Check-In Check-Up: Analyzing and Improving Pre-Appointment Engagement in a Primary Care Clinic at UVA Health System; An Analysis of EMR Design, Application, and Improvements to Aid Medical Providers in the War Against Professional Burnout

“I spend so much time in MyChart, both in and out of the clinic, and have found that our current systems are incredibly inefficient.” This paraphrased quote by Dr. Kim Dowdell, my capstone team’s client at the University Physicians Clinic, sparked the genesis of both my technical and STS projects. It occurred to me that while we could analyze opportunities for growth and engagement in electronic medical record (EMR) systems like MyChart through the technical project, without examining the impact of these systems on both patients and providers, my work as a whole would be incomplete. This revelation made my collective project sociotechnical, guiding my findings and allowing the STS and technical projects to influence each other.

The technical portion of my thesis found that personalization in the medical field is critical, particularly for eCheck-In and Annual Wellness Visit (AWV) questionnaire completion. When patients understand the uses of patient portals, they are more likely to use them, however, patients still appreciate human interaction, especially when learning, and could benefit from a pilot program that not only enrolls them in MyChart, but educates them on its many uses, including its eCheck-In capabilities. Additionally, when Dr. Dowdell messaged her patients directly, telling them to complete their AWV forms online, her pre-appointment completion rate increased by a statistically significant 19%. Our findings indicate that personalized batch messaging can increase AWV questionnaire completion rates and make AWVs more efficient, thus keeping the clinic on schedule and reducing time spent in EMRs by providers.

In my STS research, I analyzed the connection between EMR systems and provider burnout. Drawing on the STS framework of user configuration, I provided recommendations for broad changes such as incorporating provider needs more directly into EMR design and establishing a mandatory usability oversight board for new features. Additionally, I proposed quick fixes in EMR systems such as adding tools to assist providers in frequently performed tasks. My research also indicated that usability challenges persist among specific demographic groups and medical specialties, and designers should focus on these areas to ensure the long-term sustainability of the medical field. I hope that these recommendations, when implemented, will reduce provider burnout, improve patient safety and satisfaction, and enhance the overall medical experience.

Understanding the intersection of these projects proved vital. My research into how EMR systems lead to burnout among providers allowed me to ensure that the ideas, analyses, and recommendations developed through the technical project will truly support not only Dr. Dowdell but the entire UVA Health System. Through these projects, I’ve come to understand that my influence as an engineer doesn’t end with the designs and creations I make. As an individual, I have the ability to change, for better or worse, the lives of those who use my designs. It is thus imperative that I act to benefit the good–reducing provider burnout and improving clinic efficiency–while mitigating as many burdens as possible. Ultimately, the research I’ve done on provider burnout and EMR fixes has benefited my technical project, and my hands-on work in the technical project has benefited my understanding of the STS project. This combination has created a perfect storm, allowing my collective work to best support the advancement of the UVA Health System.

I would like to give special acknowledgements to UVA Professor Robert Riggs, Dr. Kim Dowdell, my capstone team, and my family for their unwavering support.

School of Engineering and Applied Science

Bachelor of Science in Systems Engineering

Technical Advisor: Robert Riggs

STS Advisor: William Davis

Technical Team Members: Katharine Chandler, Megan Spillane, Jamal Chouffani, Anna Girerd, Meredith James