MyChart Bedside Ordering Menu Expansion
Quality Improvement
Abstract
Patients at UW Health hospitals who do not speak
English and those who are visually impaired or have a
low literacy level lack access to the electronic menu
ordering system. Prior to 2/22/22, MyChart Bedside
Ordering was only accessible certain diet designations,
and menu photos were not available.
The purpose of this project is to improve MyChart
Bedside Ordering by displaying images and nutrition
information of menu items on iPads and to align it with
patients’ prescribed therapeutic diets.
During phase 1, the current menu systems and literature
were reviewed, and photos of the menu items were
taken. 80 photos were uploaded, and the app’s use
expanded to 21 additional diet designations, increasing
access among hospitalized adults by 31%. Overall, this
system works to improve the diverse population’s
independence in ordering.
Upcoming phases will continue implementing
improvements and will obtain more data regarding the
app’s accessibility and impact on nutrition care,
especially among those who had previously lacked
ordering access.
Introduction
• Electronic ordering systems are preferred over traditional
paper menus, yet limited research has explored ways to make
the electronic systems more accessible.1,2,3,4
• Culture, literacy, and one’s primary language impact patients’
dietary preferences and whether they require assistance in
understanding the menu.5,6
• Patients participate in and understand their nutrition-related
care plan to a greater extent when they order their own meals
which tend to be more nutritionally adequate.7,8 Independent
Figure 1: Sample images taken of menu items
ordering facilitates patient-centered care.7,8
• Adding images on menus improves the accessibility and
understanding of the menu among more populations.  blueberry muffin,
Prior to the implementation of this project, MyChart Bedside
Ordering was available to 27 diet designations, and menu imaging
was not available. The research team worked to incorporate
additional menu photos which launched on February 22, 2022, to
improve patient ordering and accessibility.  sandwich, flatbread
Phase 1 of this project included the addition of photos and
nutrition information to the MyChart Bedside ordering system to:
• Create inclusion across language, literacy, and visual barriers by
providing photographic representations of menu items
• Allow patients on additional therapeutic diets to partake in the
bedside ordering
Rachel Drobny and Nicole Tellock
Department of Nutritional Sciences, University of Wisconsin – Madison
Methods
Population:
• On average, 2.04% of adult patients at UW Health speak
a primary language other than English
• Many patients have vision and literacy difficulties
• Quality improvement through the addition of images is
presumed to increase the accessibility of the app these
populations
Phase 1 Quality Improvement Methods:
• The researchers and RDN organized the existing photos
to determine the remaining menu items that needed to
be photographed for the patient app
• The researchers coordinated with the RDN and room
service cooks to prepare these menu items and took 78
photos in the UW Health kitchen
• The photos were integrated into the patient app that
launched on 2/22/22. See Fig. 1 and 2 for examples.
• 70 additional stock images were retrieved from CBORD
Surveys:
• Researchers attempted conducting a patient
satisfaction survey after the update of the MyChart
Bedside Ordering application.
• A 6-question Likert-scale questionnaire was created to
evaluate the display of new images added to the app
and overall patient experience using the iPad.
• Due to the delayed launch of the new app and
difficulties in data collection from patients, few
responses were collected.
• Feedback was generally positive from the responses
that were collected. Patients expressed that the new
imaging was helpful when determining their menu
selections.
• Future phases will gather additional data regarding the
app’s accessibility to fill the gap in the research
Breakfast items:
mixed berry crepes,
breakfast sandwich,
bagel
Lunch and dinner
items: roast beef
pizza, hamburger,
linguini primavera
Desserts:
cheesecake, cherry
pie; Beverages:
almond milk, various
tea options
Results Conclusions & Future Directions
Conclusions:
Photo availability:
Phase 1 included the addition of new images in the MyChart
• Prior to the QI project, 93 photos had been taken.
Bedside Ordering application, which expanded patient ordering
• A total of 241 menu item photographs were available accessibility
by the end of phase 1 • Background research and project development was completed
• 80 photos have been uploaded to the patient app • Patients with additional dietary restrictions now have access to
(23 of which were from the researchers) to the most ordering meals on the iPads
important room service courses, including breakfast, • Initial patient feedback suggests the addition of images has
lunch, and dinner entrees, pasta, savory sides, improved the meal ordering experience and patient satisfaction
salads, fruits, vegetables, and snacks. • Created a platform for upcoming research regarding patient
satisfaction and overall use of MyChart Bedside Ordering
• The remaining 161 photos will be uploaded to
additional menu subcategories in phase 2. Future Directions:
Phases 2 and 3 will include additional improvements to the app
Expansion of Diet Eligibility: and further data collection regarding patient satisfaction:
• The incorporation of photos and nutrition
Phase 2:
information on the patient app allowed for • Upload the remaining photos for additional menu subcategories
expansion to 21 additional diet designations by June 2022
(displayed in Table 1). 
Phase 3: 
• 58% of patients had access to bedside ordering prior • Collect more satisfaction data and feedback from patients
to phase 1.  • Consider expanding the electronic system to include diets that
• 76% of patients have access to use the app after remain unavailable, such as soft and bite-sized, minced and
moist, gastric bypass, and phosphorus restrictions with >4
implementation.
dietary restrictions
• Overall, a significant increase (31%) in accessibility
• Optimize order size restrictions by October 2022
was achieved.
• The current system can regulate and display nutrition
information for up to 4 dietary restrictions at a time.
References
Table 1: 21 additional diet designations able to use the patient app
1. Maunder K, Lazarus C, Walton K, et al. Energy and protein intake increases with an
Diet Designations electronic bedside spoken meal ordering system compared to a paper menu in
hospital patients. Clin Nutr ESPEN. 2015;10(4):134-139.
All Sodium Restrictions Protein 70gm
2. Barrington V, Maunder K, Kelaart A. Engaging the patient: improving dietary intake
DASH: NAS, LowSFA, LowCaf Clear Liquids and meal experience through bedside terminal meal ordering for oncology patients. J
Hum Nutr Diet. 2018;31(6):803-809.
Esophagectomy Clear Liquids Full Liquids
3. McCray S, Maunder K, Barsha L, Mackenzie-Shalders K. Room service in a public
Esophagectomy Full Liquids Full Liquids Low Fat hospital improves nutritional intake and increases patient satisfaction while
Fat Chyl Leak 10gm All Fluid Restrictions decreasing food waste and cost. J Hum Nutr Diet. 2018;31(6):734-741.
4. McCray S, Maunder K, Norris R, et al. Bedside Menu Ordering System increases
Fat Chyl Leak 25gm Pureed energy and protein intake while decreasing plate waste and food costs in hospital
Fat Restricted 30gm Halal patients. Clin Nutr ESPEN. 2018;26:66-71.
5. Alfred M, Ubogaya K, Chen X, Wint D, Worral PS. Effectiveness of culturally focused
Fat Restricted 50gm Kosher interventions in increasing the satisfaction of hospitalized Asian patients: a
Low SFA/Cholesterol Vegan systematic review. JBI Database System Rev Implement Rep. 2016;14(8):219-256. 
All Potassium Restrictions 6. Alpers LM. Hospital food: When nurses' and ethnic minority patients' understanding
of Islamic dietary needs differ. Nurs Open. 2019;6(4):1455-1463.
7. Roberts S, Chaboyer W, Hopper Z, Marshall AP. Using technology to promote patient
engagement in nutrition care: a feasibility study. Nutrients. 2021;13(2):314.
Figure 2: Patients’ view of MyChart Bedside Ordering after
8. Roberts S, Marshall A, Chaboyer W. Hospital staffs' perceptions of an electronic
update displaying photos and nutrition information program to engage patients in nutrition care at the bedside: a qualitative study. BMC
Med Inform Decis Mak. 2017;17(1):105.
Acknowledgments
Rachel Drobny, BS1,2; Nicole Tellock, BS1,2; Sean O’Hara, MS2; Tara
LaRowe, PhD, RD, CD1
1. Department of Nutritional Sciences, University of Wisconsin –
Madison
2. Department of Clinical Nutrition, UW Health