Faculty Bibliography

Background: The Hitech Act of 2009 led to Federal funding on EHR incentives such as Advancing Care Information within MIPs and Meaningful Use. EPIC currently has a MyChart application which allows a patient to interface with their medical records and provider. The Family Health Centers (FHC) at NYU Langone is a network of 8 Federally Qualified Health Centers (FQHC) located in Brooklyn New York. The primary service area has a large immigrant population with 47% of the population reported as being foreign born, and a diverse payor mix with 12% of patients being self-pay/uninsured.
Method(s): Retrospective analysis was performed regarding 78,168 unique patients seen within the Family Health Center Network from January 2018 to December 3rd, 2018. Patient were identified by payor class and by utilization of MyChart. Given the diversity of healthcare plans afforded within New York State, payor classes were grouped into 7 broad categories: Medicaid/Managed Medicaid, commercial, Medicare/Managed Medicare, self-pay, no insurance, Child Health Plus and Med-icaid Expansion (Affordable Care Act). Patient MyChart data abstraction within the EPIC Clarity database included whether the patient was enrolled and when the last date of activity occurred. Enrollment with activity versus enrollment without activity within the last calendar year was used to gauge whether the patient would be considered an active subject in this retrospective review.
Result(s): Regarding percentage of patient enrolled in MyChart, the patient population most likely to enroll was found to be those who have commercial health plans at 41%, with Medicaid expansion plans at 37%, followed by Medicaid tied with self-pay coverage (23%) and Medicare at 18%. Utilization tells a different story with the highest utilizers found in the Medicare enrollees at 79%, followed by Medicaid expansion at 78%, then commercial plans at 77%. The next tier of active users was found to be no coverage (67%), self-pay (66%) and Medicaid (61%). Retrospective review with enrollment data was somewhat expected; high enrollment in patients with commercial plans and lower enrollment amongst Medicare beneficiaries. What was surprising was the utilization/activity data revealed an entirely different picture. Activity usage reflected two tiers. Patients who have Medicare utilize the application as much as patients who have commercial plans and Medicaid expansion. Despite connotations on patients who are self-pay or who have no coverage at all, these patients still use the application, with greater than 50% of those enrolled, actively using MyChartwithin the last calendar year.
Conclusion(s): As medical care becomes more immersed in web-based technologies, attention and opportunities exist for patients who traditionally were viewed as not having access nor inclination to use such technologies. Continued efforts should be maintained regarding enrollment regardless of the payor class or age