Language barriers in health care have fallen – but not online, study shows

In recent years, Americans have gotten used to logging on to a patient portal through their smartphone or computer to have telehealth appointments with their doctors and health care teams, see their prescriptions and lab test results, send messages to their providers, and much more. 

But a new study suggests that the integration of this technology into many aspects of patient care may have created an unintended barrier to healthcare access for the more than 25 million patients with limited English proficiency. 

The study finds that the patient portal login page for many hospitals is not accessible in at least two languages, which may limit access to these important tools for a vulnerable patient population.

The University of Michigan study finds that 29% of hospitals only offer access to their patient portal in English, and another 60% offer it in English and Spanish. Only 11% offer access to the patient portal in English, Spanish and another language.

Less than 5% of the hospitals offered their patient portal login prompts in the most common language spoken in their area that isn’t English or Spanish. 

The study, published in JAMA Network Open by a team led by Debbie W. Chen, M.D., of the U-M Medical School, also shows that hospitals where new physicians can train – called teaching hospitals – were more likely to translate the portal login prompts into at least one language.

Chen notes that federal policies and legislation, such as Section 1557 of the Affordable Care Act, are in place to support meaningful access to healthcare services for patients with limited English proficiency at hospitals, health systems, clinics and other health care locations that accept federal funding such as Medicare. 

That’s why translation services are commonly offered in such settings, through in-person or digitally connected medical translators. 

“Many patient portals, and the policies around them, were created well before the COVID-19 pandemic that spurred the use of patient portal platforms as essential tools for doctors and other providers to deliver care through virtual visits and secure messaging,” explains Chen. “My own experience as an endocrinologist using these tools to communicate with my patients, including those with limited English proficiency, inspired this study.”  

Chen and her colleagues analyzed the websites of 511 hospitals in 51 counties in 17 states where Census data showed that at least 300,000 residents had limited English proficiency. They looked at the language accessibility of the patient portal login pages. 

“We could only examine the language accessibility of this ‘front door’ to digital health technology at each hospital,” said Chen, who is a clinical assistant professor of internal medicine. “This study raises an important question: If a patient cannot log in to the patient portal, what healthcare services, such as virtual visits and secure messaging with their doctor, are they missing out on and how might that impact their health?”

She added, “While evaluating patients’ ability to log in to the portal is an important first step, additional next steps include exploring how user-friendly these platforms are in different languages beyond just the login page.”

Even if hospitals have not deliberately overlooked offering their patient portal login pages in the languages used by their patient populations, Chen hopes the new study will prompt all hospitals to consider this addressable issue.

“Our findings highlight that there is a need, even if the fix isn’t simple,” she said. “The number of people in this country who have limited English proficiency is growing. For many hospitals, patient portals are an important tool through which doctors provide care between appointments, so it is important that we make the portal accessible to all patients.”

She notes that hospitals that contract with Epic MyChart and Cerner for their patient portals were much more likely than hospitals using other vendors to offer their patient portal login prompts in two or more languages. 

This suggests that there is an opportunity for hospitals to work with their existing portal vendors to enhance non-English language options.

Patients with limited English proficiency face barriers not only when accessing patient portals, but also when seeking care through traditional methods. Chen’s previous work has examined language barriers in cancer care access at the level of the hospital operator, and when attempting to schedule a clinic appointment for specialized cancer treatment for the first time.

In addition to Chen, the study’s authors are Maya Watanabe, M.S.; Steven Xie, M.D.; Hattie H. Huston-Paterson, M.D., MSHPM; Mousumi Banerjee, Ph.D.; and Megan R. Haymart, M.D.. Chen, Banerjee and Haymart are members of the U-M Institute for Healthcare Policy and Innovation. Chen, Banerjee and Haymart are members of the Rogel Cancer Center.

The study was funded by the National Cancer Institute (K08-CA273047). 

Language Barriers and Access to Hospital Patient Portals in the US, JAMA Network Open, doi:10.1001/jamanetworkopen.2025.37864