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Improving patient portal enrolment in an academic resident continuity clinic: quality improvement made simple
  1. Courtney Rhudy1,
  2. Jane Broxterman1,
  3. Sara Stewart2,
  4. Victoria Weaver2,
  5. Cheryl Gibson2,
  6. Caylin Shankweiler1,
  7. Branden Comfort1,
  8. Becky Lowry1
  1. 1 Department of General Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
  2. 2 Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
  1. Correspondence to Dr Courtney Rhudy, Department of General Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA; crhudy{at}


Electronic health record patient portal usage has been associated with improvement in chronic disease parameters, patient functional status and patient satisfaction. Our institution’s patient portal is a secure, online health management tool that connects patients to portions of their electronic health record.

Our quality improvement project aimed to increase patient portal enrolment significantly in our Internal Medicine resident patient panels.

This study was conducted in a large, multisite health system in Kansas City, Kansas that serves a diverse patient population. Our clinic includes 65 resident patient panels. We followed a subset of 16 resident patient panels in this quality improvement project. A baseline audit showed that 35% of the 1628 patients in these panels were enrolled in the patient portal system. A standardised, nurse-initiated portal sign-up process following patient rooming was implemented. Initial results indicated a 9.6% increase in patient portal sign-up at the end of the first 4-week cycle. We then implemented educational sessions for our clinic nurses as well as attending physicians, and achieved a 15.1% increase from baseline to the end of the second 4-week cycle, resulting in 86 patient portal activations (p<0.01).

Resident physicians worked with clinic nurse partners in two formats for this project. Nurses assigned to patient rooming for residents during the clinic sessions being studied (rooming nurses) initiated the portal sign-up process. Nurses assigned to partner with the resident for longitudinal patient care management, anchor nurses, worked with residents on items such as phone messages or portal messages. Semi-structured interviews of the four anchor nurses aligned with the 16 residents were conducted at the end of the study and revealed that nursing staff perceived increased patient portal activity to be associated with a decrease in nursing workload and an increase in patient engagement.

  • ambulatory care
  • quality improvement
  • patient satisfaction

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  • Contributors BL and CR: initiated the project. BC, BL, CG, CR, CS and JB: study design. BL, CS, JB, SS and VW: performed the literature review. CG, CR and CS: designed the data collection tools. BL, CR, JB and VW: completed the abstract. CG: completed the nurse interviews; designed and conducted the statistical analysis, and wrote the strategy and results sections. CR and CS: facilitated the nursing surveys. BC, BL, CR, JB and SS: manually collected data regarding portal sign-ups weekly during cycle 1. CS: collected and managed the computerized data. All authors reviewed/edited all sections of the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval According to the Kansas University Medical Center (KUMC) Human Subjects Committee, this work met criteria for quality improvement activity exempt from ethics review.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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