P3.A007: Improving Patient Portal Activation In An Inner-City Pediatric Resident Continuity Clinic: Quality Improvement Initiative

Purpose/Objectives: Electronic patient portals have demonstrated increased patient engagement, patient satisfaction, and improved health outcomes. However, studies have shown significant disparities in activation, especially among racial minorities. Identifying and overcoming these barriers to patient portal enrollment will enable our pediatric residents to increase their quality of care.

Design/Methods: Before we began our initiatives, we conducted patient surveys to identify reasons for not enrolling in MyChart (Figure A). The most common response was, “I do not know what MyChart is”, therefore, we designed our interventions around educating and increasing awareness of the benefits of patient portals. Over the course of 18 weeks, we implemented four PDSA Cycles: (1) Posters in the Waiting Room (2) Receptionist Recruitment (3) Provider Postcards & (4) Clinic Day Competition.

Results: For PDSA 1, we designed posters for the waiting room that highlighted the most utilized MyChart features from our survey, which resulted in an average activation rate of 47.7%. For PDSA 2, we trained our receptionists to teach about MyChart during every check-in, which yielded an increased enrollment rate of 48.6%. However, the receptionists believed this intervention created too much additional workload for the front staff. Consequently, for PDSA 3, we designed postcards to be distributed by medical providers in the exam room. During this cycle, the average enrollment rate decreased to 43.2% but we learned that the residents were not motivated to hand out the postcards. To incentivize the residents, we created a competition between the five continuity clinic days for PDSA 4, which resulted in an increased average of 44.4%. During the cycle, we observed that even if the patients were persuaded by the provider to enroll in MyChart, they still needed to go to reception to receive the activation code, which proved to be an additional barrier. During our 18-week study period, our clinic saw 1,807 patients, 67% of whom were Black/African American, and resulted in an overall MyChart activation rate of 46.0%.

Conclusion/Discussion: Overall, our QI initiative achieved our intended goal. PDSA 1 & 2 yielded the highest average activation rates, highlighting the effectiveness of enrolling patients during the registration process in the waiting room. PDSA 3 & 4 had a more modest increase from baseline but were more so designed to alleviate the burden from the receptionists. Our future PDSA cycle would be to grant both receptionists & physicians the ability to generate the MyChart activation codes. In conclusion, all staff members (both medical & nonmedical) need to be aligned and motivated to increase patient portal activation.