Providing Beyond Clinic Hours: A Single-center Analysis of Patient Portal Communication in Pediatric Orthopaedic Care.
BACKGROUND: Patient portals are an increasingly common tool for patient-provider communication not only improving access for patients but also creating a significant workload for providers. However, their utilization in pediatric orthopaedics remains unclear. This study aims to quantify the clinical workload and identify sociodemographic disparities associated with patient portal messages in a pediatric orthopaedic practice. METHODS: This retrospective cohort study analyzed patient portal messages in the electronic medical record (EMR) from a single, tertiary academic hospital between August 1, 2023, and June, 30, 2025. We examined message volume and frequency in relation to patient demographics, including race, ethnicity, and primary language to identify patterns of utilization. Patients were included if they had a documented in-person or telephone- or message-based encounter. Descriptive statistics were used to summarize the patient (i.e., and family) cohort and trends in EMR use over time. Multivariable logistic and linear regressions were used to evaluate associations between messaging and patient-level characteristics. RESULTS: A total of 12,346 patient portal messages were sent during the study period, with 24% of the entire patient cohort (n = 7,790) sending medical advice messages, averaging 10 messages per patient. Patients/families of Hispanic/Latino ethnicity (odds ratio [OR]: 0.69, P = .007), Black race (OR: 0.54, P < .001), Asian race (OR: 0.64, P = .007), and those with a primary language of Spanish (OR: 0.21, P < .001) had significantly lower odds of sending a message than White, non-Hispanic/Latino, and English-speaking counterparts. These groups, along with male patients/families, also sent a significantly lower volume of messages. Having a documented telephone call was associated with increased message volume (β = 6.8, P < .001), whereas in-person visits were associated with decreased volume (β = -2.3, P < .001). CONCLUSIONS: Patient portals in pediatric orthopaedics create a dual challenge of unsustainable provider workload and inequitable patient/family utilization. The high volume of uncompensated work may contribute to provider burnout, while the digital divide may worsen existing health disparities. Addressing these issues requires systemic solutions, including fair reimbursement models and targeted strategies to ensure equitable EMR access for all families. KEY CONCEPTS: (1)This study quantifies the clinical workload and identifies sociodemographic disparities associated with over 12,000 patient portal messages in a pediatric orthopaedic practice.(2)A small subgroup of patients (24%) accounted for all messages, creating a significant and uncompensated workload for providers that may contribute to burnout.(3)Significant disparities in portal use were found, with Hispanic/Latino, Black, Asian, and Spanish-speaking families being far less likely to send messages than their White, English-speaking counterparts.(4)The language barrier proved to be the most significant factor for digital disengagement, with Spanish-speaking families having nearly 80% lower odds of sending a portal message than English-speaking families.(5)The combination of high provider workload (i.e., the number of messages) and inequitable patient access creates a dual challenge where patient portals may simultaneously risk provider burnout and worsen health disparities. LEVEL OF EVIDENCE: III, Retrospective Cohort Study.
