303 - Implementation of EHR portal enrollment services through a pediatric urgent care clinic

Publication Number: 303.5193

David M. Gordon, University of California San Francisco, San Francisco, CA, United States; Quynh Nguyen, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Tonia Vega, ZSFGH, San Francisco, CA, United States; Taylor Clark, University of California, San Francisco, School of Medicine, San Francisco, CA, United States

Background: EHR portals facilitate patient-provider communication, access to health information, and appointment scheduling. Few studies have explored enrollment in the acute care setting.

Objective: Increase the fraction of visits by eligible patients (VEPs) during which portal enrollment is completed to 50% at a pediatric urgent care clinic (PUC).

Design/Methods: Our PUC began offering portal enrollment services to health network patients in October 2023. Provider training, tipsheets, workstation placards, and EHR prompts were introduced in November 2023. An in-person patient navigator was assigned to portal enrollment one day per week in February 2024. A medical assistant (MA) was assigned to portal enrollment daily in April 2024. The fraction of VEPs during which portal enrollment was initiated (patients age 0-11, for whom proxy enrollment though a guardian is required) or completed (patients age ≥ 12) was plotted in P-type statistical process control charts. Declinations were recorded. Staff-initiated safety reports and patient grievances were monitored for enrollment content. Data were shared monthly at provider meetings. In a post-hoc analysis, predictors of enrollment were identified with logistic regression.

Results: Of the 10,347 visits to our PUC, 3333 (32.21%) were by eligible patients. Of VEPs, 395 (11.85%) resulted in enrollment and 9 ( < 0.01%) resulted in declination. Provider- and navigator-facing interventions did not affect enrollment. The addition of a dedicated MA increased enrollment from 4.1% to 34.9%. No safety reports or grievances related to enrollment were filed. Visits by patients age ≥ 12 years (adjusted OR 2.07, 95% CI 1.27 – 3.36) and visits occurring during the dedicated MA period (12.73, 9.25 – 17.51) were more likely to result in enrollment. Visits by males (1.06, 0.82-1.37), Black-identifying patients (0.61, 0.31 – 1.21), patients preferring English (1.37, 0.95 – 1.96), and patients empaneled for primary care at our co-located clinic (1.11, 0.85 – 1.46) were not associated with enrollment.

Conclusion(s): Our PUC-based portal enrollment program increased enrollment but did not achieve target performance. The introduction of a dedicated MA was associated with large-magnitude improvements. Enrollment declinations were rare and no safety events were reported. Apart from age ≥ 12 years (for which enrollment is less complex), enrollment was not associated with demographic covariates. Portal enrollment may be possible during acute care visits, but additional investigation is required at similar sites to determine replicability.

P chart, percent of visits by eligible patients resulting in EHR portal enrollment, ZSFG PUC, October 2023 - July 2024
Portal.spc.pdfEHR=electronic health record; ZSFG=Zuckerberg San Francisco General Hospital, PUC=pediatric urgent care; UCL=upper control limit; LCL=lower control limit; CL=center line; MA=medical assistant

Predictors of EHR patient portal enrollment at ZSFG PUC, October 2023 - July 2024 (n=3333)
Portal.regression.pdfEHR = electronic health record; ZSFG = Zuckerberg San Francisco General Hospital; PUC = pediatric urgent care; CHC = Children's Health Center; MA = medical assistant
*Standard error adjusted for 144 clusters by provider
ǁPatients age 0-11 years require proxy enrollment, during which the caregiver applies for access to the child's account through their own EHR portal. The process is initiated during the visit but access may not be granted for up to 2 weeks afterward. Enrollment for this age group was considered complete if proxy access was activated within 2 weeks of the PUC visit. Patients age ≥ 12 years are enrolled directly during the visit.
ƚp < 0.001

P chart, percent of visits by eligible patients resulting in EHR portal enrollment, ZSFG PUC, October 2023 - July 2024
Portal.spc.pdfEHR=electronic health record; ZSFG=Zuckerberg San Francisco General Hospital, PUC=pediatric urgent care; UCL=upper control limit; LCL=lower control limit; CL=center line; MA=medical assistant

Predictors of EHR patient portal enrollment at ZSFG PUC, October 2023 - July 2024 (n=3333)
Portal.regression.pdfEHR = electronic health record; ZSFG = Zuckerberg San Francisco General Hospital; PUC = pediatric urgent care; CHC = Children's Health Center; MA = medical assistant
*Standard error adjusted for 144 clusters by provider
ǁPatients age 0-11 years require proxy enrollment, during which the caregiver applies for access to the child's account through their own EHR portal. The process is initiated during the visit but access may not be granted for up to 2 weeks afterward. Enrollment for this age group was considered complete if proxy access was activated within 2 weeks of the PUC visit. Patients age ≥ 12 years are enrolled directly during the visit.
ƚp < 0.001