Background: Digital health (patient portals, remote monitoring devices, video visits) is a routine part of healthcare, though the digital divide may affect access.

Objective: To test and validate an electronic health record (EHR) screening tool to identify patients at risk of the digital divide.

Materials and Methods: We conducted a retrospective EHR data extraction and cross-sectional survey of participants within one healthcare system. We identified 4 potential digital divide markers from the EHR: 1) mobile phone number, 2) email address, 3) active patient portal, and 4) >2 patient portal logins in the last year. We mailed surveys to patients at higher risk (missing all four markers), intermediate risk (missing 1-3 markers) or lower risk (missing no markers). Combining EHR and survey data, we summarized the markers into risk scores and evaluated its association with patients’ report of lack of Internet access. Then, we assessed the association of EHR markers and eHealth Literacy Scale survey outcomes.

Results: 249 patients (39.4%) completed the survey (53% > 65 years, 51% female, 50% minority race, 55% rural/small town residents, 46% private insurance, 45% Medicare). Individually, the four EHR markers had high sensitivity (range 81-95%) and specificity (range 65-79%) compared with survey responses. The EHR-marker-based score (high, intermediate, low risk) predicted absence of Internet access (ROC c-statistic = 0.77). Mean digital health literacy scores significantly decreased as EHR-marker digital divide risk increased (p<0.001).

Conclusion: Using these markers, healthcare systems could target interventions and implementation strategies to support equitable patient access to digital health.