The Pandemic, the Patient Portal and a Pachyderm: 2 years later @uchealth

How do you fit a curve to your theories? Come along as CT tries to convince you that he’s right…

Over the past 2 years, our lives have been topsy-turvy. Here’s my previous post from April 2020 on the percent of patients using our My Health Connection portal at the beginning of the pandemic.

To be clear, the graphs I’ll be showing today indicates the percent of patients being seen each month at UCHealth, across all of our hospitals and clinics, who have an active My Health Connection (our brand of MyChart) patient portal account.

The tail end of the curve in March 2020 showed a dramatic uptick. So, what happened since then? In that 2020 post, I showed the March uptick in Patient Portal signups, anticipating an ongoing bump in patients. We believe this was mainly (back then) about connecting with the doctor, learning about and using Video (Virtual) Visits to see the doctor/provider since we were in the process of shutting down in-person clinics due to the pandemic.

March 2020: patients on uchealth’s portal

Of course we know what happened next: an explosion of video visits (see previous post), then the availability of COVID testing, and later the availability of COVID vaccines, all of which were easier to request and obtain via the Portal.

In the graph below, we extend our original graph and add the months following March of 2020. I think we can agree that there was a steeper increase in patient portal signups below. Specifically the months between April 2020 to April to 2021, the curve looks different. And then, following April 2021, the curve appears to change again. How do we make sense of this?

Jan 2019 – Jan 2022 patients on the portal

One way to think about this to apply a logistic regression. I’m both too unskilled and also too lazy to attempt that. Here is my powerpoint-low-tech version, where I’ve simply pasted a line on top of the graph. Are you convinced? Do you agree that April 2020 to April 2021 shows a divergent signup rate, and that after April, the signup rate has returned to some sort of “inevitable baseline growth rate”?

Theory #1: the elephant and the boa

As an aside, the curve above actually looks like that brilliant drawing by The Little Prince of an elephant swallowed by a boa constructor. Thus, the pachyderm.

Okay, back to our pseudo-analysis. Here is an alternate set of lines: maybe we just accelerated our patient portal signup for a year, and then hit our theoretical maximum at 86% of the population in our region being on the portal and there is no one else coming in, after April 2021?

Theory #2: The plateau

Sure! That looks like a better fit, right?

OR, could it be that BOTH are the case, an immediate acceleration of patient portal signups in March/April 2020, sustained increase for the year that encompasses: video visits, COVID testing, COVID vaccines, THEN a leveling off of portal signups since then?

Theory #3: Fun with more lines

Another side observation: In the headlong rush for patients signing up for our online portal service, I’m personally finding more patients who “have an active portal account” who have not seen messages I’ve sent to them. I believe there is a growing fundamental problem here with several possible causes:

  • Patients who signed up for the portal because of Covid testing or vaccine, but who otherwise do not have interest in communicating online
  • Patients whose FAMILY MEMBER or FRIEND signed them up (maybe even with the friend’s email address) just to get a Covid test or vaccine or monoclonal treatment
  • Patients who have changed email addresses (we know from previous work before the pandemic that up to 20% of patients may not be reachable at their given email address the next year)

Three Stories

Three stories, three sets of arbitrarily drawn lines. I also know that our data scientists are skilled enough to be able to do the math to justify any of these power-point-line drawings.

CMIO’s take: Now that we are seeing a dramatic drop in cases from our Omicron surge, and our hospitals are down below 100% census for the first time in TWO YEARS, we can now sit back and do some armchair theorizing. And then plan for our next chapter. Which do YOU think it is? Let me know.

Author: CT Lin

CMIO, UCHealth (Colorado); Professor, University of Colorado School of Medicine

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