCLUSION: The findings show that patients generally rely on suggestions from their health care providers and counselors in genetic testing decisions. These findings also indicate that health care providers play a critical role in helping patients decide whether to use genetic testing to detect cancer risk in the early stages.

Using health information technology to support the needs of Children with Medical Complexity: Mapping review of consumer informatics applications.

Background: Children with medical complexity (CMC) are fragile populations that require continuous care and supervision. CMC family caregivers experience many challenges trying to address CMC patients' needs which puts these caregivers in a stressful situation that may negatively impact the care of CMC patients. Consumer informatics might help these caregivers in coordinating care. However, few consumer informatics applications explicitly focus on supporting CMC caregivers' needs. Objective: This systematic mapping literature review aims to provide an overview and a structured understanding of the consumer informatics designed for CMC and their caregivers. Methods: We followed a systematic mapping literature review process to provide an overview of the existing Consumer Informatics literature for CMC, which is the scope of our study. We screened IEEE Xplore, Web of Science, and PubMed databases using a preset list of mesh terms that cover the use of medical informatics by children with medical complexities and their caregivers. The selected articles are peer-reviewed English publications that were empirically validated from January 2002 to January 2022. After selecting and filtering the articles, we analyzed them based on the preset mapping questions using the following criteria: publication year, publication source, research type, contribution type, empirical type, the need addressed, target audience, technology users, and consumer informatics' type. Results: The initial search resulted in a number of (N = 2,275) articles, and 17 selected publications were included. The results showed an increasing interest in CMC consumer informatics publications over time. Most of the studies were published in 2021, and feasibility research is the dominant research type. The most used technology was telehealth and telemedicine, followed by mobile health. The technologies addressed various needs, including; coordination & follow-up, medical safety, education & social support, daily living activities, shared decision making, information seeking, and emotional support. Most of the efforts were focused on ensuring good coordination and follow-up. Conclusions: CMC consumer informatics is a promising research field to present novel initiatives and approaches to manage the caregivers' workload. Future research should be shifted toward providing more evidence-based studies to examine the effectiveness of CMC consumer informatics solutions and identify the related challenges and limitations.

How technology impacts communication between cancer patients and their health care providers: A systematic literature review.

OBJECTIVE: To ensure the well-being of their patients, health care providers (HCPs) are putting more effort into the quality of the communication they provide in oncology clinics. With the emergence of Health Information Technology (HIT), the dynamics between doctors and patients in oncology settings have changed. The purpose of this literature review is to explore and demonstrate how various health information technologies impact doctor-patient communication in oncology settings. METHOD: A systematic literature review was conducted in 4 databases (PubMed, Cochrane, Web of Science, IEEE Xplore) to select publications that are in English, published between January 2009 and September 2020. This review reports outcomes related to the impacts of using health information technologies on doctor-patient communication according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Reviews and Meta-Analysis guidelines (PRISMA). RESULTS: We identified 31 studies which satisfied the selection and eligibility criteria. The review revealed a diverse range of HIT used to support communication between cancer patients and their HCPs in oncology settings. Outcomes related to communication were examined to demonstrate how technology can improve access to care in clinical settings and online. When technology is used effectively to support patient knowledge and shared understanding, this increases the patient's satisfaction and ability to manage emotions, make decisions, and progress in their treatment, in addition to increasing social support and building a stronger therapeutic alliance based on shared knowledge and transparency between clinicians and patients. CONCLUSION: Technology-based solutions can help strengthen the relationship and communication between patients and their doctors. They can empower the patient's well-being, help doctors make better decisions and enhance the therapeutic alliance between them. Thus, using technology to enhance communication in healthcare settings remains beneficial if its use is structured and target oriented. Future studies should focus on comparing in-depth the difference between outpatient and inpatient settings in terms of the efforts required and the extent of the impacts from both clinicians' and cancer patients' perspectives.

Online Medical Record Nonuse Among Patients: Data Analysis Study of the 2019 Health Information National Trends Survey.

BACKGROUND: Online medical records are being used to organize processes in clinical and outpatient settings and to forge doctor-patient communication techniques that build mutual understanding and trust. OBJECTIVE: We aimed to understand the reasons why patients tend to avoid using online medical records and to compare the perceptions that patients have of online medical records based on demographics and cancer diagnosis. METHODS: We used data from the Health Information National Trends Survey Cycle 3, a nationally representative survey, and assessed outcomes using descriptive statistics and chi-square tests. The patients (N=4328) included in the analysis had experienced an outpatient visit within the previous 12 months and had answered the online behavior question regarding their use of online medical records. RESULTS: Patients who were nonusers of online medical records consisted of 58.36% of the sample (2526/4328). The highest nonuser rates were for patients who were Hispanic (460/683, 67.35%), patients who were non-Hispanic Black (434/653, 66.46%), and patients who were older than 65 years (968/1520, 63.6%). Patients older than 65 years were less likely to use online medical records (odds ratio [OR] 1.51, 95% CI 1.24-1.84, P<.001). Patients who were White were more likely to use online medical records than patients who were Black (OR 1.71, 95% CI 1.43-2.05, P<.001) or Hispanic (OR 1.65, 95% CI 1.37-1.98, P<.001). Patients who were diagnosed with cancer were more likely to use online medical records compared to patients with no cancer (OR 1.31, 95% CI 1.11-1.55, 95% CI 1.11-1.55, P=.001). Among nonusers, older patients (≥65 years old) preferred speaking directly to their health care providers (OR 1.76, 95% CI 1.35-2.31, P<.001), were more concerned about privacy issues caused by online medical records (OR 1.79, 95% CI 1.22-2.66, P<.001), and felt uncomfortable using the online medical record systems (OR 10.55, 95% CI 6.06-19.89, P<.001) compared to those aged 18-34 years. Patients who were Black or Hispanic were more concerned about privacy issues (OR 1.42, 1.09-1.84, P=.007). CONCLUSIONS: Studies should consider social factors such as gender, race/ethnicity, and age when monitoring trends in eHealth use to ensure that eHealth use does not induce greater health status and health care disparities between people with different backgrounds and demographic characteristics.