HJNO Sep/Oct 2022

HEALTHCARE JOURNAL OF NEW ORLEANS  I  SEP / OCT 2022 51 Chatrian R. Kanger, MPH Senior Vice President, Population Health Access Health Louisiana worldwide COVID-19 pandemic. This was no small feat, indeed. A multidisciplinary team consisting of representatives from various service lines, including operations, business services, health information technology, and community outreach, de- vised a process to guide and help patients easily transition to be able to participate in virtual visits. Aware of the potential barri- ers, we quickly modified our EMR to cap- ture whether our patients had access to the means necessary to participate in a virtual visit: 1) access to Wi-Fi and 2) access to a smartphone, tablet, or computer Our findings were interesting and promising. In the national news, racial dis- parities dominated the discussions around access to virtual visits. However, within our local FQHC patient population, which is largely dependent upon Medicaid and disadvantaged or vulnerable, we found no racial disparities. Even among our Hispan- ic patient population, which may be that our bilingual staff were able to provide the necessary guidance. What we discovered was an age disparity. Access to Wi-Fi and/ or smartphones or tablets significantly de- creased among our patients 55 and older. We also found a geographic disparity be- tween our urban populations and rural populations, where a greater percentage of rural patients reported barriers to access- ing Wi-Fi. What we also discovered was that our staff — from before it was even time for a patient to check in for an appointment to the time after a patient had completed their visit — were on top of guiding the pa- tients through the processes and steps of how to connect, whether they were calling, texting, creating brief videos, animations ... you name it. And they were promoting and explaining how to log in and utilize the patient portal not just for test results but as a secure, timely way to communicate with their care teams about prescriptions, appointments, and/or clinical advice. We watched closely as our percentages changed over time. And then, even after the ratio of our virtual visits to in-person visits began to decline as in-person vis- its returned to a post-COVID “normal,” patient engagement with our portal re- mained constant. Looking forward, we need to continue to monitor the volume of portal messag- es and timely turnaround of responses as managing patient communications can often become a logistical or operational burden. That is why AHL staff’s extend- ed care team members assist with patient education and communication. Our teams are undergoing motivational interview- ing training. Motivational interviewing is a counseling approach designed to elicit behavior change derived from a patient’s own exploration and resolution of their ambivalence toward change. Our provid- ers and care teams understand that, just as with any other care plan, the key is to stress the importance and benefit to the patient. If the patient gets a desired out- come from utilizing the portal or any other digital remote monitoring device, they will be more likely to continue utilizing it. But more importantly, if a patient does not get a desired outcome from utilizing a tech- nology, they will be even less likely to en- gage in the future. In last month’s issue, Kenneth Cole, MD, discussed that if we are going to create healthier communities, we need to design better digital solutions that empower and engage patients. And that it is through that marriage of digital and human connec- tions, such as understanding our patients’ pain points, preferences, and goals that we will foster continued, connected provid- er-patient relationships. The key is to pro- vide patients an opportunity to be heard and to listen to their previous experienc- es and to ask questions. It is so easy as a busy clinician to be rushed or to miss out on that opportunity to pause and just lis- ten ... perhaps that is why the patient portal has become such a mainstay. It gives pa- tients a direct channel for their voices to be heard. n REFERENCES 1 Irizarry, T., DeVito Dabbs, A., & Curran, C. R. (2015). Patient Portals and Patient Engagement: A State of the Science Review. Journal of med- ical Internet research, 17(6), e148. https://doi. org/10.2196/jmir.4255 2 Turner, K; Nguyen, O.; Hong, Y.R.; et al. “Use of Electronic Health Record Patient Portal Accounts Among Patients With Smartphone-Only Internet Access.” JAMA Network Open 4, no. 7 (July 26, 2021). doi:10.1001/jamanetworkopen.2021.18229 3 Eschler, J.; Meas, P. L.; Lozano, P.; et al. “Inte- grating the patient portal into the health man- agement work ecosystem: user acceptance of a novel prototype.” AMIA Annual Symposium Pro- ceedings (2016): 541–550. PMCID: PMC5333335 4 Nahm, E.S.; Diblasi, C.; Gonzales, E.; et al. “Pa- tient-Centered Personal Health Record and Portal Implementation Toolkit for Ambulatory Clinics: A Feasibility Study.” Computers Informat- ics Nursing 35, no. 4 (April 2017): 176–185. doi: 10.1097/CIN.0000000000000318 RESOURCES Johnson, C.; Richwine, C.; Patel, V. “Individuals’ Access and Use of Patient Portals and Smart- phone Health Apps, 2020.” Office of the Na- tional Coordinaor for Health IT, ONC Data Brief, no.57 (September 2021). https://www.healthit . gov/data/data-briefs/individuals-access-and- use-patient-portals-and-smartphone-health- apps-2020. Chatrian R.Kanger,MPH, is the senior vice president of Population Health, where she is responsible for aligning resources and clinical information systems to leverage performance improvement initiatives across theAccess Health Louisiana network.Chatrianworks across partners,health plans,departments,and care teams to devise care coordination systems aimed at improving quality, reducing costs, and monitoring patient outcomes. Chenier Reynolds-Montz, MS, is vice president of School Health & Strategic Media for Access Health Louisiana. She currently serves as president of the Louisiana School-Based Health Alliance and is re- sponsible for themarketing, branding, and develop- ment of community health centers and school-based health centers within the Access Health Louisiana Network.