Patient Portals for Inpatients - Quality Improvement Project

Objective

Explore possible uses, impacts and benefit accelerants for the Connect Care patient portal (MyAHS Connect) when introduced or promoted to patients (and their families) admitted to hospital for acute care.

Opportunity

The Connect Care clinical information system (CIS) continues to deploy throughout Alberta, with the University of Alberta Hospital already 1.5 years into its implementation. The CIS includes a comprehensive patient portal service (MyAHS Connect) that can be offered to Albertans who receive care where Connect Care is the record of care.

MyAHS Connect has functions that could prove useful to inpatients, including secure communications, access to information and guidance about health conditions, and access to most parts of the health record (e.g., problem lists, medical history, social history, test results, clinical documents, care plans, advance care planning tools, etc.). The patient portal is recently enhanced to include additional functions that display only when patients are hospitalized. These include synopses of key information in the inpatient record as well as communication and care planning tools (e.g., hospital 'day-at-a-glance'). Patients can elect to share these functions with family members or other designated decision-makers.

There are many potential advantages to inpatient portal use, even if limited to 'day-at-a-glance' as a communication tool for patients and families trying to anticipate multidisciplinary team activities and how best to fit in things like family supports and conferences. However, there are currently no supports for patients or staff respecting how best to use hospital-specific portal functions or how to adapt uses of community-oriented functions.

An emerging literature about uses of patient portals in hospitals provides some direction about possible approaches to promoting MyAHS Connect inpatient features. However, little is known about use cases for hospital-specific features or about how to support clinicians adapting to this level of information sharing with patients.

Challenges

  • Hospitalizations have many phases. The patient portal value-case may be limited during the first days when a patient is acutely unwell and clinicians are focused on urgent issues.

  • There are barriers to access for MyAHS Connect (particularly, Alberta Health requirement that use of the AHS patient portal be handled through MADI (MyAlberta Digital Identity) which imposes sign-up difficulties, limits eligible populations, and incurs delays in portal activation.

  • MyAHS Connect adoption is still limited in the Edmonton Zone, and so a QI project needs to address barriers to access as well as potential inpatient barriers to use.

  • MyAHS Connect currently supports English-only. The tool can present the user interface in many different languages but this has not been configured in Alberta and will not be available during the QI Project timeline.

  • Most clinicians, including physicians and nurses, have very limited knowledge of the patient portal and likely struggle to explain its value to patients.

  • Decisions by Alberta Health disallow provision of MyAHS Connect account to physicians, trainees and students unless they are a patient at a Connect Care facility. This further limits clinician awareness and comfort with the portal.

  • The Alberta context is challenged by 'competing' patient portals, with inadequate information about differences between My Personal Health Record (Alberta Health diary-type offering with access to some lab results) and MyAHS Connect (full patient portal, tethered to health care services, that brings the patient into a circle of care).

Scope

  • Interventions

    • This quality improvement project is intentionally exploratory, hopefully leading to follow-on projects with more focused interventions and evaluations.

    • Participatory action research methods are emulated to derive possibly impactful interventions to improve the uptake, use, and perceived value associated with use of MyAHS Connect in acute hospital inpatient settings.

  • Locations

    • General Internal Medicine inpatient units at University of Alberta Hospital

Timelines

  • Team building

    • Mid-March 2021: identify core team members and hold project initiation meeting to confirm roles and time resources

    • End-March 2021: identify subject matter experts, portal technical supports, builders, advisors and interested stakeholders

      • Presentation to Connect Care Medicine Area Council

      • Introduction to Medicine Strategic Clinical Improvement Council (2021-03-18)

      • Presentation to Connect Care Portals Committee

    • Mid-April 2021: confirm project scope, interventions, iterative improvement approach

    • May 2021: develop and document intervention(s)

    • June-August 2021: PDSA #1 with trial intervention(s)

    • September 2021: PDSA #2 with refined intervention(s)

    • October 2021: Project summary, abstract, QI poster and feedback to stakeholder groups with recommendations

Understanding needs and opportunities

Participants