Rapid growth in surgeons’ use of secure messaging in a patient portal

Abstract

Background Use of secure messaging through patient portals has risen substantially in recent years due to provider incentives and consumer demand. Secure messaging may increase patient satisfaction and improve outcomes, but also adds to physician workload. Most prior studies of secure messaging focused on primary care and medical specialties. We examined surgeons’ use of secure messaging and the contribution of messaging to outpatient interactions in a broadly-deployed patient portal. Methods We determined the number of clinic visits and secure messages for surgical providers in the first three years (2008–10) after patient portal deployment at an academic medical center. We calculated the proportion of outpatient interaction conducted through messaging for each specialty. Logistic regression models compared the likelihood of message-based versus clinic outpatient interaction across surgical specialties. Results Over the study period, surgical providers delivered care in 648,200 clinic visits and received 83,912 messages, with more than 200% growth in monthly message volume. Surgical specialties receiving the most messages were orthopedics/podiatry (25.1%), otolaryngology (20.1%), urology (10.8%), and general surgery (9.6%); vascular surgery (0.8%) and pediatric general surgery (0.2%) received the fewest. The proportion of outpatient interactions conducted through secure messaging increased significantly from 5.4% in 2008 to 15.3% in 2010 (p<0.001) with all specialties experiencing growth. Heart/lung transplantation (74.9%), liver/kidney/pancreas transplantation (69.5%), and general surgery (48.7%) had the highest proportion of message-based outpatient interaction by the end of the study. Conclusions This study demonstrates rapid adoption of online secure messaging across surgical specialties with significant growth in its use for outpatient interaction. Some specialties, particularly those with long-term follow-up, interacted with patients more through secure messaging than in person. As surgeons devote more time to secure messaging, additional research will be needed to understand the care delivered through online interactions and to develop models for reimbursement.

Complexity of medical decision-making in care provided by surgeons through patient portals

“…Earlier research has shown rapid growth in the use of MHAV portal messaging amongst surgeons in the initial years of after patient portal deployment with significant variation across all clinical specialties and surgical subspecialties. [16, 17] This study corroborates the persistent variability in the use of messaging across surgical specialties and demonstrates shifts in the utilization of messaging beyond the early adoption phase of patient portals. Our study shows that most surgical specialties frequently received portal messages from patients, and many surgical providers often interact with patients through the portal, yet some specialties, such as pediatric surgery and trauma rarely, if at all, utilize patient-provider messaging in the portal.…”

“…[15] Further, messaging adoption by surgical patients and providers grew rapidly across surgical subspecialties. [16] Although providers conduct growing numbers of online encounters by exchanging messages with patients through such portals, the nature of such communications has not been analyzed for surgery. [16, 17]…”

Review of information technology for surgical patient care

“…[55-57] All of these studies were observational and involved web-based applications allowing patients and their family members to view portions of the EHR or interact with healthcare systems through messaging. In one study, parents of patients undergoing congenital cardiac surgery at Miami Children’s Hospital from 2006 to 2009 were offered access to a system that allowed users to view admission notes, discharge summaries, discharge instructions, operative images, and daily bedside images of the patient.…”

“…Furthermore, portal message exchanges between surgical patients and providers continued to increase over time, with messaging accounting for 5.4 % of outpatient interactions in 2008 and 15.3% in 2010. [57] The exact nature of patient and provider interactions conducted through messaging was not explored.…”

Usability Assessment of Secure Messaging for Clinical Document Sharing between Health Care Providers and Patients

“…Secure electronic messaging tools within Web-based patient portals are being implemented rapidly in health care, 1 and there is growing enthusiasm among providers and patients to use this form of communication. [2][3][4][5] The percentage of nonfederal acute care hospitals in the United States that offer secure messaging services (e.g., viewing, downloading, and transmitting data, such as clinical documents, between providers and patients or providers only) has been increasing steadily in recent years. 6 Secure messaging systems, which are often offered in conjunction with personal health record (PHR) systems, can help providers reach patients during vulnerable periods (e.g., after hospital discharge) when they may be at a higher risk for an adverse drug event.…”