Ask the Expert: How Can I Increase Patient Engagement through a Non-English Patient Portal?

Ambualtory Committee_Sherman, Lynn_Headshot  by Lynn Sherman, MBA
Chief Financial Officer
  Charles B. Wang Community Health Center


What is the CBWCHC Chinese Language Patient Portal (CLPP)?

Launched in December 2013 with funding provided in part by the New York Community Trust, the CBWCHC Chinese language patient portal provides services in Chinese (both Traditional and Simplified) and is available in addition to the original English platform that was released in July 2013. The patient portal is a secure online website that gives patients convenient 24 hour access to their personal health information from anywhere with an internet connection. Services provided in the portal include allowing patients to access their health records, review lab results, schedule appointments, refill medications, and communicate with their health care providers.

Your healthcare system serves primarily patients in the Asian American community. Were there special issues to consider in terms of technology adoption and language among your patient population?

In 2013, CBWCHC served over forty-seven thousand patients, of whom 95 percent were Asian American - predominantly Chinese Americans - and 89 percent were best served in a language other than English. Asian American New Yorkers in general face major socioeconomic barriers that have implications for health access. Nearly half of New York City’s Asian Americans speak English “less than very well”, an indicator of high rates of limited English proficiency (LEP). LEP was even higher for Chinese Americans at 59 percent. In addition, more than a third of Asian Americans in New York City have less than a high school diploma and 15 percent live below the poverty line (U.S. Census Bureau, 2011).

The Meaningful Use and Patient-Centered Medical Home (PCMH) goals have acknowledged patient portals as a key platform in improving access to health care for various efforts around patient engagement such as access to medical records, communication with providers, education, and wellness tracking (HIMSS, 2010). Along with positive outcomes such as enhanced provider communications and improved adherence to treatment for patients with chronic illnesses, availability of linguistically appropriate electronic portals may provide a beneficial tool to address issues with access to care among LEP patients. It is within this context that the CBWCHC CLPP was developed.

How did you prepare for the implementation of the Chinese language patient portal at CBWCHC?

In preparation for the launch of the CLPP, an interdisciplinary project team of executive staff, health educators, IT professionals, evaluators, and administrators collaborated to develop and review the portal to ensure that services were easily accessible, culturally-sensitive, and beneficial to reaching positive health outcomes.  Monthly project team meetings were conducted where members at different stages of implementation shared their updates, challenges, questions, and advice. 

A workflow plan was developed at the beginning stages of the project,with feedback from the project team staff, indicating specific staff, resources, and expected deadlines needed for each project step. Project deliverables included technical developments, planning pre and post evaluation on usability and satisfaction among users, and marketing activities.

Planning activities culminated in the launch of the portal that included a press conference with members of the Chinese media, a briefing session with funders and key stakeholders, and extensive evaluation activities on patient and staff satisfaction with the portal’s available services. In addition, the CBWCHC project team composed a roadmap that documented experiences with implementing and developing the CLPP, limitations that need to be addressed, as well as suggestions for other health centers in developing their own unique project work plans.  

What were some of the limitations to implementation that were encountered?

A major limitation during the design phase of the Chinese patient portal was the limitations of the existing programming software platform. While many of the features of the original English language patient portal were able to be translated into Chinese characters, the actual generated medical record that patients see in the portal are in English.

Along with technological limitations of the portal software, other barriers to patient use of the portal revolve around issues with access. Low computer or internet proficiency may hinder the experience of some patients in navigating the features of the portal.  In the case of the CBWCHC portal project, it is less likely that patients with limited access to the internet and low e-literacy levels will enroll in the portal. Due to these barriers, it is crucial that considerable investments are made towards sustainability efforts that include documenting individual health center experiences with implementation, sustained evaluation activities on portal effectiveness, and availability of health education workshops on portal use.

Any other comments you have about implementing non-English portal technology?

Health literacy remains a significant problem and barrier to delivery of quality healthcare. The replication of EHR patient portals in languages other than English has potential to provide benefits and assistance for these high-risk groups that are susceptible to low health literacy (e.g., minorities, immigrants, and persons with limited education).

Through development of the CLPP, CBWCHC has made an effort to address the importance of patient-centered care and has provided a blueprint for other health centers to refine and refer to as they consider developing their own patient centered tools. Consistent with the goals of the PCMH, promoting patient engagement through tools such as linguistically-appropriate patient portals is a key step for maintaining the importance of individual patient needs in receiving care services.

Lynn Sherman, MBA, is the CFO at the Charles B. Wang Community Health Center (CBWCHC), a Federally Qualified Health Center and Level 3 PCMH that provides comprehensive medical and support services to medically underserved Asian Americans and other vulnerable populations in the New York City metropolitan area. Ms. Sherman co-chairs the HIMSS Ambulatory Task Force, where she participates in discussion topics on outreach efforts, lessons learned from best practices, and advocating for information technologies for the underserved and populations at risk.