Primary Care Provider MyChart Patient Advice Request Message Gender-Specific Workload at the University of Vermont Health Network

Background: The utilization of MyChart messaging has improved the accessibility of primary care with the convenience and flexibility of communication. However, providers receive little reimbursement despite an increased workload from patient advice request messages. Female primary care providers receive more medical questions and experience a higher in-basket workload. Increased time spent on the EHR is correlated with increased provider burnout rates. Thus, the larger EHR burden on female providers exacerbates burnout rates and the gender-based wage gap in primary care. Methods: Signal data from Epic was obtained from primary care providers who received patient medical advice requests. This data were analyzed using excel. Key Results: Female providers received more patient medical advice request messages than non-female providers (mean-Female(F) = 68.28 messages, mean-Non-Female (NF) = 49.22 messages, p=0.005) and spent more active time in their in-baskets (mean-F=1.85 mins/day, mean-NF=1.35 mins/day, p=0.006). Female and non-female providers had equivalent turnaround times for these messages (mean-F= 2.61 days, mean-NF = 2.25 days, p=0.68). Staff handling of messages did not differ between female and nonfemale providers. Discussion: Female-identifying providers receive significantly more patient medical advice question messages and a have a subsequent larger message workload than their male colleagues. Future analysis should include providers’ patient demographics to identify correlations between higher message load and patient panels. Workflow support and patient messaging guidelines should be considered to alleviate the unpaid workload associated with higher message volume. References: 1. Huang M, Fan J, Prigge J, Shah ND, Costello BA, Yao L. Characterizing Patient-Clinician Communication in Secure Medical Messages: Retrospective Study. J Med Internet Res. 2022;24(1):e17273. doi:10.2196/17273 2. Hoonakker PLT, Carayon P, Cartmill RS. The impact of secure messaging on workflow in primary care: Results of a multiple-case, multiple-method study. Int J Med Inform. 2017;100:63-76. doi:10.1016/j.ijmedinf.2017.01.004 3. Rittenberg E, Liebman JB, Rexrode KM. Primary Care Physician Gender and Electronic Health Record Workload. J GEN INTERN MED. 2022;37(13):3295-3301. doi:10.1007/s11606-021-07298-z 4. Rotenstein L, Gitomer R, Landon B. Pursuing Gender Equity by Paying for What Matters in Primary Care. New England Journal of Medicine. 2023;389(3):198-200. doi:10.1056/NEJMp230128

Rehabilitation of a Patient with Diabetic Myonecrosis: A Case Report

Setting: Inpatient rehabilitation unit at a university hospital Patient: 37-year-old male with diabetic myonecrosis. Case Description: The patient had a long-standing history of uncontrolled diabetes mellitus with multiple comorbidities, including end-stage renal disease on dialysis and diabetic myonecrosis of the left biceps femoris diagnosed by biopsy and magnetic resonance imaging (MRI.) On this admission, he presented with right leg pain and swelling, found to be a reoccurrence of diabetic myonecrosis in the vastus lateralis, medialis, and intermedius, diagnosed by MRI only. Prior to admission, he lived alone in a wheelchair inaccessible duplex and required minimal assistance with housekeeping. Assessment/Results: Upon initial consultation, he ambulated 25-50 feet at a minimum assistance level with a single point cane. As he was unsafe to return home alone, he was transferred to inpatient rehabilitation after a two week acute hospitalization. During his rehabilitation stay, he increasingly was unable to tolerate standing secondary to pain, and at discharge, he was non-ambulatory despite many attempts at pain control and assistive devices for ambulation. His right leg swelling persisted throughout his stay. After five weeks on our unit, he was discharged to a long-term care facility at a wheelchair independent level. One year later he still was not ambulating, and still lived in the long-term care facility. Discussion: Diabetic myonecrosis is an uncommon complication of both insulin-dependent and non-insulin dependent diabetics. Symptoms usually resolve on their own with rest and analgesics within weeks to several months. There are reports of physical therapy prolonging the recovery period and exacerbating symptoms, which may have happened with our patient. Conclusions: Download poster

MyChart Messaging: Patient Preferences about Timing of Provider Responses to Medical Advice Requests

Background: Patients frequently utilize portal messaging to reach their healthcare provider.1 This mode of communication allows for greater patient engagement in health concerns.2 MyChart messaging has grown recently, increasing physician workload.3,4 Understanding patient preferences for MyChart messaging may improve patient communication, potentially decreasing the response burden on physicians. Methods: A 12-question REDCap survey was sent via MyChart message to 31,502 patients in 8 UVM Health Network (UVMHN) affiliated adult primary care and family medicine practices. Survey data were analyzed in excel. Key Results: The survey was completed by 2011 (6.4%) patients, with 77% of respondents having used MyChart to ask their provider a question. MyChart messaging is always or often (69.1%) the first method patients use to contact their healthcare provider with 22% submitting urgent concerns. There is a significant association between when a patient prefers to receive a message and the time it takes providers to respond to their message (p \u3c 0.001). On average, patients would prefer to not restrict MyChart messaging to business hours. Discussion: Patients prefer prompt message responses from their providers and providers are meeting this preference. Future work could better observe the relationship between provider response time and patient preferences for physician response time. Data from Epic should be analyzed to determine if patient perceptions align with MyChart message records. Other efforts should include educating patients about appropriate messages to send via MyChart, or if a phone call is warranted. 1 North F, Luhman KE, Mallmann EA, Mallmann TJ, Tulledge-Scheitel SM, North EJ, Pecina JL. A Retrospective Analysis of Provider-to-Patient Secure Messages: How Much Are They Increasing, Who Is Doing the Work, and Is the Work Happening After Hours? JMIR Med Inform. 2020 Jul 8;8(7):e16521. doi: 10.2196/16521. 2 Avdagovska M, Ballermann M, Olson K, Graham T, Menon D, Stafinski T. Patient Portal Implementation and Uptake: Qualitative Comparative Case Study. J Med Internet Res. 2020;22(7):e18973. 3 Arndt BG, Beasley JW, Watkinson MD, et al. Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations. Ann Fam Med. 2017;15(5):419-426. 4 Laccetti AL, Chen B, Cai J, et al. Increase in Cancer Center Staff Effort Related to Electronic Patient Portal Use. J Oncol Pract. 2016 (12):e981- e990

21st Century Cures Act: Patient Perceptions on Open Information Sharing in Vermont Primary Care Clinics

Introduction: The 21st Century Cures Act federally mandated the release of progress notes, laboratory test results, and radiology/pathology reports to the patient’s electronic health record (EHR) portal. This study investigates patient perspectives on shared notes and addresses provider concerns about patient uptake due to potential factors like worry, confusion, and distress at the University of Vermont Medical Center. Materials and Methods: An electronic cross-sectional survey was designed and distributed to 7,240 eligible patients, adults who logged into MyChart on Epic and had an outpatient/telemedical visit at either the Colchester Family Medicine and South Burlington Primary Care locations in Vermont within one year prior to the study. Results: The survey response rate was 4.6%. Of the respondents, 90% agreed that the use of shared notes is a good idea, 76% found accessing notes easy, and 2% felt more worried about their health because of shared notes. 89%, 85%, and 82% of respondents found visit notes important for understanding their health, remembering their care plan, and feeling in control of their care, respectively. Conclusions: Based on this survey, provider concerns about patient stress may be overstated, as patients appear to benefit from shared notes through increased engagement with their health, communication with providers, and adherence to care plans

Provider Perspectives on Language Barriers in MyChart Enrollment for Patients with Limited English Proficiency

Background: There are 25 million people in the United States with limited English proficiency (LEP). Patients with LEP are a vulnerable population who may have worse health outcomes compared to English-proficient patients, as they face barriers to safe, effective, and high-quality care. Previous studies show this population is likely to benefit from utilization of patient portals, which allow users to access personal health information and communicate with healthcare providers. Current literature reports that patients with LEP and their families have a strong interest in using the patient portal as it can help them understand their providers and health, remember their care plan, and have more control over their health. However, there is less portal access and utilization among patients with LEP. This study was conducted to obtain provider perspectives surrounding MyChart engagement of patients with LEP to identify potential barriers to MyChart enrollment at the University of Vermont Health Network (UVMHN). Methods: EPIC’s Slicer Dicer tool was utilized to obtain UVMHN patient counts organized by reported language and MyChart activation. Data was collected from an anonymous REDCap survey sent to 211 providers within UVMHN Departments of General Internal Medicine, Family Medicine, and Pediatrics, and analyzed utilizing Excel. Results: 67.9% of UVMHN Primary Care English speakers have MyChart activated compared to 46.9% of patients with LEP. Providers strongly believe that MyChart is beneficial to patients and families with 72.1% of providers agreeing that it improves the patient-provider relationship. When asked specifically about patients with LEP, 36% of providers agree that MyChart access is beneficial to care. 49% report they are likely to encourage MyChart enrollment to their patients with LEP; however, only 14% know how to assist in enrollment. Differences in knowledge of language services are seen in different visit modalities: 78.1% of providers report ability to provide language services during in-person visits compared to 48.8% for video visits and 46.3% for telephone visits. Once made aware of the differences in MyChart activation status between English proficient patients and patients with LEP, providers frequently requested more education around language assistance, MyChart activation instructions to provide patients in their dominant language, translation tools within EPIC, and training for support staff to also encourage patients with LEP to enroll in MyChart. Conclusions: While providers overwhelmingly believe MyChart is useful to patient care and are likely to recommend it to their patients with LEP, they lack the tools and education necessary to aid in equitable enrollment. Educational materials and translated resources should be created for providers to utilize in assisting their patients with LEP. A follow-up study with patients would provide an opportunity to compare patient and provider responses and gain additional perspectives on MyChart access and utilization

Recurrent Concussion, How Many is Too Many? Sport- Football

Please view the clinical abstract in the attached PDF fil