Background: Patient portals are increasingly used to support digital health engagement,
but little is known about how caregivers used patient portals before, during, and
after the COVID-19 pandemic.
Objectives: To examine longitudinal changes in caregiver engagement with pediatric
patient portals, focusing on logins, session duration, messaging behaviors, and provider
response times across pre-pandemic, pandemic, and post-pandemic periods.
Methods: We conducted a retrospective cohort study using de-identified MyChart data
from caregivers of children aged 0 through 11 who received care at four pediatric
primary care clinics in the Southeastern U.S. between March 2018 and March 2023. Generalized
linear models were used to compare portal engagement across pre-pandemic, pandemic,
and post-pandemic periods. Outcomes included login frequency, session duration, message
volume, message types and recipients, and provider response times, all normalized
per user per year.
Results: Among 478 caregivers, portal logins and session duration increased significantly
during and post-pandemic, with 16-fold increases post-pandemic compared to pre-pandemic
(p < 0.001). Message volume declined substantially during the pandemic (p < 0.001)
but returned to baseline levels. Provider response times shortened during the pandemic
and remained lower than pre-pandemic levels (p = 0.032). Messaging to primary care
declined and did not recover fully, while specialty care messaging increased across
all periods. Appointment and medical advice messages declined during the pandemic,
with only the latter rebounding. Customer service inquiries rose significantly and
remained elevated, and medication renewal messages increased markedly post-pandemic.
Conclusions: The COVID-19 pandemic initiated lasting changes in caregivers' engagement
with pediatric patient portals, including deeper engagement, quicker provider responses,
and shifts in messaging patterns. Findings can be used to guide and optimize caregiver-centered
digital health strategies in pediatrics. Future work should explore potential provider
burnout from increased portal workload, incorporate multicenter studies, and link
portal use to clinical characteristics to better inform digital health interventions.
