An analysis of patient-provider secure messaging at two Veterans Health Administration medical centers: message content and resolution through secure messaging

Shimada, Stephanie L.; Petrakis, Beth Ann; Rothendler, James A.; Zirkle, Maryan; Zhao, Shibei; Feng, Hui; Fix, Gemmae M.; Ozkaynak, Mustafa; Martin, Tracey; Johnson, Sharon A.; Tulu, Bengisu; Gordon, Howard S.; Simon, Steven R.; Woods, Susan

doi:10.1093/jamia/ocx021

Cited by 49 publications

(50 citation statements)

References 33 publications

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“…Our analysis revealed that the majority of patient secure messages included logistical content, demonstrating the organizing efforts of patients to ensure that they had the resources (eg, prescriptions) needed for their own care. These findings are consistent with previous studies, including some studies conducted in VA, highlighting the frequent use of email and secure messaging by patients to address administrative issues and related care actions [ 29 , 41 , 42 , 44 - 46 ]. Although there may be a tendency to view such content as uncomplicated or routine, we believe that it underscores the importance of secure messaging as a tool that patients use to promote care coordination.…”

Section: Discussionsupporting

confidence: 92%

“…Nearly half of the patient messages in our sample were coded as information updates, in which they informed health care team members about some aspect of their health. Patient provision of such updates has been documented in previous studies [ 42 , 44 , 46 ] and is a powerful illustration of how secure messaging can facilitate the shift from episodic to continuous care and cultivate ongoing, healing relationships as argued for by the Institute of Medicine [ 60 ]. In addition to providing updates, patients also used secure messaging to seek information about a variety of topics.…”

Section: Discussionmentioning

confidence: 99%

“…Although previous research has examined the content of electronic communication between patients and providers extensively [ 30 , 41 - 46 ], less research has focused on the “socioemotional” aspects of the communication enacted by those messages, including how socioemotional tone is expressed and whether it reflects the patient-centered goals of eliciting patients’ perspectives, addressing their needs, expressing and responding to emotions, and contributing to a therapeutic partnership [ 28 ]. One study of secure messaging identified patient frustration with a perceived lack of empathy in some physician-sent electronic communications [ 30 ], suggesting that the socioemotional communication that could facilitate patient-centered goals may be lacking in electronic messages.…”

Section: Introductionmentioning

confidence: 99%

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Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging

Hogan¹,

Luger²,

Volkman³

et al. 2018

J Med Internet Res

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BackgroundAs information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages.ObjectiveRecognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages.MethodsWe conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads.ResultsOf the 711 messages coded from the 384 messaging threads, 52.5% (373/711) were sent by patients and 47.5% (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6%, 308/373 vs 89.1%, 301/338), were neutral in tone (70.2%, 262/373 vs 82.0%, 277/338), and respectful in nature (25.7%, 96/373 vs 33.4%, 113/338). Secure messages from health care team members sometimes appeared hurried (25.4%, 86/338) but also displayed friendliness or warmth (18.9%, 64/338) and reassurance or encouragement (18.6%, 63/338). Most patient messages involved either providing or seeking information; however, the majority of health care team member messages involved information provision in response to patient questions.ConclusionsThis evaluation is an important step toward understanding the content and socioemotional tone that is part of the secure messaging exchanges between patients and health care team members. Our findings were encouraging; however, there are opportunities for improvement. As health care organizations seek to supplement traditional encounters with virtual care, they must reexamine their use of secure messaging, including the patient centeredness of the communication, and the potential for more proactive use by health care team members.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging

Hogan¹,

Luger²,

Volkman³

et al. 2018

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…As we noted in the introduction, the purpose of this paper was three-fold. First, we sought to present basic measurements of usage that are similar to other studies found in the literature [25][26][27][28]. In so doing, we hope to foster both a greater understanding of usage and open conversations about similarities with ambulatory portals.…”

Section: Discussionmentioning

confidence: 95%

Patient Engagement as Measured by Inpatient Portal Use: Methodology for Log File Analysis (Preprint)

Huerta¹,

Fareed²,

Hefner³

et al. 2018

Preprint

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Background: Inpatient Portals (IPPs) have the potential to increase patient engagement and satisfaction with their healthcare. An IPP provides a hospitalized patient with similar functions to those found in outpatient portals, including the ability to view vital signs, laboratory results, medication information, schedule appointments and communicate with their provider. However, IPPs may offer additional functions such as meal planning, real-time messaging with the inpatient care team, daily schedules, and access to educational materials relevant to their specific condition. In practice, IPPs have been developed as websites and tablet apps, with hospitals providing the required technology as a component of care during the patient's stay.

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“…29 In another study, Shimada et al coded secure messages sent to primary care providers via an outpatient portal and found that they were most frequently transactional in nature, involving requests for medication refills and questions about scheduling. 30 However, needs specific to hospitalized patients may be appreciably different in this context and merely providing portal functions in the inpatient environment similar to those available in outpatient settings may be insufficient. Hospitalization may serve as a cue to action, increasing the patient's focus on their health and potentially increasing their willingness to use a portal to engage in their care.…”

Section: Background and Significancementioning

confidence: 99%

Understanding Secure Messaging in the Inpatient Environment: A New Avenue for Communication and Patient Engagement

et al. 2018

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Background Patient portals, and the secure messaging feature in particular, have been studied in the outpatient setting, but research in the inpatient setting is relatively less mature. Objective To understand the topics discussed in secure messaging in the inpatient environment, we analyzed and categorized messages sent within an inpatient portal. Materials and Methods This observational study examined the content of all secure messages sent from December 2013 to June 2017 within an inpatient portal at a large Midwestern academic medical center (AMC). We analyzed a total of 2,598 messages, categorizing them by sender (patient, family, or care team member), type, and topic, and conducted a descriptive analysis of categories and an examination of code co-occurrence. Results Patients were the most frequent message senders (63%); family members sent the fewest messages (10%). We identified five types of messages: Alert/Request; Thanks; Response; Question; and Other (typo/test message). Patient messages included Alerts/Requests (38%), Questions (31%), Statements of Thanks (24%), Response (1.2%), and Other (5%). We also identified 14 nonmutually exclusive message

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An analysis of patient-provider secure messaging at two Veterans Health Administration medical centers: message content and resolution through secure messaging

Abstract: The majority of messages were transactional and initiated by patients or caregivers. Not all content categories were fully addressed over SM. Further education and training for both patients and clinical teams could improve the quality and efficiency of SM communication.

Cited by 49 publications

References 33 publications

Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging

Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging

Patient Engagement as Measured by Inpatient Portal Use: Methodology for Log File Analysis (Preprint)

Understanding Secure Messaging in the Inpatient Environment: A New Avenue for Communication and Patient Engagement

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