{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:58:01Z","timestamp":1782842281267,"version":"3.54.5"},"reference-count":27,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Mhealth Uhealth"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec sec-type=\"background\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The COVID-19 pandemic accelerated telemedicine and mobile app use, potentially changing our historic model of maternity care. MyChart is a widely adopted mobile app used in health care settings specifically for its role in facilitating communication between health care providers and patients with its messaging function in a secure patient portal. However, previous studies analyzing portal use in obstetric populations have demonstrated significant sociodemographic disparities in portal enrollment and messaging, specifically showing that patients who have a low income and are non-Hispanic Black, Hispanic, and uninsured are less likely to use patient portals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"objective\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>The study aimed to estimate changes in patient portal use and intensity in prenatal care before and during the pandemic period and to identify sociodemographic and clinical disparities that continued during the pandemic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"methods\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This retrospective cohort study used electronic medical record (EMR) and administrative data from our health system\u2019s Enterprise Data Warehouse. Records were obtained for the first pregnancy episode of all patients who received antenatal care at 8 academically affiliated practices and delivered at a large urban academic medical center from January 1, 2018, to July 22, 2021, in Chicago, Illinois. All patients were aged 18 years or older and attended \u22653 clinical encounters during pregnancy at the practices that used the EMR portal. Patients were categorized by the number of secure messages sent during pregnancy as nonusers or as infrequent (\u22645 messages), moderate (6-14 messages), or frequent (\u226515 messages) users. Monthly portal use and intensity rates were computed over 43 months from 2018 to 2021 before, during, and after the COVID-19 pandemic shutdown. A logistic regression model was estimated to identify patient sociodemographic and clinical subgroups with the highest portal nonuse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 12,380 patients, 2681 (21.7%) never used the portal, and 2680 (21.6%), 3754 (30.3%), and 3265 (26.4%) were infrequent, moderate, and frequent users, respectively. Portal use and intensity increased significantly over the study period, particularly after the pandemic. The number of nonusing patients decreased between 2018 and 2021, from 996 of 3522 (28.3%) in 2018 to only 227 of 1743 (13%) in the first 7 months of 2021. Conversely, the number of patients with 15 or more messages doubled, from 642 of 3522 (18.2%) in 2018 to 654 of 1743 (37.5%) in 2021. The youngest patients, non-Hispanic Black and Hispanic patients, and, particularly, non\u2013English-speaking patients had significantly higher odds of continued nonuse. Patients with preexisting comorbidities, hypertensive disorders of pregnancy, diabetes, and a history of mental health conditions were all significantly associated with higher portal use and intensity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Reducing disparities in messaging use will require outreach and assistance to low-use patient groups, including education addressing health literacy and encouraging appropriate and effective use of messaging.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2196\/51637","type":"journal-article","created":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T09:28:22Z","timestamp":1701422902000},"page":"e51637-e51637","source":"Crossref","is-referenced-by-count":11,"title":["Use of Electronic Patient Messaging by Pregnant Patients Receiving Prenatal Care at an Academic Health System: Retrospective Cohort Study"],"prefix":"10.2196","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7070-9160","authenticated-orcid":false,"given":"Kai","family":"Holder","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3665-8897","authenticated-orcid":false,"given":"Joe","family":"Feinglass","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4044-5763","authenticated-orcid":false,"given":"Charlotte","family":"Niznik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6274-0544","authenticated-orcid":false,"given":"Lynn M","family":"Yee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2024,4,29]]},"reference":[{"issue":"11","key":"R1","doi-asserted-by":"publisher","first-page":"623","DOI":"10.1016\/j.jcjq.2020.08.007","article-title":"Using electronic health record and administrative data to analyze maternal and neonatal delivery complications","volume":"46","author":"Huennekens","journal-title":"Jt Comm J Qual Patient Saf"},{"issue":"1 Pt 2","key":"R2","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1111\/1475-6773.12134","article-title":"The Medicare electronic health record incentive program: provider performance on core and menu measures","volume":"49","author":"Wright","journal-title":"Health Serv Res"},{"issue":"6","key":"R3","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.4255","article-title":"Patient portals and patient engagement: a state of the science review","volume":"17","author":"Irizarry","journal-title":"J Med Internet Res"},{"issue":"5","key":"R4","doi-asserted-by":"publisher","first-page":"683","DOI":"10.1197\/jamia.M3169","article-title":"Disparities in use of a personal health record in a managed care organization","volume":"16","author":"Roblin","journal-title":"J Am Med Inform Assoc"},{"issue":"3","key":"R5","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1097\/AOG.0000000000004276","article-title":"Ensuring equitable implementation of telemedicine in perinatal care","volume":"137","author":"Ukoha","journal-title":"Obstet Gynecol"},{"issue":"9","key":"R6","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1089\/tmj.2015.0207","article-title":"Secure messaging in electronic health records and its impact on diabetes clinical outcomes: a systematic review","volume":"22","author":"Kuo","journal-title":"Telemed J E Health"},{"issue":"2","key":"R7","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.3171","article-title":"The effect of patient portals on quality outcomes and its implications to meaningful use: a systematic review","volume":"17","author":"Kruse","journal-title":"J Med Internet Res"},{"key":"R8","doi-asserted-by":"crossref","unstructured":"Goldzweig CL Towfigh AA Paige NM et al. 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