Catalysts for Change
In our 2018 cycle of Catalyst, clinic staff learned about human-centered design and used these strategies to boost patient engagement with its MyWellness patient portal.
The first step was to create a team of staff members to take the lead on the project. The team, dubbed “MyWellness Portal Champions,” included two clerks (frontline staff), a lead registered nurse, and the nurse manager and medical director at the clinic. These staff members were chosen because they were familiar with different aspects of clinic operations — from checking in patients to treatment to clinic management — and were committed to the goal of boosting portal enrollment.
Seeing the Problem from a Patient and Staff POV
First, the team wanted to understand the experience of both clinic patients and frontline staff. To do this, they conducted interviews with patients as they enrolled on the portal, and the frontline clerks who registered clinic patients.
The team created journey maps of both the patients’ and the clerks’ experience with the enrollment process. Mapping the experience of these participants helped the team identify potential barriers to enrollment. Some examples include:
- One young mother had heard about the portal but didn’t know what services it provided; for example, she didn’t know that it would give her online access to test results.
- An elderly patient had little technology experience, and no computer at home.
- A clerk at the clinic had never used the portal herself so was reluctant to recommend it to patients.
- Another clerk wasn’t used to asking patients for their email addresses, and worried that doing so might seem intrusive.
Barbara Rubino, the LAC+USC Assistant Primary Care Director, called journey mapping “one of the most impactful parts of the whole process. We kept going back to the journey map, it was our guiding document.”
Finding What Works
The clinic hosted a health agency-wide summit to discuss the issue, and share information about enrollment barriers and brainstorm potential solutions. They considered ways of refining messaging to patients to encourage enrollment, for example. But during discussions with colleagues, the team identified what turned out to be a key solution, the “opt out” strategy, which had been implemented with some success at other sites.
The strategy is simple: when a patient registers for an appointment at the clinic, the clerk requests the patient’s email address, and the patient is immediately sent an invitation to sign up on MyWellness patient portal. (The strategy is called “opt out” because all patients receive an invitation to enroll unless they opt out.)
Educating Patients and Staff Alike
Front desk staff began implementing the strategy, generating an email invitation for portal enrollment when a patient registered at the clinic. The team educated staff and patients alike about the process, and the value of portal enrollment. They installed two enrollment stations in the clinic waiting room, so patients could enroll on site, with assistance from clinic staff, and IT support if there were technical issues. The team also conducted training demonstrations for clinic staff.
At first trainings stressed the benefits of increased portal use:
- Enhanced patient/medical team communication
- Improved patient awareness and management of health conditions
- Fewer patient phone calls and walk-ins
But the team soon discovered that for patients and frontline staff alike, a lack of awareness turned out to be the greatest barrier to portal enrollment. When patients learned about the portal and the services it offers, they were almost always eager to sign up. As Barbara Rubino put it, “We didn’t need to sell them on it. We just needed to let them know about it.”
Some frontline clerks were initially reluctant to ask patients for their email addresses because they simple weren’t used to doing so. In addition, many weren’t familiar with the portal itself, so didn’t feel comfortable recommending it to patients. This initial reluctance was dispelled by training demonstrations that allowed staff members to use the portal as if they were patients. “We encouraged them play around with it and experience the portal from a patient’s perspective,” said Rubino. “They said, ‘Look, I can get my test results!’ It helped them understand what a valuable resource the portal is.”
There were also some initial technical barriers to access at the enrollment stations installed in the clinic lobby. The tablet that was first installed was not user-friendly, so a keyboard was attached to make it more accessible; another station with a mobile computer was installed as well. The stations allowed patients to enroll onsite; they were also helpful for patients without access to a cell phone or computer at home. The technical issues were resolved by support from the IT department, and a phone was installed for patients to use if they needed additional technical support.
Other steps the team took to boost enrollment included posting signs promoting the portal, and running informational videos on television monitors in the waiting area.
To test the effectiveness of the project, the team monitored patient enrollment rates, and found that there was steady increase in enrollment in the months following the introduction of the All Hands on Deck for MyWellness Patient Portal project.
Spreading the Word
The team began to spread the word about its program to other primary care clinics in the Department of Health Services. They created a guide, “All Hands on Deck for MyWellness Portal Toolkit,” which outlines steps to increase portal enrollment. They pitched the Toolkit to leaders at all primary clinics at LAC + USC Medical Center. The Toolkit is now being used at clinics throughout the Department.
Results
When Primary Care Adult West launched All Hands on Deck for MyWellness Patient Portal in January, 2018, patient enrollment in the portal was 4 percent, or 800 out of approximately 20,000 patients. After the program was implemented, enrollment increased steadily. By July, it had reached 7 percent; it was 8 percent by August, and 9 percent by the end of November, 2018. According to Barbara Rubino, the clinic’s goal is to boost enrollment to 12 percent among empaneled patients by June 2019.
Lessons Learned
Barbara Rubino underscores the importance of assembling a dedicated team to spearhead the project. She says she took a step back and let the frontline staff on the team, MyWellness Portal Champions, comprised of two clerks and a nurse, take the lead. “They rose to the challenge beyond all expectations,” according to Rubino. “They implemented the project here, and they are now educating staff at other clinics. The project has launched them into new roles—it has added additional meaning to their work and their work day.”
Rubino also emphasized the importance of gathering feedback from end users early in the process, and ongoing education for team members and clinic staff.
Next Steps
At the Adult West clinic, staff will continue to enroll patients using the All Hands on Deck “opt out” strategy, and encourage patients to use the MyWellness enrollment stations. They will continue to play videos about portal enrollment in patient waiting rooms. They also plan to create informational materials targeted to specific patients and locations, and to involve patients in the design of these materials.
The team will reach out to staff at the five LAC+USC clinics that have not yet received training on portal enrollment, and continue to share information, including training and pitch videos, at other sites in the Department of Health Services.
