Rapid Implementation of Remote Online Patient Portal Activation in a Children's Hospital During the COVID-19 Pandemic

Purpose/Objectives: To describe the rapid implementation of remote patient portal activation in a pediatric integrated delivery network during the initial phase of the COVID-19 pandemic. We sought to increase the percentage of patients with active portal status upon discharge by 15% (absolute change) across inpatient units within 3 months. Design/Methods: A multidisciplinary taskforce utilized QI tools (fishbone diagram, process map) to identify barriers to successful inpatient patient portal activation. PDSA cycles included rapid cycle training of the remote MyChart enrollment workflow for hospital unit clerks (HUCs), increased patient education about portal functionality, standardized portal enrollment workflow across all inpatient units, and improved visibility of portal status for clinical staff and HUCs. The primary measure was the percentage of admitted patients with active MyChart status upon discharge. Baseline data was collected retrospectively via Epic Reporting Workbench. A patient portal activation dashboard was used to monitor progress on a weekly basis. We used statistical process control charts to examine the impact. Results: We completed training and clinical decision support tools (Unit Manager view and MyChart® status Epic column) creation within 2 weeks from the start of the initiative. Active online patient portal status upon hospital discharge increased from 44% to 66% (a 22% absolute increase) within 12 weeks. The process demonstrated a consecutive upward trend of 5 or more data points, consistent with special cause variation at the end of April 2020. During the same time period, the percentage of online patient portal activation within 7 days after hospital discharge increased from 6.0% to 24%, and the patient portal offer rate increased from 73% to 85% across all inpatient units. Conclusion/Discussion: We rapidly and effectively implemented a remote proxy portal activation process in the inpatient setting. Remote activation, training, clinical decision support, multidisciplinary involvement, and emphasis on the portal as integral to ongoing care allowed us to dramatically increase activation.

Rapid expansion of specialty practice telemedicine delivers timesensitive care during COVID-19

Background: The unprecedented impact of SARS-CoV-2/COVID-19 worldwide pandemic on healthcare hasbeen profound. At our large quaternary care pediatric healthcare system, in response to change how wedeliver care, a telemedicine strategy was rapidly developed with a priority to address the needs of patientsrequiring specialty time sensitive ambulatory care. One obvious opportunity was to rapidly expandtelemedicine capabilities to address the impact quarantines and stay at home orders would have on thedelivery of care to children with chronic conditions. We had some telemedicine capabilities in certainpopulations, however when our community shut down we responded with an immediate plan to expandtelemedicine services in a large multi-specialty practice. During the first week of the stay at home order, ourambulatory volumes drop by 69% reinforcing concerns regarding delays care (Fig. 1). Methods: We establisheda leadership model, task forces, and communication plan. We rapidly adapted to ongoing changes andaddressed specific needs including clinic workflow, patient populations, patient capabilities to utilize telehealth, education of clinical teams, and daily visible tracking tools. We measured daily telemedicinevolumes by practice, total visits, and proportion of telemedicine visits. Results: The 69% decrease inambulatory volume was countered with a 42,300% increase in telemedicine visits. Prior to COVID-19, weaveraged 4 telemedicine visits weekly and currently complete over 2,000. Through telemedicine, we aremaintaining a clinic volume of 57% of expected with 68% of all those visits being provided throughtelemedicine (Figure 2). All specialty services provide telemedicine. Certain specialty clinics adapted totelemedicine easier than others;allergy/asthma (98%;n = 581), pulmonary (97%;n = 390), neurology (96%;n =1,004), dermatology (95%;1,175), and otolaryngology (91%;n = 1,314) clinics experienced the greatest degreesof success over the past month while ophthalmology (55%;n = 531), cardiology (35%;n = 576) and orthopedics(14%;n = 1,713) faced challenges. Additionally, 30% of all completed telemedicine visits were for new referralvisits. Conclusion: We rapidly expanded telemedicine to provide time sensitive care in a large ambulatoryspecialty practice. Certain specialties were more amenable to telehealth for various reasons--vital signsavailable from home monitoring, ability to assess neurologic function in natural settings, etc. We realized thatevery specialty could do some aspect of telemedicine yet for others it was more challenging due to the needfor ancillary tests (Echocardiogram, x-rays, ophthalmology adjuncts, etc.) or lack of a good substitute forphysical exam findings (murmurs, abdominal exams, etc.). We successfully completed new referral visits (aprevious concern in specialty practices). Future steps to sustain our telemedicine practice are to continue torefinine best telemedicine practices, identifying appropriate populations and visit types, track financial impact,and measure patient outcomes.