Remote enrollment into a telehealth-delivering patient portal: Barriers faced in an urban population during the COVID-19 pandemic

Abstract

Telehealth drastically reduces the time burden of appointments and increases access to care for homebound patients. During the COVID-19 pandemic, many outpatient practices closed, requiring an expansion of telemedicine capabilities. However, a significant number of patients remain unconnected to telehealth-capable patient portals. Currently, no literature exists on the success of and barriers to remote enrollment in telehealth patient portals. From March 26 to May 8, 2020, a total of 324 patients were discharged from Mount Sinai Beth Israel (MSBI), a teaching hospital in New York City. Study volunteers attempted to contact and enroll patients in the MyChart patient portal to allow the completion of a post-discharge video visit. If patients were unable to enroll, barriers were documented and coded for themes. Of the 324 patients discharged from MSBI during the study period, 277 (85%) were not yet enrolled in MyChart. Volunteers successfully contacted 136 patients (49% of those eligible), and 39 (14%) were successfully enrolled. Inability to contact patients was the most significant barrier. For those successfully contacted but not enrolled, the most frequent barrier was becoming lost to follow-up (29% of those contacted), followed by lack of interest in remote appointments (21%) and patient technological limitations (9%). Male patients, and those aged 40–59, were significantly less likely to successfully enroll compared to other patients. Telehealth is critical for healthcare delivery. Remote enrollment in a telemedicine-capable patient portal is feasible, yet underperforms compared to reported in-person enrollment rates. Health systems can improve telehealth infrastructure by incorporating patient portal enrollment into in-person workflows, educating on the importance of telehealth, and devising workarounds for technological barriers.

Patient Portal Perceptions in an Urban Community Health Center Setting: Insights for Telehealth

“…Many of these patient-perceived top features are more administrative (appointment scheduling and medication refills), so additional effort may be needed to demonstrate the value of other communication options such as clinician messaging or telehealth via the portal. 26,27 It is also important to note the effect of external factors (demographic variables) on technology adoption. Different age groups, genders, levels of educational attainment, or degree of comorbidity have different values and needs.…”

The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating

“…[47][48][49][50][51][52][53]55 • The patient-facing initiatives reported in the literature are limited to technological training and support, with an emphasis on mitigating the risk of digital health disparities. [47][48][49][50]52,[55][56][57][58][59][60][61][62] Developing and deploying portal tools to respond to COVID-19…”

“…49,51,53 While the literature generally shows that patients are receptive to virtual health care services, 48,58,60,61 patients may also need support to adopt virtual care. The two main approaches in the existing literature focus largely on technical support: offering multiple opportunities for one-on-one patient portal and video visit support (e.g., technical support hotline) [47][48][49]52,55,56 and providing training and educational resources, sometimes in multiple languages, especially leveraging existing communication modalities (e.g., appointment reminders). 49,50,52,55,57 Only one publication reported efforts to address structural issues like the digital divide, such as providing tablets to patients lacking technological resources.…”

Concurring of Neural Machines for Robust Session Key Generation and Validation in Telecare Health System During COVID-19 Pandemic

“…Francke et al [ 11 ] had surveyed a group of patients who took telehealth treatments during the COVID-19. It had provided healthcare services in the critical hours.…”