BMJ Qual Improv Report 6: doi:10.1136/bmjquality.u214811.w5926
  • BMJ Quality Improvement Programme

Impact of health portal enrolment with email reminders at an academic rheumatology clinic

  1. Shirley Chow
  1. Division of rheumatology, Sunnybrook Health Sciences Center, Canada
  1. Correspondence to Arielle Mendel ariellemendel{at}
  • Received 13 September 2016
  • Revision requested 7 November 2016
  • Revised 23 November 2016
  • Published 7 March 2017


Missed appointments reduce the quality, safety and efficiency of healthcare delivery. ‘No-Shows’ (NS) have been identified as a problem within the rheumatology clinic at Sunnybrook Health Sciences Center in Toronto, Ontario.

NS were studied through a prospective chart review and telephone interviews. Over 6 months, 110 NS took place (rate 2.5-6.8%). From interviews, 85% of NS were attributed to forgetting, being unaware of the appointment, having the wrong date, or another miscommunication. Fifty-seven percent of patients were interested in an appointment reminder, including electronic reminders (46%).

Patients were encouraged to enroll in the hospital's electronic patient portal, MyChart, and email reminders were implemented at one clinic for portal users. A detailed follow-up card was also given to patients. Process measures included portal enrolment, email reminder receipt, and call volumes. Outcome measures were NS and patient and staff satisfaction.

During the intervention, 120/274 (44%) surveyed patients had MyChart accounts. Of these, 73 (61%) received the e-mail reminder and 72 (99%) found the e-mail helpful. Twenty-two patients knew about their appointment from the e-mail reminder alone. Improvement in attendance was seen after 3.5 months, but it was not sustained thereafter.

Prior to this intervention there was no appointment reminder system at this clinic, and the email reminder demonstrated high patient satisfaction. Low portal enrolment, technical difficulties, and the inability of the intervention to reach new patients were possible reasons why the intervention was unsuccessful at reducing NS.

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