Impacts of epic MyChart and healthy planet on clinical care measures: a scoping review protocol

Abstract

Introduction

Epic MyChart, used as a patient portal or within Epic Healthy Planet programmes, is integrated with the Epic electronic health record system, enabling secure access to health information, communication with clinicians and self-management tools. Despite increasing portal adoption in the UK and internationally, there is fragmented and unclear evidence demonstrating impact on clinical outcomes, engagement, safety, experience, efficiency and equity. This scoping review will map existing research on Epic MyChart, identify barriers and facilitators to uptake, and explore technical and operational determinants influencing implementation.

Methods and analysis

We will conduct a scoping review guided by Arksey and O’Malley’s framework, refined by Levac et al, and report according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and PRISMA-Equity guidelines. Eligible studies will include original research evaluating Epic MyChart or Epic Healthy Planet programmes, reporting outcomes related to patient-reported measures, clinical effectiveness, engagement, safety, efficiency or equity. Searches will cover MEDLINE, CINAHL, PsycINFO, EMBASE, Cochrane CENTRAL, Scopus, trial registries and grey literature. Two reviewers will independently screen records and extract data on study characteristics, outcomes, equity factors and implementation determinants. Quantitative findings will be synthesised narratively using synthesis without meta-analysis guidance; qualitative data will undergo thematic synthesis. Stakeholder consultations with health informatics experts, clinicians, data scientists and health system managers, alongside a patient and public involvement workshop, will support interpretation of findings. A logic model will illustrate relationships between portal features, implementation factors and outcomes. Although focused on Epic MyChart, the review will offer insights relevant to other patient portals, as many implementation and equity considerations are shared across digital health systems.

Ethics and dissemination

Ethical approval is not required as the review uses published data. Findings will be disseminated through peer-reviewed publication, conferences and stakeholder engagement to inform implementation of patient portals internationally.

Trial registration number

The protocol is registered on the Open Science Framework (https://osf.io/5azdh/overview).

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• The scoping review uses established methodological guidance, following Arksey and O’Malley’s framework with refinements by Levac et al, and will be reported in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) and PRISMA-Equity standards.

• A comprehensive and reproducible search strategy has been developed with an experienced information specialist, including multiple bibliographic databases, trial registries and grey literature sources.

• Data extraction is informed by predefined frameworks, including the Place of residence, Race or ethnicity, Occupation, Gender, Religion, Education, Socioeconomic status, Social capital, plus additional factors such as age, disability, sexual orientation, and other sources of vulnerability (PROGRESS-Plus) framework and Consolidated Framework for Implementation Research 2.0, to support systematic mapping of equity and implementation determinants.

• Consultations with stakeholders such as health informatics experts, clinicians, data scientists, and health system managers and patient and public involvement groups will improve the impact and relevance of the scoping review.

• There is no formal assessment of risk of bias in scoping reviews, limiting our understanding of the quality of the research included.

Introduction

Patient portals are secure digital interfaces (apps or websites) supporting self-management and engagement through secure access to medical notes, appointment scheduling, result interpretation and communication with their healthcare practitioners.¹ Epic MyChart is a tethered patient portal, linked to a widely used patient electronic health record (EHR) system Epic, for healthcare-based services.² Epic MyChart is a comprehensive software platform that supports a wide range of healthcare functions.³ It includes tools for patient self-management, clinical care documentation, as well as billing and financial management. The population health management tool within Epic’s application, called Healthy Planet, is also integrated with MyChart for outreach, monitoring or self-management.⁴ Epic MyChart is one of the most widely used patient portals globally, with approximately 325 million Epic MyChart users recorded worldwide in 2025.⁵ First launched in the USA in 2000,⁶ access has reached other countries like Canada,⁷ Norway⁸ and the UK.⁹ In the UK, the Epic MyChart patient portal is used across several National Health Service (NHS) trusts using Epic as their EHR.¹⁰

Most countries, including the UK, have made a shift towards health technologies to achieve their long-term objectives.¹¹ The UK’s NHS 10-Year Health Plan aims to prioritise the expansion of digital health via the use of patient portals.¹² The new NHS plan outlines some substantial goals like the creation of a unified single patient record by 2028, the expansion of the NHS App to manage all patient-related inquiries and the integration of third-party digital health services such as Epic MyChart into the NHS app, all while ensuring digital inclusion and accessibility.¹²

Evidence has shown that patient portals, in general, can improve engagement with and access to healthcare services, which in turn can improve patient health outcomes.^{13 14} In particular, studies have shown that using patient portals can improve health outcomes in patients with chronic disease such as reducing blood pressure,¹⁵ improve patient-centred decision-making,¹⁶ reduce administrative burden and costs (by reducing unscheduled high-cost healthcare utilisation),^{17 18} reduce emergency department visits¹⁹ and decrease rates of ‘did not attend’ (DNA) or ‘no show’ appointments,²⁰ while also facilitating communication with healthcare professionals and overall patient satisfaction.²¹ Studies comparing portal to non-portal users have demonstrated significant improvements in medical adherence and engagement in preventative screening programmes and better disease control in active portal users.¹⁷ However, uptake is often uneven, with barriers such as low digital/health literacy, privacy concerns and misalignment between patient expectations and portal functionality.21,25 Providers also report concerns about workload and patient distress when viewing sensitive results.²⁴ These factors risk creating a digital divide in healthcare, where benefits accrue to those with greater resources and skills, while others are left behind. Understanding these equity implications is important to identify whether patient portals reduce or exacerbate health inequalities and inform strategies for inclusive implementation.

Previous literature reviews have primarily examined electronic health record systems, including Epic,²⁶ but none have synthesised Epic MyChart-specific effects and key clinical measures such as equity and implementation determinants that can impact outcomes across health systems. Existing reviews are also outdated given the rapid pace of digital adoption and the growing number of evaluations being published internationally. Despite the central role of patient portals in many countries’ healthcare strategies, their collective benefits for patients and providers remain poorly understood. Without a clear understanding of the evidence, patient experiences and the technical and operational challenges of implementing portals, health systems cannot fully leverage their potential, address inequalities or reduce staff workload. This scoping review aims to fill this gap by mapping the evidence on Epic MyChart’s impacts on patient health outcomes, engagement, safety, experience, equity in access to care and efficiency, and by identifying gaps to inform future reviews and evaluations. Although the review focuses on Epic MyChart, many of the technical, operational and equity issues it will raise are shared across other patient portals and EHR-integrated systems. The findings are therefore designed to generate insights that are transferable to a wide range of digital health platforms beyond Epic.

Methods and analysis

Methodology

We selected a scoping review methodology as it allows for a comprehensive synthesis of both peer-reviewed and grey literature, capturing the breadth of existing evidence.²⁷ Scoping reviews are particularly suited to mapping the extent and nature of research, identifying strengths, weaknesses and gaps in the evidence base. Given our focus on exploring the impacts of Epic MyChart on a broad range of outcomes, this approach was deemed most appropriate. The review was conducted following Arksey and O’Malley’s foundational framework²⁷, with refinements based on guidance from Levac et al and Peters et al.27,29 In line with Levac et al’s recommendation to involve stakeholders, the review was developed in consultation with a multidisciplinary team comprising health informatics experts, clinicians, data scientists and health system managers.²⁸ The framework comprises six stages: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarising and reporting the result; and (6) consultation.

The protocol was developed and reviewed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines, which provide a structured framework for ensuring transparency and completeness in systematic review protocols and was adapted to the scoping review methodology (see online supplemental appendix 1 for completed checklist).³⁰ The completed scoping review will adhere to the PRISMA extension for scoping reviews (PRISMA-ScR 2018) and PRISMA-Equity (PRISMA-E 2012) reporting standards, which outline evidence-based criteria for transparent reporting and incorporate considerations of health equity in reviews.^{31 32} This review protocol is registered with the Open Science Framework (OSF; registration link: https://osf.io/5azdh/overview).³³ We expect to complete stages 1–3 by January 2026, stage 4 by February 2026 and stages 5–6 by June 2026.

Stage 1: identifying the research question

We will address the following research questions

1. What impacts does MyChart have on patient health outcomes, clinical effectiveness, engagement, safety, experience, efficiency and equity across different populations?

2. What barriers and enablers influence uptake and use of patient portals from patient and provider perspectives?

3. What technical and operational factors influence successful implementation in health systems?

Stage 2: identifying relevant studies

Relevant studies will be identified by searching the following research databases

• MEDLINE.

• CINAHL.

• PsycINFO.

• EMBASE.

• Cochrane CENTRAL.

• Scopus.

• Web of Science.

• Institute of Electrical and Electronics Engineers Xplore.

• Association for Computing Machinery Digital Library.

• Trials registries (ClinicalTrials.gov, International Standard Randomised Controlled Trial Number Registry, WHO International Clinical Trials Registry Platform, European Union Clinical Trials Register).

Grey literature will also be searched including NHS England/NHS App publications, government Department of Health and Social Care/NHS Digital reports, other government’s reports, Epic documentation/user group white papers, OpenGrey, ProQuest Dissertations & Theses, medRxiv/bioRxiv and a Google Scholar sweep of the first 200 results. In addition to database searches, we will conduct forward citation searching and backward citation searching through reference list screening of included studies.

The research team and an experienced university research librarian developed the search strategy (see online supplemental appendix 2). Our search strategies will include keywords for Epic-specific technical terms such as ‘Healthy Planet’ (for population health/registry work) and ‘MyChart’ (for inpatient portal access). We will include keywords and Medical Subject Headings terms for ‘patient portal’, ‘electronic health records’ and ‘electronic medical records’, ‘telemedicine’ and telehealth’ and keywords that describe the functionalities of MyChart such as ‘appointment scheduling’. We used the PRESS (Peer Review of Electronic Search Strategies) checklist to ensure quality and accuracy.³⁴

Eligibility criteria

This review will only include studies that clearly identify the use of Epic Systems’ MyChart or Healthy Planet. MyChart must have been explicitly evaluated either as a patient portal only or for population health management programmes using MyChart within Epic, in any care setting, country and language. Other patient portals with similar names (eg, ‘MyChart’ used by Sunnybrook Health Sciences Centre in Toronto, which is not Epic based) are excluded. To ensure precision in our search, we distinguish between the following Epic components: (1) MyChart as the patient-facing application layer (web and mobile interfaces); (2) Epic EHR as the underlying clinical system; (3) Care Everywhere for health information exchange between Epic instances; (4) Fast Healthcare Interoperability Resources (FHIR) Application Programming Interface (API) integrations enabling third-party apps to connect to MyChart data; and (5) Substitutable Medical Applications, Reusable Technologies (SMART) on FHIR apps launched from within MyChart that extend functionality beyond native Epic features.³⁵ We will focus only on (1) MyChart as the patient-facing application layer (web and mobile interfaces); this architectural clarity will guide our inclusion decisions and help distinguish MyChart-specific effects from broader Epic EHR impacts. We will include studies that report on outcomes related to Patient-Reported Outcome Measures (PROMs), Patient-Reported Experience Measures (PREMs), clinical effectiveness, engagement, safety, efficiency or equity, and will include both quantitative and qualitative study designs. The review’s inclusion and exclusion criteria are summarised in more detail using the Population, Interventions, Comparators, Outcomes (PICO) framework in table 1.

Table 1. Review inclusion and exclusion criteria.

Category	Inclusion criteria	Exclusion criteria
Population	Patients with an active MyChart account and caregivers with proxy access. All patient subgroups and disease areas included.	N/A
Intervention	MyChart must be explicitly stated in the intervention logic. Used either as: • Stream A: Patient-facing portal • Stream B: Epic Healthy Planet–enabled programme using MyChart for outreach, monitoring or self-management. Brand criterion: Must explicitly identify Epic Systems MyChart. Healthy Planet feature specification: For Stream B studies, we will extract which specific Healthy Planet capabilities are used: (a) registry-based care gap identification and stratification algorithms; (b) automated outreach campaigns via MyChart messaging; (c) remote patient monitoring (RPM) device integration; (d) social determinants of health (SDOH) screening and community resource linkages. Programmes using only automated reminders will be distinguished from those with integrated RPM or SDOH workflows.	Portals not linked to Epic or EHR-only programmes without MyChart engagement.
Comparator	Usual care, alternative interventions or patient portals, pre-post comparisons, adoption-gradient comparisons, or no comparator.	N/A
Outcomes	Studies reporting on any of the following: Patient-Reported Outcome Measures (PROMs) for example, standardised surveys like the Patient Health Questionnaire-9 (PHQ-9) Patient-Reported Experience Measures (PREMs) for example, care feedback surveys Clinical effectiveness, eg, changes in clinical/physiological outcomes like blood pressure or weight, vaccination uptake Engagement, eg, logins to portals Safety, eg, follow-up on abnormal results Efficiency, eg, missed appointments, provider workload, eg, message volume, inbox time Equity, eg, differences in uptake/access by demographic factors such as ethnicity, age, gender Interoperability and data exchange, eg, cross-organisational data sharing, data portability, Fast Healthcare Interoperability Resources API usage, third-party app integration, AI use	N/A
Study design	Randomised and non-randomised studies, observational studies, qualitative studies, mixed methods studies.	N/A
Context	Any country; inpatient and outpatient settings included.	N/A
Language	Any language; non-English studies will require machine translation and adjudication.	N/A
Article type	Original research studies and grey literature (eg, healthcare or policy reports where an evaluation of MyChart has been undertaken).	Conference abstracts, letters, review articles, editorials, commentaries, notes, protocols.
Timeframe	Studies published from inception to 5 December 2025.	N/A
Access	N/A	Studies where full text is not available.

API, Application Programming Interface; EHR, electronic health record; N/A, Not applicable.

Stage 3: study selection

We will use the Covidence reference management software to remove duplicates and manage records.³⁶ After removal of duplicates, all identified studies will undergo title and abstract screening in the first instance followed by full-text screening. Studies will be assessed against the inclusion and exclusion criteria and those that are ineligible will be excluded. Researchers will communicate throughout the screening process to discuss any challenges arising in study selection and clarify the inclusion and exclusion criteria if necessary. Two members of the research team will independently perform title, abstract and full-text screenings of the studies and discuss any discrepancies with a third reviewer. The study selection process will be recorded in a PRISMA 2020 flow diagram with reasons for exclusion to meet transparency requirements.³⁷ The same process will be applied to grey literature with pre-specified screening criteria to preserve reproducibility. Inter-rater reliability for both stages of screening will be calculated using Cohen’s kappa statistic.³⁸

Stage 4: charting the data

Two independent researchers will extract the data. A standardised data extraction form will be developed in Covidence. It will be piloted by two researchers on a few selected articles to check it is suitable for extracting data consistently and accurately and amendments made if needed. Two researchers will chart the data and a third reviewer will check the extracted data for accuracy. Any discrepancies will be resolved through discussion and consulting with the third reviewer if necessary. We will document any protocol deviations in the final manuscript, in line with PRISMA 2020 guidance. ³⁹ The extraction template will be made available on OSF or in supplementary materials to ensure reproducibility and auditability. Table 2 outlines the information that will be captured in the form.

Table 2. Data extraction domains and details.

Domain	Details captured
Publication details	Author(s), year of publication, type of article, study aims, country of origin.
Patient characteristics	Demographic information (eg, age, gender, ethnicity, socioeconomic status).
Methods	Study design, comparator, confounder handling, follow-up duration, effect measures, analysis.
Outcomes	Clinical effectiveness: care gap closure (eg, screenings, vaccinations), chronic disease control (eg, achieving target control bands), changes in clinical/physiological measurements such as blood pressure, weight, glycated hemoglobin (HbA1c) etc. Service efficiency: missed appointments, messaging workload, cost/savings, Emergency Department visits, hospital admissions/readmissions PROMs: standardised outcome measures such as PHQ-9 (depression), Short Form 36 (SF-36; functional status) PREMs: standardised experience measures such as Friends & Family Test (FFT) Patient safety: time-to-follow-up on abnormal results, diagnostic delays, medication-related issues, privacy incidents, natural experiments from result-release policy changes Engagement: patient activation, portal logins, secure messages, telehealth usage, remote monitoring enrolment, proxy access use, e-check-in completion
Equity Data40	Analysis by equity-relevant characteristics following the PROGRESS-Plus framework.
Implementation determinants	MyChart features: Outreach channels, messaging, telehealth, remote monitoring, templates, and any use of AI. We will extract critical configuration choices that likely explain outcome variance where reported: (a) test result release policies (immediate vs provider-gated, with timing details); (b) message triage workflows and response time targets; (c) portal enrolment procedures (opt-in vs auto-enrolment vs opt-out); (d) MyChart-integrated tools enabled (e-check-in, questionnaires, specific telehealth platforms, SMART on FHIR apps); (e) Epic version and build number where reported; (f) customisation of patient-facing interfaces and workflows. Interoperability, eg, NHS/other App integration, social care linkages and system-wide API integration. Equity enablers: languages, accessibility, device modality. Governance: proxy/adolescent rules. Given the equity implications, we will extract detailed proxy access data including proxy relationship types (parent, spouse, caregiver), age-based proxy rules (paediatric, adolescent, adult), proxy activation rates by demographic group, proxy usage patterns, barriers to proxy enrolment, and caregiver burden indicators. Proxy workflows are critical for paediatric care, elder care, and patients with disabilities, revealing important disparities in caregiver burden and digital health access. Temporal factors: Epic version/build number, implementation date, era classification (Early 2000–2010, Expansion 2011–2018, Modern 2019–present).

API, Application Programming Interface; FHIR, Fast Healthcare Interoperability Resources; NHS, National Health Service; PHQ-9, Patient Health Questionnaire-9; PREMs, Patient-Reported Experience Measures; PROGRESS-Plus, Place of residence, Race or ethnicity, Occupation, Gender, Religion, Education, Socioeconomic status, Social capital, plus additional factors such as age, disability, sexual orientation, and other sources of vulnerability; PROMs, Patient-Reported Outcome Measures; SMART, Substitutable Medical Applications, Reusable Technologies.

Stage 5: collating, summarising and reporting the results

We will present a descriptive summary of each of the included studies to describe the characteristics of the study. For quantitative data, we will not conduct meta-analysis, as this is a scoping review intended to map the extent, range and nature of evidence rather than to statistically synthesise effect sizes. The anticipated heterogeneity in study designs, populations, interventions and outcomes makes meta-analysis inappropriate. Instead, we will apply the synthesis without meta-analysis (SWiM) guideline to support a transparent and structured narrative synthesis of quantitative findings. Where feasible, we will explore patterns across intervention streams (eg, Stream A vs Stream B), population health management features and Place of residence, Race or ethnicity, Occupation, Gender, Religion, Education, Socioeconomic status, Social capital, plus additional factors such as age, disability, sexual orientation, and other sources of vulnerability (PROGRESS-Plus) subgroups.⁴⁰ Predefined effect measures will include risk ratios, mean differences and engagement rates where reported.

For qualitative data, we will conduct a thematic synthesis and findings will be mapped to the Consolidated Framework for Implementation Research (CFIR 2.0) domains.⁴¹ We will report according to the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) statement.⁴² This synthesis will help identify contextual factors influencing portal implementation and use. We aim to develop a logic model to illustrate the relationships between portal features, implementation determinants and outcomes.³⁹ The model will depict: (1) inputs (portal configuration, organisational context), (2) mechanisms (patient activation, provider workflow changes), (3) outcomes (clinical, engagement, safety, experience, efficiency, equity) and (4) feedback loops (eg, result-release policy changes influencing patient anxiety and subsequent portal use). The logic model will explicitly hypothesise how technical configuration decisions (eg, auto-enrolment policies, immediate result release, language availability) mediate equity outcomes. For example, opt-in enrolment may exacerbate disparities by requiring digital literacy and proactive engagement, while auto-enrolment with opt-out may improve equity but raise different privacy concerns. These configuration-equity pathways will be central to our implementation analysis. The logic model will support interpretation of findings and inform future evaluation and implementation strategies and will be shared on OSF.

The review will also explicitly examine outcomes by demographic or other relevant factors whenever possible to assess equity. We will adopt the PRISMA-Equity approach and apply the PROGRESS-Plus framework (considering place of residence, race/ethnicity/language, occupation, gender/sex, education, socioeconomic status, social capital and ‘Plus’ factors such as age, disability and literacy) to structure our data extraction and synthesis, including noting the use of proxy access where reported.^{31 40} Beyond traditional demographic factors, we will extract digital phenotyping data as equity indicators: (a) device type (iOS vs Android vs web browser) as a proxy for socioeconomic status; (b) language preference and availability of translated interfaces; (c) use of assisted access technologies (screen readers, voice control); (d) geographic broadband availability data where reported; (e) digital literacy indicators; (f) multi-device access patterns. These technical access factors reveal important equity dimensions beyond traditional PROGRESS-Plus categories.

Stage 6: consultation

We will consult with stakeholders throughout the scoping review process to identify relevant literature and support interpretation of the findings. Stakeholders will include NHS Trust staff, digital health experts, clinicians, data scientists, patient safety leads, inbox managers, adolescent medicine/safeguarding specialists, interpreting services, digital inclusion teams, Epic implementation specialists, health information exchange coordinators, FHIR integration developers, and patient and public involvement groups. When preliminary results are available, we will conduct a workshop or interviews to gather feedback on emerging themes, equity issues and implementation challenges. These insights will inform the final synthesis, logic model and recommendations.

Patient and public involvement statement

This project will be developed in collaboration with patient groups such as the Patient and Public Engagement for Digital group at Guy’s and St Thomas’ NHS Foundation Trust, which includes patient representatives with lived experience of using digital health tools. We plan to involve this group in the interpretation and dissemination of the scoping review findings, particularly in relation to equity, accessibility and patient experience. Their insights will help ensure that the review reflects patient priorities and supports the development of inclusive digital health strategies.

Ethics and dissemination

Ethical approval is not required for this scoping review as it will use published and publicly available data. We plan to disseminate the results of this review through publication in a peer-reviewed journal and presentations at relevant conferences. The findings will help identify gaps in the research literature and inform the optimisation and design of future digital health interventions, including patient portal strategies and population health management programmes.