Development and evaluation of an artificial intelligence-based workflow for the prioritization of patient portal messages.

Abstract

Accelerating demand for patient messaging has impacted the practice of many providers. Messages are not recommended for urgent medical issues, but some do require rapid attention. This presents an opportunity for artificial intelligence (AI) methods to prioritize review of messages. Our study aimed to highlight some patient portal messages for prioritized review using a custom AI system integrated into the electronic health record (EHR). We developed a Bidirectional Encoder Representations from Transformers (BERT)-based large language model using 40132 patient-sent messages to identify patterns involving high acuity topics that warrant an immediate callback. The model was then implemented into 2 shared pools of patient messages managed by dozens of registered nurses. A primary outcome, such as the time before messages were read, was evaluated with a difference-in-difference methodology. Model validation on an expert-reviewed dataset (n = 7260) yielded very promising performance (C-statistic = 97%, average-precision = 72%). A binarized output (precision = 67%, sensitivity = 63%) was integrated into the EHR for 2 years. In a pre-post analysis (n = 396466), an improvement exceeding the trend was observed in the time high-scoring messages sit unread (21 minutes, 63 vs 42 for messages sent outside business hours). Our work shows great promise in improving care when AI is aligned with human workflow. Future work involves audience expansion, aiding users with suggested actions, and drafting responses. Many patients utilize patient portal messages, and while most messages are routine, a small fraction describe alarming symptoms. Our AI-based workflow shortens the turnaround time to get a trained clinician to review these messages to provide safer, higher-quality care.