Behind Epic’s Award-Winning MyChart Patient Portal Advancements

MyChart Keeps Paces with Provider & Consumer Demands

In 2020, Epic relaunched MyChart with a reimagined process for how patients might interact with technology to manage their healthcare. In the past, the tool was static and relied on the patient to navigate and coordinate the different things they had to do to manage their own healthcare journeys.

“For a while, the focus was building out those core capabilities that every patient needed, but as time went on, there's a ton of different things that you might need to do as you interact with the healthcare organization,” Trevor Berceau, a product development lead at Epic who was instrumental in the redesign, explained during the interview.

MyChart now orchestrates the digital experience around the patient-user, Berceau explained. For example, instead of assuming a patient knows to book a referral, the tool pushes that prompt to the top of the page to help the patient handle it first.

Epic has also focused on how it can design MyChart to keep up with the connected health tools more and more patients are using.

That aids the company’s mission to help patients take care of themselves in between visits, ideally moving the needle on clinical outcomes. By flagging chronic medical conditions within the tool, promoting prescribed patient education content, and offering care management advice on its own, the patient portal is being leveraged far beyond the patient data access functions it was originally built on.

And that approach has been pretty successful for Epic’s clients, Bina said. At the Louisiana-based Ochsner Health, a home monitoring program hosted on MyChart yielded a 33 percent reduction in emergency department visits, he reported. Baptist Health in Kentucky saw a similar reduction in blood pressure after enrolling patients on a MyChart hypertension management program as they estimated they’d have seen from starting a new medication.

Frankly, it hasn’t been hard to conceive this level of innovation, Berceau conceded. Creating isn’t the hard part.

“We have no shortage of ideas,” he stated. “The limitation isn't what are the things that can be dreamed up with 185 million active MyChart users, including pretty much everyone here at Epic. There are always different ideas coming into the pipeline. But as we look and try and figure out which things are going to make the biggest impact, where do we spend our time?”

Epic consults with its customer and patient-user base to prioritize new concepts. In some cases, the vendor is able to connect with a customer’s patient and family advisory council (PFAC), and it also has its own advisory council of patients for usability testing and surveying.

“As we look to prioritize, we take a lot of those things and then look to distill down where we can potentially line up some of these different interests to make the biggest impact,” Berceau said. “An area that we put a ton of focus on several years ago was that self-service arrival space. And that was a great example of something that is good for healthcare organizations and good for patients.”

To be clear, Epic said it knows patients still want a personal touch in healthcare, but it sees its technology as supporting personalization at the point of care.

“We do see the in-person experiencing experience changing a lot,” Bina said. “The patient is doing a lot more of the documentation, especially pre-visit, so not having to go away to the registration desk, then go check in, and then have a start-from-scratch conversation with a nurse about your past medical history.

“Instead, the patient's doing a lot of that work upfront so that the time at the clinic is much more focused on communicating with the clinician who’s caring for them.”

Patient relationships with health technology are set to evolve yet again, this time with the insurgence of generative AI and large language models. Like the rest of the health tech space, Epic is keeping an eye on these trends and how they will affect their patient-facing tools.

Epic Dips Its Toes in the AI Waters

Epic hasn’t been immune to the impact generative AI and large language models have had on the world. According to Bina, the company is embracing these tools to enhance its technology capabilities.

“We're absolutely using both NLP technology and large language models to help support and improve the ability for patients to do messaging with their clinicians, and it happens on both sides of the equation,” he said. “Large language models are a real key to managing messaging volumes and improving the speed in which we can communicate back to patients.”

When a patient sends a message over MyChart, the tool can extract information and make sure it gets the right prioritization or is sent to the right person. For example, if the message is sent in Spanish, it is directed to a translator before being sent to a provider.

The tool can also use large language models to generate a response using the information the patient provided and appropriate context. Clinicians review the response before sending it out and have the option to edit.

In another enhancement, Bina said Epic is using LLMs to interpret free text in MyChart’s SMS test messaging options. For example, if a patient received an SMS appointment notification, they previously would’ve only been able to respond with select options. With the LLM in place, patients can enter free text such as, “Tuesday afternoons work best.” Patients then get a human-generated response showing the different Tuesday afternoon appointments that are available.

At the crux of these functions is provider or human review, Bina said.

“We use the large language models to digest the information the patient's sending, but not to do the answering,” he emphasized. “We don't want it to hallucinate an available time for the patient. Instead, we use our own structures and supports to then say what times are going to be available from there.”

Human review is not just about quality control, Berceau added.

“As a developer, we are really excited to work with large language models, but a key part of it part has been the responsibility, ethics, and safety of, how do we do this well?” he stressed. “With the generated message responses, there's that step of the clinician reviewing it.”

All of this folds into creating a better patient experience, the pair agreed. Studies not affiliated with Epic have found that patient-facing chatbots that leverage generative AI can give patients good health information and can even do so with empathy.

When AI is integrated into provider-facing EHRs, like through ambient documentation, it leaves the provider free to have a more meaningful connection at the point of care, Bina said.

Still, for all of the technological advances Epic has pursued, Bina and Berceau said the company remains fixed on the question of tech equity in healthcare.

Epic Stresses Accessibility in ‘Tech-quity’

Although the patient portal has been viewed as the bedrock of patient engagement technology for nearly a decade, there are steep divides in who uses the tool. In January 2023, ONC reported that despite high overall adoption levels, patient portal use is lower in populations of color. That trend is likely driven by Black and Hispanic patients getting fewer nudges from providers to use the tool.

The solution to that problem in many ways lies with the provider—equitable adoption will come with equitable engagement—but that doesn’t mean Epic isn’t focused on health equity.

Berceau noted that MyChart is designed with health and digital health literacy in mind; every patient-facing tool that Epic makes goes through a health literacy review, and the vendor targets a fourth-grade reading level. That’s on top of the 12 out-of-the-box translations Epic offers.

“We also pay a lot of attention to accessibility, so people who maybe have limited vision impairment or other things like that who rely on screen readers. We support many different platforms for operating system screen reader combinations,” Berceau added.

Epic is able to make these designs by getting insights right from the source, Berceau continued.

Every developer at Epic must complete what the vendor calls immersion, where they are required to spend several days each year on-site watching people use the software they build. In the accessibility realm, specifically, Epic has worked with patient and provider users with visual impairments to better learn how to make its tools functional for all populations.

The vendor looks at big-picture metrics, too, Bina explained.

“We do constantly track and monitor usage across the entire community of patients and look at different usage patterns across different populations,” he noted.

“Whether we're looking at it from a Social Vulnerability Index, an ethnicity perspective, or an age perspective, that helps us target. If we see that there's a big difference between how a different age group might be using MyChart or their effectiveness of using it in certain scenarios, then that allows us to focus our usability testing and analyze the things that we can be doing better for that specific group.”

Despite its focus on usability and accessibility, Epic knows there is more consumer demand for patient portal use than organizations often give their patients credit for. Some of the vendor’s customers have seen patient portal adoption rates surge from 30 or 40 percent up to 90 percent simply by asking every single patient if they want to use the tool.

“What that really showed was that we oftentimes underestimate patients’ abilities to be able to take advantage and use this technology once they know that it's available,” Bina stated. “We've been actively working within the application to create the kind of tools, education, and learning to help patients become increasingly sophisticated users of the system.”

And with those users, the outcomes should be on the horizon, Berceau said, noting that Epic is already seeing the fruits of its labors on building a solid base of patient portal functionality.

“It does feel like we're at an inflection point where the capabilities are there. We're seeing that increasing adoption, we're seeing those success stories on the clinical side, and seeing huge success stories on the convenience and access side, too,” he concluded.

“Seeing all of these pockets of success, we're right on the brink of groups really starting to understand how do they take these technology pieces that are now available and use them to shift how care is delivered. We're past the digitization and we're past the trial period with this technology. We're seeing proven outcomes that it works, and we're going to see the floodgates open with people really transforming what they're doing with healthcare.”