Check-In Check-Up: Analyzing and Improving Pre-Appointment Engagement in a Primary Care Clinic at UVA Health System; From Fragmentation to Integration: How Government Intervention Shapes Medical Record Utilization

Medical records are a critical component of a nation’s healthcare system, yet inefficiencies persist due to both technical limitations and social barriers. These inefficiencies undermine effective use of medical records and hinder patient outcomes, leading to poor overall healthcare. My technical project focuses on a specific patient portal within the UVA Health System, examining how patients engage with electronic medical records (EMRs) before appointments. This project addresses technical and behavioral aspects of medical record utilization by identifying barriers to engagement and proposing strategies to improve the user experience. It contributes to solving the broader problem by offering tangible improvements to how digital health tools are used in a real-world clinical setting. My STS paper expands the scope of the problem by investigating how national level factors shape the adoption of medical records. Through a comparative analysis of developed and developing countries, I explored how government intervention, through technological infrastructure, government policies, and cultural readiness, impacts utilization of medical record systems. This project relates to the broader issue by revealing how various technical and social factors influence the success of medical record keeping systems across different nations.
For the technical paper, the problem that was investigated was how to increase patients’ pre appointment engagement in a primary care clinic in the UVA Health System. Pre-appointment engagement, like electronically checking-in (eCheck-In), is essential in ensuring better care, increasing appointment efficiency, and improving patient satisfaction. The study investigated strategies to improve patient engagement with the patient portal by analyzing usage barriers, pre visit questionnaire completion, and the impact of provider messaging. Six years of data were analyzed to track eCheck-In completion rates and demographic trends. Additionally, a survey was conducted at the clinic to assess patient comfort with digital tools, patient portal usage, and preferences for check-in methods. Short interviews with both patients and providers were also conducted to gain insight into their experience with the patient portal. It was concluded that there was a significant difference in pre-appointment engagement and eCheck-In completion rates when personalized messages were sent out to patients by their providers. Additionally, insights gathered from in-person interviews and the survey concluded that there are three recurring barriers to eCheck-In adoption: redundancy in the check-in process, discomfort with mobile access, and usability frustrations.
My STS paper worked to address the discrepancies in medical record keeping in developed versus developing nations. I worked to determine why there is a vast difference in the utilization of medical record systems by conducting a case study comparing their use in sub-Saharan African and Nordic countries. This was essential because the severe lack of utilization in developing nations like sub-Saharan Africa has led to poor healthcare outcomes. To do this I analyzed policy reports, academic literature, and public health data. I determined that government intervention in the form of a technical, organizational, and cultural aspect influences the utilization of these systems. Specifically, technical infrastructure, government policies, and cultural readiness all influence how effective and accessible medical records are in these nations.
Overall, I contributed to addressing inefficiencies in medical record systems through my STS and technical projects. By giving solid recommendations to a primary care clinic, we were able to address the problem of a lack of pre-appointment engagement with EMRs. To address low questionnaire and eCheck-In completion rates, we proposed personalized batch messaging, eliminating redundant in-person check-ins, increasing patient portal app awareness, and piloting an educational program to build digital adeptness. While effective for our clinic, a limitation was the scalability of our recommendations, so future research should explore how our recommendations can be applied across different institutions. Furthermore, my STS paper addressed three aspects of medical record utilization. First, governments should invest in stable electricity, internet expansion, and affordable digital tools for healthcare providers. Second, developing nations can benefit from targeted government policies that focus on funding, training, and regulation. Finally, governments should support culturally tailored EMR systems, public education campaigns, and strong data security measures. While these are actionable recommendations, a limitation was that variations within developing nations themselves mean that a one-size-fits-all approach may not be applicable, and further research should explore country-specific solutions.
I would like to extend my gratitude to Professor Caitlin Wylie for her invaluable guidance on my STS paper. I am also grateful to my peers and classmates, whose thoughtful feedback shaped the many iterations of my paper. Additionally, I would like to express my appreciation to Professor Robert Riggs and my Systems Engineering capstone team for their hard work and dedication to the technical project.

School of Engineering and Applied Science
Bachelor of Science in Systems and Information Engineering
Technical Advisor: Robert Riggs
STS Advisor: Caitlin Wylie
Technical Team Members: Katharine Chandler, Jamal Chouffani, Anna Girerd, Meredith James, Luke Kemmerer