Patient-to-physician messaging: volume nearly tripled as more patients joined system, but per capita rate plateaued

Abstract

Patients want to be able to communicate with their physicians by e-mail. However, physicians are often concerned about the impact that such communications will have on their time, productivity, and reimbursement. Typically, physicians are not reimbursed for time spent communicating with patients electronically. But under federal meaningful-use criteria for information technology, physicians can receive a modest incentive for such communications. Little is known about trends in secure e-mail messaging between physicians and patients. To understand these trends, we analyzed the volume of messages in a large academic health system's patient portal in the period 2001-10. At the end of 2010, 49,778 patients (22.7 percent of all patients seen within the system) had enrolled in the portal, and 36.9 percent of enrolled patients (8.4 percent of all patients) had sent at least one message to a physician. Physicians in the aggregate saw a near tripling of e-mail messages during the study period. However, the number of messages per hundred patients per month stabilized between 2005 and 2010, at an average of 18.9 messages. As physician reimbursement moves toward global payments, physicians' and patients' participation in secure messaging will likely increase, and electronic communication should be considered part of physicians' job descriptions.

Keywords: Access To Care; Information Technology; Organization and Delivery of Care; Primary Care; Research And Technology.

EXHIBIT 1. Number Of Patients Enrolled In The PatientSite Portal, 2001–10

Source/Notes: SOURCE Authors’ analysis of PatientSite data. NOTES In 2004 and beyond, the system removed patients who had not logge into the system within two years. “Messaging patients” are those who sent a secure message in a given calendar year.

EXHIBIT 2. Number Of Messages Per 100 Patients And Per Physician Sent Through The PatientSite Portal, 2001–10

Source/Notes: SOURCE Authors’ analysis of PatientSite message tables and user data. NOTES “Messages per 100 patients” is the average number of messages sent per hundred enrolled patients per month. “Messages per physician” is the average number of messages received by each physician (the number of messages divided by the number of participating physicians) per month. “Appointment requests” and “Rx refill requests” are the average numbers of requests for appointments and prescription refills, respectively, sent per hundred enrolled patients per month through a separate portal functionality from messaging. Whisker marks denote standard deviations.

EXHIBIT 3. Variability In Number Of Messages Sent To Physicians Through The PatientSite Portal In 2010, By Specialty

Source/Notes: SOURCE Authors’ analysis of PatientSite data and Beth Israel Deaconess Medical Center scheduling data. NOTES The center line in each shaded box represents the median, and the box represents the interquartile range (with the top line indicating the seventy-fifth percentile and the bottom line the twenty-fifth percentile). For psychiatry, only one physician used the system in 2010, and thus no interquartile range is provided. The dots indicate all observations. “FTE adjusted” represents extrapolation of message volumes that academic and other part-time primary care physicians with less than full-time clinical effort would have if they practiced full time.

EXHIBIT 4. Estimated Growth In Secure Messaging Within Primary Care Physician Panels, 2001–10

Source/Notes: SOURCE Authors’ analysis of PatientSite data and Beth Israel Deaconess Medical Center scheduling data. NOTES Each dot represents the median for physicians’ panels. Whisker marks denote the twenty-fifth and seventy-fifth percentiles. The denominator is the number of unique patients seen by each physician.