A Retrospective Analysis of Provider-to-Patient Secure Messages: How Much Are They Increasing, Who Is Doing the Work, and Is the Work Happening After Hours?

Sidna M Tulledge-Scheitel,Emily J North,Toby J Mallmann,Jennifer L Pecina,Kristine E Luhman,Eric A Mallmann,Frederick North

doi:10.2196/16521

Abstract

BackgroundPatient portal registration and the use of secure messaging are increasing. However, little is known about how the work of responding to and initiating patient messages is distributed among care team members and how these messages may affect work after hours.ObjectiveThis study aimed to examine the growth of secure messages and determine how the work of provider responses to patient-initiated secure messages and provider-initiated secure messages is distributed across care teams and across work and after-work hours.MethodsWe collected secure messages sent from providers from January 1, 2013, to March 15, 2018, at Mayo Clinic, Rochester, Minnesota, both in response to patient secure messages and provider-initiated secure messages. We examined counts of messages over time, how the work of responding to messages and initiating messages was distributed among health care workers, messages sent per provider, messages per unique patient, and when the work was completed (proportion of messages sent after standard work hours).ResultsPortal registration for patients having clinic visits increased from 33% to 62%, and increasingly more patients and providers were engaged in messaging. Provider message responses to individual patients increased significantly in both primary care and specialty practices. Message responses per specialty physician provider increased from 15 responses per provider per year to 53 responses per provider per year from 2013 to 2018, resulting in a 253% increase. Primary care physician message responses increased from 153 per provider per year to 322 from 2013 to 2018, resulting in a 110% increase. Physicians, nurse practitioners, physician assistants, and registered nurses, all contributed to the substantial increases in the number of messages sent.ConclusionsProvider-sent secure messages at a large health care institution have increased substantially since implementation of secure messaging between patients and providers. The effort of responding to and initiating messages to patients was distributed across multiple provider categories. The percentage of message responses occurring after hours showed little substantial change over time compared with the overall increase in message volume.

Highlights

BackgroundThe volume of secure messages in health care institutions is increasing
The effort of responding to and initiating messages to patients was distributed across multiple provider categories
With providers responsible for an increasing number of secure messages, we looked at how secure messages to patients are distributed among staff at a large health care institution

Summary

Introduction

The volume of secure messages in health care institutions is increasing. A major national survey in 2013 found that 29.6% of the US population had used the internet or email to communicate with a physician or a physician’s office in the previous 12 months [1]. Lee et al [2] found that 37% of customers of a pharmacy chain reported contacting their physicians by email in the last 6 months. Several health care systems in the United States have examined the increase in the number of messages from patients. Masterman et al, and Shenson et al [4,5,6] showed dramatic increases in message volumes across multiple specialties, including surgical and pediatric specialties. Patient portal registration and the use of secure messaging are increasing. Little is known about how the work of responding to and initiating patient messages is distributed among care team members and how these messages may affect work after hours

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