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 3 years (2008-2010) 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.

Keywords: Consumer health informatics; Patient engagement; Patient portal; Patient–provider communication; Secure messaging; Surgery.

Figure 1. Surgical Specialty Use of Secure Messaging and Encounter Volume

Message volume per month (black solid line) and outpatient clinic encounter volume (gray solid line) are plotted on the left y-axis at logarithmic scale. The percentage of all outpatient interactions accounted for by secure messaging (black dotted line) is plotted on the right y-axis at linear scale. Months are along the x-axis. The specialties are ordered left-to-right, top-to-bottom, by highest percentage of outpatient interactions conducted by secure messaging at the end of the study period. (Note: Monthly message volumes below 10 per month are represented by a break in the plotted line.)

Figure 2. Likelihood of Messaging Use across Surgical Specialties by Month

Probability estimates were calculated from logistic regression models controlling for age, gender, race, and time of initial message.