168 - Improving Patient Portal Activation Rates for Pediatric Families with Spanish as Preferred Language

Poster Number: 168
Publication Number: 168.2049

Background: Despite patient portals (PP) having significant potential to improve patient engagement, little is known about disparities in PP adoption in pediatrics. Previous studies have described disparities specifically by preferred language, but they primarily focused on adult populations and did not address whether disparities could be associated with portal platform design and patient/staff workflows.

Objective: Our institution-wide quality improvement (QI) initiative aimed to increase PP activation rates for pediatric families with Spanish as their preferred language (PSPL) seeking ambulatory care at Stanford Medicine Children’s Health (SMCH).

Design/Methods: An interdisciplinary team of parents, leaders of the clinical informatics, PP, marketing, digital health, and operations teams led the project. MyChart is the electronic PP associated with our electronic health record (Epic Systems©). We used interviews of stakeholders and quantitative analysis of MyChart activation audit data to develop a multi-faceted approach to improving activations (Figure 1). Data analysis focused on patients (0-21 years old) without prior active MyChart and observed their offer and activation rates September 2020-21. Interventions optimized the MyChart activation user interface and experience (UI/UX) and outgoing activation email/text messages. The primary outcome tracked using statistical process control chart was monthly percentage of PSPL with newly activated MyChart accounts.

Results: Our quantitative retrospective analysis showed that PSPL were less likely to be offered (64.9% vs 82.7%,p < 0.001) and activate (22.7% vs 55.2%,p < 0.001) PP than patients with English as preferred language (PEPL). Specifically, PSPL (20.2%) were offered less codes via Instant Activation (IA i.e email/text, the most effective activation method) compared to PEPL (75.0%,p < 0.001), showing barriers within the IA process. Key MyChart UI/UX changes made in the IA process are highlighted in Figure 2. Our primary outcome metric is shown in Figure 3. Over the first 3 months since implementation, we saw an increase in the mean percentage of PSPL with newly activated MyChart accounts from 42.2% to 50.6% without a rise in number of Helpdesk calls and unanswered Spanish patient messages.

Conclusion(s): Significant disparities in PP activation rates by language are prevalent and associated with the platform interface, previously little explored in pediatrics. Optimizing the platform UI/UX and workflows improved access for PSPL. Next steps include ongoing analysis of our results, optimizing patient orientation experience to PP and staff activation workflows.