Improving Parent/Guardian Electronic Health Record Compliance for School-Aged Children Through Text Message Nudges

Background: 96% of United States (U.S.) healthcare systems use Electronic Health Records (EHRs) to document and coordinate healthcare. More than 97% of all U.S. adults have cell phones. Text message nudges are a popular positive behavioral intervention encouraging EHR engagement and improve health literacy and care coordination by overcoming obstacles related to Social Determinants of Health (SDOH) through communication and outreach. For Pennsylvania (PA) State Requirements to attend public school, children must have up-to-date health records (physicals, immunization records, hearing, vision, scoliosis, and dental screenings) on file with the school district nursing office. An incomplete SchoolCare EHR may negatively impact student attendance, healthcare, or delay medical treatment.

Purpose: 60% of a rural secondary school in South-Central Pennsylvania had an incomplete EHR for the 2023-2024 school year. The quality improvement project aims to improve EHR compliance rates for grades 6-12 using text message nudges for ~1800 students.

Methods: Text message nudge reminders were sent to parents/guardians to complete student EHRs as part of a quality improvement protocol intervention.

Findings/Results: Pre- and post-intervention results nearly doubled EHR compliance rates from 40% to 75% EHR compliance for the first day of the 2024-2025 school year. Overall, EHR compliance achieved was 95% eight weeks after intervention.

Implications: Text message nudges help overcome barriers related to SDOH and improve community health literacy outreach.

Conclusions: Text message nudges improve parent/guardian SchoolCare EHR compliance.