Finding Meaning in Meaningful Use: Implementing a Patient Portal in an Urban Safety Net Academic Hospital

Shobha Sadasivaiah, MD, MPH*; Stephen Kiyoi, MLIS, MS HAIL, AHIP; Neda Ratanawongsa, MD, MPH and Courtney R Lyles, PhD, University of California San Francisco/ San Francisco General Hospital, San Francisco, CA

Meeting: Hospital Medicine 2016

Abstract number: 299

Categories: Innovations Abstracts, Technology in Hospital Medicine

Keywords: , , ,

Background: Driven by meaningful use (MU) incentives, many safety net systems have adopted patient portals, which offer patients online access to their health information. Portal use correlates with increased engagement and better health outcomes, but there are many challenges to effectively engage patients and meet MU metrics in safety net settings.

Purpose: We implemented a patient portal at an urban safety net academic medical center serving 40% patients with limited health literacy and 45% who speak English as a second language. Our multidisciplinary patient engagement workgroup included the following stakeholders: staff, clinicians, medical library, information technology, and researchers, with outreach to patient advisory boards. This group developed a comprehensive enrollment workflow and training strategy to improve hospitalized patient engagement in a resource-poor setting while also meeting meaningful use metrics.

Description: Our patient portal was launched in February 2015. We developed brochures in English, Spanish, Chinese, Russian, Vietnamese, and Tagalog and posted English-only instructional videos on the health network website. Our library coordinated groups of 2-5 local university students as volunteer Health Technology Educators for a 100-hour, 8-week rotation to educate and enroll patients, including facilitated first logins. In October 2015, nursing integrated into the admission workflow a 1-item assessment of portal interest to enhance patient engagement through clinical care team support.

During the first six weeks of the integrated nursing assessment, nurses asked 1235 (98%) patients admitted to medical/surgical units about portal interest. Of those, 514 (42%) reported portal interest. Reasons for decline were: not interested (49%), no ability to use computers/no access to computers (25%), non-English speaking (10%), physically/mentally unable (8%), did not want to say (8%).
Since February 2015, volunteers have approached 2128 total patients, spending an average of 8.5 minutes with each interested patient who was available to enroll immediately and issued 645 (30%) patients electronic access.  Of those 645, 277 (43%) logged into the portal. Not all patients could be approached during their hospital stay due to clinical interruptions or lack of an available volunteer.  This intensive outreach required 1540 volunteer hours and 0.5 FTE of library staff.

Conclusions: Significant proportions of patients expressed interest in portal access, but they required substantial, resource intensive volunteer assistance to complete the process. Safety net systems serving diverse populations may have difficulty achieving MU metrics given the usability of vendor portals and security requirements. Our portal workgroup is using A3 processes to improve patient engagement and is developing a portal curriculum tailored to limited literacy patients, funded by the National Library of Medicine.

To cite this abstract:

Sadasivaiah S, Kiyoi S, Ratanawongsa N, Lyles CR. Finding Meaning in Meaningful Use: Implementing a Patient Portal in an Urban Safety Net Academic Hospital [abstract]. Journal of Hospital Medicine. 2016; 11 (suppl 1). http://www.shmabstracts.com/abstract/finding-meaning-in-meaningful-use-implementing-a-patient-portal-in-an-urban-safety-net-academic-hospital/. Accessed July 27, 2017.

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