Screenshot of MyChart Spanish out-of-the-box. App offerings are on the left (communicate with your doctor, request refills, access test results, and schedule appointments) and a login username and password field is on the right. All the writing is in Spanish.

MyChart Spanish: online patient portal access

Exploratory and Strategic Research

Role: Lead Bilingual UX Researcher

Research Methods: Survey, Interviews, Usability Testing

Project Team: Cristela Daniel-Valdez, Eva Wong, Banning Hendricks, Hans VanDerSchaaf PhD., Anthony Cheng M.D.

Tools: Qualtrics, Figma, Webex

The Problem

The COVID pandemic heightened the need for digital healthcare options that allow patients to conveniently access virtual visits, schedule appointments, request medication refills, and message their doctor via digital health portals. Patient portals have the potential to enhance patient-doctor relationships, improve health status awareness, and may reduce hospital readmissions (Nicolás, Cook, et al.). However, OHSU patients with Limited English Proficiency (LEP) who speak Spanish do not have access to a digital health portal in Spanish, likely resulting in health access barriers, decreased agency in accessing healthcare services, and negatively affecting the patient experience. More than 100 research studies now show substantial health disparities between patients who access digital patient portals and those who do not (Carini, Villani, Pezzullo, et al.). We needed to research the operational needs to turn on Epic's MyChart Spanish at OHSU with the goal of improving patients' access, agency, and potential outcomes of their time and care.

Research Goals

To identify key elements of Epic's MyChart Spanish interface that would lead to an accessible and intuitive experience for Spanish-speaking patients (including text in the MyChart interface, as well as workflows and communications - clinical, administrative, etc.)
To uncover potential usability barriers and pain points with Epic's MyChart Spanish out-of-the-box and create recommendations for improvements
To inform a proposal for operationalizing MyChart Spanish

The Research Process

Image of person pointing at orange sticky notes on a whiteboard

What do we know?

Assessed the current workflow for patients with LEP
Studied what academic research data shows in regard to the potential implications that access barriers may have on patient health
We compared academic findings with internal patient data to gather potential differences in health outcomes for patients with LEP vs English-speaking patients
We spoke to other medical institutions that have MyChart Spanish and asked them to share their experiences from an administrative and operational standpoint
We assessed Epic's MyChart Spanish out-of-the-box and Epic team assessed what customizations are possible

Image of the MyChart Spanish webpage prototype on a Macbook Air

What don't we know?

Our internal Spanish-speaking representatives assessed MyChart's Spanish out-of-the-box content strategy and made recommendations for readability enhancements.
I tested the out-of-the-box MyChart Spanish and the language recommendations made with six patients to gather general impressions and assess possible pain points.
Because MyChart is an interface that Epic manages, I collected insights and presented recommendations for changes we had control over and the potential risks for the changes we could not make.

Doctor with stethoscope around their neck holding a cell phone

What are the opportunities and risks?

We collaborated on potential solutions to build on the present. For example, how could existing resources, such as Language Services, be leveraged?
We assessed needs and costs associated with operationalization, such as additional bilingual front desk and Epic support desk staff members
We assessed risks and came up with mitigation ideas for the potential increase of digital triage and patient-to-provider messaging
We explored implementation approaches (phased, vs. all services at once)
The team created an SBAR to request support and funding for operationalizing MyChart Spanish

Patient Interview and User Testing Insights

When patients cannot find what they need in Spanish, they call with the expectation that they will be on hold for a long time, or they request help from a family member or a friend
All patients reported some level of discomfort using interpreters, with concerns being incorrect or incomplete translations and the inability to choose the interpreter's gender (particularly for women), which validated the need for increased agency in accessing care
When seeing the interface in Spanish during usability testing, patients expressed gratitude and did not express concern if some of the text was in English
Although patients reported some text in English was okay, we noticed that 4/6 patients were unable to understand the bill due to incomplete page translations (gaps between out-of-the box translations and custom translations).
If patients message a provider in Spanish using the Spanish patient portal, they expect the provider's response to be in Spanish
80% of patients needed prompting to click on the out-of-the-box interface button that turns on MyChart Spanish. This is likely due to its small size and poor color contrast. This alone could potentially result in poor discoverability of the product.
Similarly, if they click to call on the support phone number, patients expected availability of support line staff that speaks Spanish.

Image of 'Ver en Español' link text on upper right hand corner of the MyChart log-in screen. Link text is blue on a blue background.

Link on log-in page to turn on MyChart Spanish

Blue graphic of tired person with bags under their eyes sitting criss-cross on while on the phone

Academic Research

Four charts showing decline in hospital admission, readmission, and emergency department visits after introduction of digital health portal. Last chart shows increase in number of outpatient visits.

(A) Hospital admissiona, (B) 30-day all-cause hospital readmissionb, (C) emergency department visitc, (D) number of outpatient visitsd.

Hospital readmission decreased after the introduction of a digital health portal (Nicolás, Cook, et al., 2018)

"Patients with LEP [Limited English Proficiency] already face significant challenges, such as higher rates of complications, worse outcomes, and decreased satisfaction, when navigating through the health care system." (Linggonegoro, Sanchez-Flores, Huang, 2021)
"Patient portals have the potential to enhance the doctor-patient relationship, improve health status awareness, and increase adherence to therapy" (Carini et al, 2021.)
"Dual-handset interpreter telephone at every bedside July 15, 2008 to Mar 14, 2009...There was a significant decrease in observed 30-day readmission rates for the LEP [Limited English Proficiency] group during the 8-month intervention period compared with 18 months preintervention" (Karliner et al., 2017)
"Patient portal utilization has been linked to 'significant decreases in office visits…, changes in medication regimen, and better adherence to treatment' [13], along with improved chronic disease management and disease awareness [8,9]" (Beal LL, Kolman JM, Jones SL, Khleif A, Menser T., 2021)
“Language-concordant care has been demonstrated to improve patient outcomes, lower healthcare costs, increase satisfaction, and reduce medical errors [12]” (Ortega et al., 2022)
"The results of this exploratory study indicate that the presence of an e-mail address was associated with a better OS [overall survival of cancer]" (Heudel et al., 2022)

UX and Strategic Recommendations

Given the equity concerns and academic research findings highlighting differing health outcomes, the recommendation was to turn on the MyChart Spanish patient portal with the goals to:
1. Improve patient outcomes and reduce costs
  - More use of virtual visits and digital health utilization
  - Patients can get care quickly
  - Better health outcomes
  - Increased revenue and reduced costs (including possibly avoiding readmissions)
2. Improve patient experience
  - Patients wouldn't have to wait as long on the phone
  - Patients have more agency
  - Patients can more easily access care
3. Improve staff satisfaction
  - Increase patients' ability to self-service
  - Reduce call volumes at clinics
MyChart Spanish "out-of-the-box" comes with many elements from the English version of MyChart translated to Spanish, however, any text that OHSU customizes or adds to MyChart needs to be manually translated and entered by OHSU. Therefore, we created a workflow recommendation for all content updates and additions to be translated and added in Spanish (e.g. who is responsible and what turn-around time should be anticipated?)
Because 80% of patients needed prompting to see it, we recommended size and color contrast improvements to the link that turns on MyChart Spanish.
Anticipating socialization and increased use of the service, the team presented potential risks and mitigation ideas for the likely increase of digital triage and patient-to-provider messaging in Spanish (e.g. hiring more bilingual staff, and establishing a workflow to leverage language and translation services digitally).

Outcome and Opportunities

We took the findings and recommendations on a road show across the institution and got buy-in from several teams
- Risks and mitigation ideas were important when discussing a strategy to move forward
- The teams identified the funding and resources needed to roll out MyChart in Spanish
- The team developed a phased approach for rolling out different features of the tool (i.e. appointment scheduling, checking test results, messaging providers, etc.)
OHSU launched phase 1 of MyChart Spanish to patients in October 2023 🎉
Phase 2 is next, with patient-to-provider messaging workflows underway.
Once all features of MyChart Spanish are turned on, we will have the opportunity to analyze and compare health outcomes and emergency department use for patients with LEP pre and post-implementation.