Check-In Check-Up: Analyzing and Improving Pre-Appointment Engagement in a Primary Care Clinic at UVA Health System; Investigating the Growing Demand for Employer-Provided In Vitro Fertilization (IVF) Coverage in the Post-Roe Era of Reproductive Healthcare

The University of Virginia Health System’s Epic-powered patient portal, MyChart, empowers patients to manage appointments, view records, and complete pre-visit tasks like eCheck-In. However, at UVA University Physicians Clinic in Charlottesville, Virginia (UPC), usage remains inconsistent, limiting MyChart’s potential to streamline care and enhance the patient experience. My technical project investigates barriers to two specific forms of pre-appointment engagement: eCheck-In and the Medicare Annual Wellness Visit (AWV) questionnaire. Using a mixed-methods approach—EMR data analysis, patient and provider surveys and interviews, and field observations—we identified three key barriers: redundancy in the check-in process, discomfort with mobile technology, and usability issues for older adults.

To address these gaps, we proposed a multi-pronged strategy. First, we evaluated a personalized messaging intervention implemented by one of the providers, which increased AWV questionnaire completion rates by 18.6%. Second, we recommended a conditional batch messaging system with provider-authenticated reminders to patients through the EMR system and geolocation-based mobile check-in to reduce front-desk congestion. Finally, we proposed a volunteer-led education pilot program where UVA students assist patients with navigating the MyChart patient portal, particularly targeting older adults or those less comfortable with technology.

Together, these efforts aim to boost MyChart usage at the UPC, improve clinical workflow, and enhance the patient experience. These interventions offer not only immediate benefits for UPC but also a scalable model for increasing EMR engagement across the broader UVA Health System and other institutions. By blending personalized provider outreach with patient-facing digital education, this project highlights how simple, thoughtful interventions can have an outsized impact on patient-centered care.

In the wake of legal decisions such as the 2024 Alabama Supreme Court ruling classifying frozen embryos as legal persons and the overturning of Roe v. Wade (1973), access to in vitro fertilization (IVF) has grown increasingly uncertain—especially in states with restrictive reproductive policies. My STS research project explores whether employers should provide IVF coverage to address emerging disparities in fertility care. Applying the Social Construction of Technology (SCOT) framework alongside feminist critique, I argue that IVF is shaped not only by medical efficacy but also by political, institutional, and socioeconomic forces that determine who can access it.

SCOT reveals how various social groups—patients, clinicians, lawmakers, employers, and insurers—contest the meaning and use of IVF. For some, IVF is essential reproductive care; for others, it is elective or ethically fraught. Through the feminist critique framework, drawing on Michelle Murphy’s Seizing the Means of Reproduction, I highlight how contemporary debates around IVF reflect long-standing struggles for reproductive autonomy, where access is stratified by race, class, geography, and employer policy.

Through a comparative case study of Alabama and New York, I show how state-level laws and corporate practices shape divergent reproductive landscapes. In Alabama, IVF access was abruptly halted due to embryo personhood rulings. In contrast, New York mandates IVF coverage for many insurance plans and supports legislative efforts to expand access. I also examine corporate initiatives which support fertility treatments, such as those at Southwest Airlines and Bain & Company, which demonstrate that IVF coverage can be financially viable and socially transformative.

Ultimately, I argue that employer-provided IVF benefits are essential for ensuring equitable access to reproductive care, especially in an era of increasing legal uncertainty. These benefits not only support individuals in building families but also reflect broader commitments to diversity, equity, and inclusion in the workplace.

While my technical and STS projects tackle different aspects of healthcare—one focusing on patient portal engagement and the other on reproductive rights—they are united by a common goal: empowering patients through better access and support. My technical work seeks to enhance the usability and impact of MyChart, a digital health tool that could be especially valuable for patients undergoing complex treatments like IVF. My STS project, meanwhile, critiques the structural barriers that limit access to IVF in the first place, particularly for patients who lack insurance or employer support.

Together, these projects underscore the need for systems-level thinking in healthcare. A patient pursuing IVF might use MyChart to schedule appointments, track hormone levels, view lab results, and message their provider. However, if the portal is underutilized due to design flaws, lack of awareness, or limited mobile access, the patient may miss critical updates. Similarly, if a patient’s employer does not offer IVF benefits, the financial burden imposed by paying for IVF out-of-pocket may prevent them from accessing care at all.

These dual lenses—technological and institutional—demonstrate how digital infrastructure and workplace policy jointly shape healthcare experiences. The EMR system can streamline and personalize care, but only for patients who can afford and access the treatments it supports. MyChart cannot substitute for affordable IVF coverage, but it can complement it—making care more navigable, timely, and empowering.

Ultimately, these projects advocate for a healthcare system that is not just efficient but equitable. By enhancing both the tools patients use and the structures that determine access, we can build a model of care that meets people where they are and supports their full spectrum of needs—reproductive, technological, and beyond.

School of Engineering and Applied Science

Bachelor of Science in Systems Engineering

Technical Advisor: Robert Riggs

STS Advisor: Joshua Earle

Technical Team Members: Jamal Chouffani, Anna Girerd, Meredith James, Luke Kemmerer, Megan Spillane