Background/Purpose: Patient portals provide patients and caregivers the opportunity to be more engaged in their healthcare, as it promotes autonomy and encourages patients and caregivers to take an active role in their care. The adoption of patient portals in the pediatric population compared to the adult population is complex as healthcare providers need to balance the privacy of the patient whilst providing information access to the caregiver. Since the implementation of an electronic medical record system at our pediatric institution in 2018, the enrollment and activation of patients/caregivers profiles to the patient portal has been low. The objectives of this quality improvement project were a) to double the patient/caregiver enrollment and activation of the patient portal profiles from the baseline rate over one-year period; b) to understand barriers to enrollment and activation; and c) to identify and create systems to facilitate enrollment and activation of the patient portal.

Methods: Iterative Plan-Do-Study-Act (PDSA) cycles were used to create culture change amongst the healthcare team to promote increased patient portal enrollment and activation. Strategies were initially launched with the quality improvement team champions and were later spread to other members of the healthcare team. Results from the PDSA cycles were reviewed and shared with the healthcare team on regular intervals. Feedback from the team were used to inform each successive iterative cycle.

Results: Strategies employed during PDSA cycles that were directed at the healthcare team included educational sessions, pre-clinic identification of patients with inactive profiles, reminders within the electronic medical record, email reminders, and weekly updates. Strategies targeted to patients/caregivers in PDSA cycles included the creation of patient/caregiver activation instructions, and placement of the registration link in email signatures of healthcare team members, after visit summaries, and appointment reminder emails.
The combined strategies increased enrollment and activation from the baseline rate of 15% to 41% over a one-year period. Using a multi-pronged strategy, which informed patients about the opportunity to enroll at various points of contact with the clinic, created a redundancy mechanism that also facilitated enrollment. Barriers to enrollment and activation included patients/caregivers not activating their profile within the eligible period, patient/caregivers not wanting to enroll due to privacy concerns, healthcare team forgetting to offer enrollment, activation emails being misdirected to patients’/caregivers’ spam, and the need for patients to re-enroll at ages 12 and 16.

Conclusion: Strategic planning and education of stakeholders are important in the implementation of new programs. Designing small changes that stakeholders are willing to adopt into their daily routine also facilitates this process. Helping stakeholders understand the benefit of patient portal access augmented their willingness to assist enrolling patients/caregivers. Similarly, patients/caregivers were eager to enroll after understanding the functionalities of the application.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/a-multifaceted-approach-to-increasing-enrollment-and-activation-of-pediatric-rheumatology-patient-portal-profiles/