3 ways to improve patient portal enrollment


Patient portals have the potential to create a more personalized healthcare experience for consumers, especially during the coronavirus pandemic.

Patients can privately message physicians through the portal, ask questions, and improve access to their medical data. And portals provide them with tools to help them remain actively engaged in their care.

Portals offer a lot.

The problem is, patients just aren’t using them — at least not as much as they could be. A large-scale study published in the journal Health Affairs found that 63% of insured adults who had visited a doctor in the previous year hadn’t logged in to the portal during that time frame. The study pinned this on a lack of physician, health system, and insurer engagement in promoting it. Nearly 40 percent of patients surveyed said portal enrollment hadn’t been offered to them.

And some patients said they preferred face-to-face communication or were concerned with privacy or security. Still, others didn’t fully understand why they needed to use a portal.

Identifying the barriers to adoption is the first step toward crafting strategies improving patient portal use. The second is adopting strategies to overcome those challenges. Here are the top three:

Send portal invitations via text message

Texting has become one of the most widely used forms of communication — even among older adults. It is fast, efficient, and inexpensive. And it has an impressive reach, with as many as 98 percent of text messages read within three minutes of receipt.

Sending a portal invitation via text message could inform patients who don’t know about the portal and provide a convenient way to sign up.

In 2016, Cedars-Sinai wanted to increase MyChart patient portal enrollment so that patients had greater access to their data and could verify their information and fill out their health histories online before arriving at a clinic or hospital.

“We wanted our patients’ health information to be more accessible to them,” said Ramin Rasoulian, a lead applications specialist for the enterprise.

The health system had tried using email to send an activation key, instead of a paper handout, but it wasn’t seeing much improvement. Since Cedars was already using WELL to send out text reminders, they sent the portal activation link through a text message along with the patient’s regular appointment reminder.

“We were struggling with how to create strategies around the activation, and this was one that really stood out,” Rasoulian said.

WELL allowed Cedars to identify which patients weren’t currently enrolled in MyChart and only send the messages to that group.

Within five months of implementing the new system, enrollment increased by 19 percent overall, with some clinics seeing as high as 67 percent increases in enrollment. Overall, texting portal invitations generated a positive response, improved utilization, and even shifted attitudes.

“The narrative has shifted,” Rasoulian said. Referring to texting’s ability to improve administrative processes, he said, “It’s naturally part of your workflow. It just immensely improves it.”

Provide in-person help with portal activation

Even for young, tech savvy patients, a little help enrolling in the patient portal goes a long way.

In a study published by the Journal of Adolescent Health, MyChart staff approached 96 adolescent patients in an urban primary care clinic. They offered to help patients sign up for and download the portal program. More than 87 percent of participants enrolled in MyChart and 79 percent of participants reported being “satisfied” or “very satisfied” with the program. They also agreed that using an electronic health record app is necessary and valuable.

Did most of these patients actually need the help downloading the app? Probably not. But the personal contact may have provided that final push to get them to activate and use the app.

In another study, nurses at a large health system offered to help patients sign up for the portal after rooming. A total of 1,628 patients participated in the study, and more than a third were already enrolled. After four weeks, enrollment increased 10 percent. After eight weeks — and adding educational sessions for nurses — enrollment increased by a total of 15 percent, resulting in 86 new patient enrollments.

But new enrollments weren’t the only positive effect of assisted sign-ups. Participating nurses found that when patients use the portal, their workload decreased. And overall patient engagement increased — a win for all.

Offer patient portal education

One reason patients may not want to engage with portals is lack of understanding in how to use them. Just as healthcare systems and physicians are more likely to adopt the EHR when trained and educated, patients may also be more likely to activate and use portals with instruction and educational resources.

A study published in 2019 evaluated the impact of an e-learning platform on older adults with chronic conditions. Researchers looked at whether the intervention could improve portal adoption, knowledge, selected health outcomes, patient portal self efficacy and use, and e-health literacy in older adults

“Lack of support for older adults using PPs remains a critical gap in most implementation processes,” researchers said.

After four months, patients in the group that used the online learning platform used the portal more often. They also showed higher levels of self-efficacy with the portal. That means they developed the ability to achieve their own goals or desired outcomes using the technology.

Online courses, training videos, and other educational material could help effectively encourage more patients to engage with portals. For patients with chronic illness, this could be a game-changer. It could help them to manage their conditions more effectively with valuable new resources. It could also offer tools to help them follow treatment plans, make appointments, and communicate with doctors.

WELL improves portal enrollment

Whether your goal is to provide another channel for secure messaging, improve access to patient data, or offer virtual care, WELL can help coordinate patient portal enrollment. ♥

4 Ways Texting Can Improve Patient Outcomes


Texting is the preferred form of communication for the majority of American adults.

Text messages are good for more than just sending beach selfies and telling your lunch date you’re running late. Texting in healthcare serves as an effective method for patient communication and can even improve patient outcomes.

Recent research backs it up. Texting can reduce no-shows and hospital readmission rates. It can also improve medication adherence and provide addiction support. Texting has a wide array of use-cases to improve patient outcomes. Here are the top four:

Reduce no-show rates

When patients miss appointments, their health suffers.

For example, for patients with diabetes, missed appointments are associated with reduced blood sugar control. No-shows also correlate to higher emergency department and hospital care and up to a 60 percent higher readmission rate. For patients on hemodialysis, a missed appointment may increase the risk for ending up in the hospital again or even dying.

Texting appointment reminders is a simple, cost-effective strategy for reminding patients to come to their appointments. Eisenhower Health in Southern California reduced its no-show rate by 71 percent after implementing WELL’s appointment reminders and bidirectional texting. Even the health system’s high senior population embraced texting.

These results illustrate the potential of appointment reminders to increase appointment attendance and improve patient outcomes.

Reduce hospital readmissions

Showing up for scheduled appointments is a good thing. Being readmitted to the hospital, not so much. Texting has the potential to reduce hospital readmissions, too.

A trial published in journal ESC Heart Failure evaluated whether text messaging would reduce readmission and death rates in patients with chronic heart failure.

Researchers randomized 762 patients to receive SMS, structured telephone support (STS), or usual care after they left the hospital.

At 180 days after initial discharge, patients who had received follow-up text messages and structured telephone support were nine percent less likely to be readmitted. Additionally, they were 10 percent more likely to take prescribed medications.

Provide addiction support

Text messaging may also support people recovering from substance abuse or addiction. In one study, youth who had finished treatment for substance abuse disorders received text messages providing feedback, support, and reminders. The messages encouraged them to engage in extracurricular activities. And the messages prompted teens to seek self-help to support the recovery process and prevent relapse.

The study found that after 90 days, extracurricular activities increased and participants saw lower rates of relapse. Researchers concluded that mobile approaches may be effective for increasing adherence to a wide-array of behaviors associated with recovery.

Text messaging might also be useful in helping people quit smoking. In Norway, a group of 4,378 patients in a virtual smoking cessation program received surveys via text messages to help them quit smoking. Six months after they quit, more 21 percent of participants had responded, and 11 percent reported that they had been cigarette free for seven days. It might not sound impressive, but that’s roughly 57 percent higher than the average success rate for quitting smoking.

Help patients manage their health

Diabetes can be tough to manage. People have to personally monitor their blood sugar levels, change their diet, and take medication consistently.

A study published in JMIR Diabetes found that text messaging may provide a practical solution.  It found that diabetes patients who received text messages encouraging them to self-report their data were more likely to see drops in their glucose levels.

Patients received daily reminders to report their blood glucose data. If the levels were too high, care managers received a message by email, text, or through the EHR. After that, providers received appropriate data to develop a follow-up plan.

After four months using this system, patients with HbA1c level of over 8 percent saw a drop of -1.15 percent.

Clear, effective communication — whatever the medium — improves outcomes

Texting provides another outlet for patient engagement. And it can improve outcomes across a wide swath of conditions and patient demographics.

Ultimately, patients need to be informed and empowered. And they need to receive the resources they need to succeed. These include regular communication with their provider, self-management tools, and resources to help them take care of their health on a daily basis. Text messaging is an efficient, cost-effective solution for improving patient outcomes. ♥

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