Researchers with the University of Michigan made headlines in October for a study highlighting a persistent gap in health equity: Only a small fraction of U.S. hospital patient portals are accessible in multiple languages. The majority English-only options underscore a critical reminder for hospitals – and for journalists covering health access – that digital health tools often fail to meet the needs of linguistically diverse populations.
Key findings
For the study, published in JAMA Network Open, researchers analyzed the websites of 511 hospitals in 51 counties in 17 states where data from the U.S. Census Bureau indicated that at least 300,000 residents had limited English proficiency. In fall 2024, they reviewed the language accessibility of the patient portal login pages.
About 90% of U.S. hospitals offer patient portals, but research suggests that while only 70% of patients receive access, just 34% regularly use the portal to view, download or transmit their health information.
This latest study mirrors that trend, suggesting that language may be one of the greatest barriers to health information. Journalists covering health IT and health equity should consider patient accessibility when writing about electronic health records and portals. We list some suggested story angles at the end of this post.
English and Spanish most common languages seen in portals
At 150 hospitals in the study (29% of the sample), patient portals were accessible only in English, and at 305 hospitals (nearly 60% of the sample), patient portals were accessible only in English and Spanish. What’s worse, just 24 hospitals (4.7%) offered portal access in the most common language spoken in their area that wasn’t English or Spanish. Patient portals were accessible in English, Spanish and at least one additional language at just 56 hospitals, or about 11% of the sample size. The other languages included were Arabic, Chinese, Bengali, Creole, French, Korean, Polish, Portuguese, Russian and Turkish.
Further analyses showed that teaching hospitals were more than twice as likely to offer portals with multilingual accessibility compared with nonteaching hospitals, while hospitals that used commercial electronic health record vendors other than Epic’s MyChart or Cerner had lower odds.
In other nuances, states with higher employment of interpreters and/or translators had a higher proportion of hospitals with portals accessible in at least two languages, as were a higher proportion of government-owned and nonprofit hospitals.
Multilingual options needed for messaging health care teams
As digital health care continues to evolve, the authors said, “prioritizing language accessibility in its design is essential to ensure inclusivity for all patients.”
Most hospitals described on their websites the option for patients to communicate with their health care teams through secure portal messaging, a trend that has been growing since the peak COVID-19 pandemic. There already have been some barriers to this technology including challenges with digital literacy and broadband access, and offering this option in a nonpreferred language only compounds the problem.
Since the first bilingual English and Spanish portal was introduced in 2011, the U.S. population has grown more linguistically diverse, the authors wrote. Today, more than 41 million individuals speak Spanish and more than 26 million individuals speak a language other than English or Spanish.
“Achieving equitable health care access will require an intentional redesign of patient portals to support meaningful engagement…beginning with multilingual accessibility at the portal login page,” they said. At a minimum, if a portal is not offered in a preferred language, there should be an option to call and speak with an interpreter to help facilitate scheduling appointments or to translate live during telehealth appointments. That piece was not assessed in the study.
Other common languages can vary by region
More than one in five people — 22% — speaks a language other than English at home, according to data released earlier this year by the U.S. Census Bureau. The information revealed that among speakers of other languages, 61% spoke Spanish and 78% spoke an Indo-European language such as Spanish, German, French and Italian. To be fair, 62% of people who spoke these languages also reported they spoke English “very well.”
As could be expected, some of the languages varied by region, the data found. For example, in Maine and Vermont, French was the most common language other than English. In Hawaii, the Philippine language Iloko was the most common language other than English, followed by Tagalog and Japanese. A native North American language mostly spoken by American Indians was in the top 15 languages in nine states. Tables provided by the Census Bureau break down language use for 42 languages and among all 50 states.
Story ideas
There are various ways journalists could continue to follow this story:
- Localize it – See what hospitals in your area are doing. Interview patients who speak other languages to note their experience with patient portals.
- Pursue the tech angle – What commercial electronic health record vendors offer translation to other languages? For homegrown systems, are translators available to help? Besides patient portals, are other remote monitoring tools being offered in additional languages besides English?
- Pursue the research angle – What are other investigators finding? For example, a quick internet search led to this study from earlier this year by researchers at Kaiser Permanente, finding that Latino and Chinese adults with limited English proficiency were less likely than those with greater English proficiency to have a portal account, to have sent secure messages to their physicians, and to access digital tools.
Resources
- Language Barriers and Access to Hospital Patient Portals in the US – JAMA Network Open
- Language barriers in health care have fallen – but not online, study shows – News release about the study from the University of Michigan
- New Data on Detailed Languages Spoken at Home and the Ability to Speak English – News release from the U.S. Census Bureau
