To access, purchase, authenticate, or subscribe to the full-text of this article, please visit this link: http://dx.doi.org/10.1016/j.hlpt.2016.11.004 Byline: Jessica S. Ancker [firstname.lastname@example.org] (a,*), Sarah Nosal (b), Diane Hauser (b), Christopher Way (a), Neil Calman (b) Keywords Personal health record; Health information technology; Health disparities; Chronic illness; Socioeconomic status Highlights * Patient access to medical records may help them understand their health and manage their healthcare. * An opt-in policy for medical record access was associated with large socioeconomic disparities between those who did and did not access their medical records. * Replacing the opt-in policy with a universal access policy nearly eliminated these disparities over 4 years. Abstract Background Patient access to medical records may help them manage their healthcare. After socioeconomic disparities were found in early adoption of a patient portal, a safety net medical organization implemented universal access policies, a mobile portal app, and a Spanish version. The objective of this study was to estimate the effect of the changes on socioeconomic disparities in use of the patient portal. Methods Retrospective cohort study of 129,738 adult patients visiting the Institute for Family Health between 2011 and 2014. Logistic regression was used to model the odds of receiving portal access and using the portal. Results In 2011, members of socioeconomically disadvantaged groups were less likely to receive offers to use the portal and subsequently to use it. In 2014, black patients became just as likely as other racial groups to use the portal, but publicly insured and uninsured patients were still less likely to become users. Uptake of the mobile app was slow. Conclusions Replacing an opt-in policy with a universal access policy was associated with a large reduction in socioeconomic disparities between those who did and did not access their medical records. However, a small digital divide remained evident in use of the technology, probably due to structural factors beyond the control of the healthcare system such as lack of computer access by less affluent patients. Author Affiliation: (a) Weill Cornell Medical College, Division of Health Informatics, Department of Healthcare Policy and Research, New York, NY, USA (b) Institute for Family Health and Mount Sinai Icahn School of Medicine, Department of Family Medicine, New York, NY, USA * Correspondence to: 425 E. 61st St., Suite 301, New York, NY 10065, USA. Fax: +1 646 962 0105.