Opportunity 

In the spring of 2020, shelter-in-place orders required health systems to pause nonurgent medical visits to help slow the spread of coronavirus. 

To ensure adherence to the guidelines, clinical teams in the Department of Dermatology at Penn Medicine faced a monumental challenge – converting the bulk of upcoming in-person visits to virtual video visits with next to no infrastructure in place. Before the pandemic, virtual patient engagement in the department was limited to asynchronous, non-reimbursable communication via myPennMedicine (MPM), Penn Medicine’s patient portal.   

Further complicating this shift, skin examination can be challenging via video due to low-quality connections and issues associated with maneuvering the webcam to areas of the skin that are difficult to reach. Because of this, having patients submit high-quality photos before virtual visits is vital for medical decision-making. So vital that if they are not submitted, visits may be canceled. 

Initially, the workflow to obtain pre-visit photo submissions required clinic staff to take burdensome, manual action – reaching out to each patient, notifying them of the photo requirement, and providing lengthy verbal and written instructions on how to share their photos via MPM. Monitoring for completion also required manual effort and oversight. 

Intervention  

We designed and developed Penn Preview in partnership with the Dermatology Innovation Workgroup and the Way to Health and Switchboard teams. This program leverages automated text messaging, initially triggered upon appointment scheduling, to provide guidance and coaching to patients and facilitates photo collection in advance of virtual visits.  

Patients scheduled for virtual visits receive clear and concise instructions via text message, links to resources, and clear visual aids designed to coach them to submit high-quality photos. Patients have the option to submit their photos via MPM or directly via text message. 

On the backend, clinic staff can view the status of patients’ photo submissions and follow up with those who are non-compliant. When a photo is submitted, it is transmitted directly into the patient’s electronic health record for convenient provider access. 

Impact  

In early 2021 after a successful pilot, Penn Preview was scaled across the Department of Dermatology. The program increased pre-visit photo submission by 31 percentage points and improved submission quality: The percentage of optimal photos received rose from 32 to 53 overall, and 72 percent of photos sent via text message were categorized as optimal. Penn Preview also reduced the burden on clinic staff by providing automated guidance to patients and insights about compliance to clinicians. 

Penn Preview also led to modest improvements in accessibility and inclusivity. Engagement increased for Black patients, patients with an annual income under $75,000, and patients receiving Medicaid. And 50 percent of photo submissions came through text message, a modality that enables patients without access to in-home Internet or smartphone technology to use Penn Preview.