Improving access and communication of rural cancer patients through enhanced usage of patient portal.

292 Background: Oncology patients living in medically underserved areas are at increased risk of care gaps due to limited communication with their care teams –often stemming from low utilization of the patient portal CareSpace, our EMR's two-way patient portal. These gaps can lead to missed provider communications, missed appointments, and limited access to medical records. Notably, 45% of patients were listed as having declined portal invitations, often without fully understanding the portal’s benefits. To address this issue, we aimed to quantify the number of patients in "declined” status and implement targeted quality improvement interventions at multiple points of care, with the goal of reducing the “declined” status to 35%. Methods: Three Plan-Do-Study-Act (PDSA) cycles were conducted to identify and address the causes of low CareSpace utilization focusing on the functionality of the CareSpace invitation tool and the performance of our Patient Support Services (PSS) staff. Results: PDSA 1: Analysis revealed that patients were automatically assigned to “declined” status if no email address was entered into the system. To address this, we disabled the automation process. PDSA 2: We implemented a new workflow in which email addresses were collected at the referral stage, allowing the Central Referral Office team to automatically send CareSpace portal invitations. PDSA 3: Further analysis showed that new patient packet forms were missing a designated line for email addresses, and that PSS staff were inconsistent in collecting email data and sending invitations. With support from departmental leadership, we revised the patient intake forms to include an email address field and reinforced training for the PSS team to ensure consistent verification and invitation practices. The removal of the automated “declined” designation in PDSA 1 led to an immediate drop in patients listed as “declined,” from 45% to 36%. Following PDSA 2, the rate decreased further to 32%, surpassing our initial target. Finally, the improvements implemented during PDSA 3 reduced the “declined” status rate to 28% (From x to y patients). Conclusions: We identified key barriers within both the CareSpace app and the PSS workflow, and addressed them through three PDSA cycles with input from all stakeholders. As a result, we reduced the proportion of patients in “declined” status to 28%, surpassing our initial goal of 35%, and generating interest in similar initiatives across the organization. These interventions significantly improved patient portal enrollment, particularly in medically underserved areas. Barriers and Next Steps: One ongoing challenge is that portal invitations expire after 48 hours. To address this, we are partnering with our Business Intelligence team to develop an automated bot that will periodically resend invitations. This solution is expected to further reduce barriers to portal adoption and enhance access to care.