Prior to the growth, adoption and use of its patient portal, Ann & Robert H. Lurie Children's Hospital of Chicago had only two entry points for patients looking to receive care – calling the centralized access center or walking into the emergency room.

THE PROBLEM

There were multiple phone numbers that linked to each of the separate specialties with complex phone trees that sometimes rerouted to the centralized access center or sometimes would land with the specialty that a patient was looking to schedule with. Regardless, it was a time-consuming process.

Lurie Children’s patients and families experienced disjointed scheduling and registration problems and had a limited scope of appointment availability, leading to long delays in care. And with more than 50% of patients on Medicaid, time is difficult to come by for many parents and a scheduling opportunity to receive care at Lurie Children’s should not be a barrier to care, said Ravi Patel, vice president of digital health at Ann & Robert H. Lurie Children's Hospital of Chicago.

PROPOSAL

"A patient portal was proposed as part of our digital front door baseline platform, where we transformed the high-touch, phone-based system into an omnichannel engagement system and developed end-to-end functionality," Patel explained. "The digital front door strategy tied into the patient portal, interactive websites and marketing, two-way texting, and a singular phone system.

"Within these different patient engagement systems, functions like digital registration, appointment scheduling, digital clinic visit tools, virtual care provision and feedback all became possible and integrated," he continued. "The proposal of this technology was to leverage the demand for digital services from our patients and providers."

Most patient families prefer self-scheduling their medical care, paying online and having personalized communication tools – the digital front door offers all of that and seeks to optimize ambulatory operations, he added.

"The digital transformation was staged in four phases over two years," Patel recalled. "Phase one was to increase adoption of the digital front door and its core functional capabilities, which consisted of functioning digital communications, online bill pay and medication refills. Having these services available was critical to increasing patient portal activation and driving users to effectively leverage the portal.

"Setting up a robust education/support structure for both clinicians and patients should be prioritized and established before implementation."

Ravi Patel, Ann & Robert H. Lurie Children's Hospital of Chicago

"Phase two involved creating online scheduling for new patients seeking primary care and activating new and return direct online scheduling for specialty departments," he continued. "This phase was specific for addressing the desire for self-scheduling and aimed to increase patient portal adoption and online bill pay even more."

Phase three focused on the integration of telehealth and making all these tools available in Spanish. Phase four prioritized the development of educational materials, asynchronous e-visits and service recovery.

"Addressing our scheduling strategy and operational efficiency and optimizing our care flows with the patient portal and digital front door alleviated the issues we were seeing with our limited entry points to care at Lurie Children’s," he reported.

MEETING THE CHALLENGE

Ensuring Lurie Children’s staff was comfortable with the patient portal technology was an important piece to ensuring this transition would be effective in meeting the challenge. The aforementioned functionalities were the tools used by patients to effectively engage with staff as their care providers in a variety of modalities.

RESULTS

One way Lurie Children’s monitors the success of the technology is by tracking patient portal use. 91% of patients have logged into their portal account within three months of an encounter.

"We see our patients actively engaging with the digital tools," Patel said. "This increase is attributed to diligent performance management of activation workflows, defined goals, and transparent and easily accessible monitoring dashboard for end users and managers. Higher patient portal use also is attributed to a 65% decrease in patient encounters where portal activation codes were not offered or activated.

"Additionally, since July 2020, our online scheduling rate increased 14-fold, going from 0.1% up to 14% as of October 2023," he continued. "Lurie Children’s has undertaken an extensive decision tree project that uses logic to ensure the right patient is scheduled with the right provider at the right location and time with the right method."

These algorithms have vastly increased the ability to self-schedule and improve the overall scheduling experience for families and patients, referring providers, and other Lurie Children’s Hospital clinicians, he added. Decision trees have been key in the online scheduling success and have helped expedite appointment scheduling, he said.

ADVICE FOR OTHERS

"If another organization was considering adopting a similar technology, setting up a robust education/support structure for both clinicians and patients should be prioritized and established before implementation," Patel advised.

"Finding a way to bridge the gap with teenage patients also is difficult," he continued. "The legal restrictions within the state create challenges with proxy support/access and teenage rights to access their own private health information. Having high portal activation and usage in a pediatric institution is difficult because you're dealing with two different levels of access and health rights."

Sorting out the legal component is a difficult obstacle to overcome but should be considered if an institution is thinking about implementing a similar portal system, he added.

"Most important, addressing the unconscious bias is critical to drive equality in access to the patient portal and thereby promoting equity in the various tools available to patients to use at their preference to access the healthcare needed for them and their families," he concluded.

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