Check-In Check-Up: Analyzing and Improving Pre-Appointment Engagement in a Primary Care Clinic at UVA Health System; ADVANCING HEALTHCARE IN LMICS: SOCIO-TECHNICAL BARRIERS FOR EQUITABLE HEALTHCARE ACCESS

Digital healthcare tools are reshaping healthcare, but major gaps in usability and access remain –– both at UVA Health and in low- and middle-income countries (LMICs). As part of my Technical Capstone, I worked with UVA’s University Physician’s Clinic (UPC), where low patient engagement with MyChart – an electronic medical record (EMR) portal – creates communication barriers between patients and clinicians, and increases clinician workload. Similarly, LMICs face deeper obstacles to digital healthcare adoption, including infrastructure limitations and misaligned research priorities. My Science, Technology, and Society (STS) research explores the interconnectedness of the elements of healthcare in LMICs, aiming to identify long-term solutions for equitable access and increased quality of care through case studies and broad pattern analysis. UVA Health uses Epic, a cloud-based EMR system, with a secure patient portal called MyChart that facilitates patient engagement through provider messaging, record access, and pre-appointment task completion. At the primary care clinic UPC, patient engagement metrics were low in 2024 with only 35.3% of patients completing eCheck-in before their appointment. Our team aimed to improve portal engagement – especially with pre-appointment tasks – so patients can arrive at their appointment having already completed their paperwork, freeing up time for more meaningful care. Through both quantitative and qualitative research analysis, our team identified redundancy, low tech literacy, and poor app use as major barriers for portal adoption and usage. We found that one provider’s personalized messaging approach raised AWV completion by 18.6%, suggesting that education and outreach strategies could boost engagement and improve care efficiency. The portal engagement challenges that UVA faces underscore a deeper issue: technology alone will not improve healthcare systems. Healthcare access and quality of care depends on workforce, funding, and infrastructure, among other human and social elements which my STS research investigates in detail. My STS research explores the socio-technical barriers limiting equitable healthcare in low- and middle-income countries (LMICs), focusing on three key challenges: underutilization of EMRs, healthcare workforce migration, and misaligned funding from high-income countries. The relationship between these factors is explained through Actor-Network Theory (ANT), revealing that these issues must be addressed together. Case studies, such as Uganda’s Stre@mline platform, demonstrate the power of LMIC-native technology-centered solutions to improve healthcare access, reduce dependency on foreign aid, and retain healthcare workers through better infrastructure and policy alignment. Digital health tools are an integral part to making healthcare efficient, but their success depends on more than just technology: It requires attention to social and systemic issues that shape adoption and usage. At the UPC clinic at UVA, low MyChart pre-appointment engagement hinders clinic workflow and appointment quality. In LMICs, patient portals are rare despite their potential to improve efficiency, but deeper issues such as low tech proficiency, limited funding, and poor workforce retention are necessary to support successful implementation as well as overall healthcare system improvements. Both my technical project and STS research highlight the importance of creating sustainable, multi-faceted solutions.