| Enlisting staff support |
Pursuing financial benefit and competitive advantage |
“We had already budgeted to receive the meaningful use money, so we were committed.” (executive, Site 2) |
| Providing all patients with access to their electronic health information |
“… Patients really care about their health. […] It’s important to them and it’s important for them to know what’s going on in their bodies and themselves and their children so this is why we’re doing it, not because we just want to get another e-mail on our information here.” (clinic manager, Site 1) “Portal helps patients feel empowered. They’re taking care of their own health care.’” (call center, Site 1) “It revolutionizes the way patients can have access to their records.” (program coordinator, Site 3) “We’re not doing these things because we’re going to get money.” (IT director, Site 4) |
| Promising improved quality and efficiency |
“We needed to sell it to providers as less work to track down patients.” (clinic manager, Site 1) “This is convenient. You can save a phone call. You can save time.” (nurse midwife, Site 3) “MAs [medical assistants] think portal is more efficient than playing phone tag with patients.” (operations management team member, Site 1) |
| Fitting the portal into clinic routines |
Enrolling patients |
“We think it’s the right thing to do, but… we stopped other work to get our enrollment numbers.” (executive, Site 2) “When a site wasn’t meeting the goal, we moved around the staff, like Tetris.” (executive, Site 2) “So one of the things that they told the staff was just try to enroll at every opportunity.” (executive, Site 1) “… We had high school volunteers who were available during summer. […] We used even some of our non-clinic staff that worked in our health promotions center.” (program coordinator, Site 1) |
| Moving patients from enrollment to use |
“So sometimes if a patient, they’re starting using patient portal, they don’t know where to find their labs.… It’s easier for us to go and then show them, ‘Oh, you can click here,’ because you’re familiar with your own patient portal.…” (front-line staff, Site 1) “… We’re a do-it-yourself type people, so we made some self-made kiosks.… I got some balloons that said ‘Patient Portal’ and then ‘Access your lab results.’… We tried a lot of different things and then had to go back and say, ‘Well, maybe that didn’t quite work.…’” (program coordinator, Site 1) “I think nearly every patient, we had to explain what the portal was. Some of them didn’t even use technology at all, so we had to set them up with an e-mail. If there was time, we would teach them how to navigate their inbox. That was a new experience for them.” (program coordinator, Site 2) |
| Routing patients’ messages |
“I know we get some messages.… If the volume went up, the monitoring of the inboxes would have to shift over to a clinical person or we would have to hire someone.” (clinic manager, Site 1) “… Now you have two different ways of doing things because you have patients who are on Portal and patients who aren’t on Portal… You have an extra workflow to figure out.” (program coordinator, Site 1) “The MAs have to read them all then re-forward those important messages to the doctors and then the doctors read it.… They [clinicians] are not actually complaining about the message, like responding to the message, they just complain a little bit about too many messages.” (program coordinator, Site 5) |
| Rethinking meaningful use |
Limits to portal access and usability |
EHR vendors “It’s like nobody [at portal vendor] looked at how to use the Internet when they designed it [the portal].” (executive, Site 4) “The products are just not there yet. It’s definitely been tough for us.” (executive, Site 3) Patients “A lot of our patients in the safety net… Most of our patients are Hispanic. They would get on the portal and say, I don’t know what it’s saying.” (clinic manager, Site 1) “… 90% of our patients are native-Chinese speakers. So it’s a really big problem for our next step if we want to activate more features or we want to encourage more people to really use the service.” (program coordinator, Site 5) “I think the biggest issue is Internet access at home. A lot of them just don’t have it.” (front-line staff, Site 2) “A lot of [patients] don’t have computers. A lot of them don’t have internet at home.… A lot of the patients that don’t really like Internet or don’t really like to give us a lot of information, they’re very private.…” (front-line staff, Site 1) “Some patients wouldn’t use it because they want the social interaction [at the clinic]; this clinic has a higher homeless patient population that likely doesn’t have access to computers.…” (nurse, Site 4) |
