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. 2015 Apr 29;6(2):288-304.
doi: 10.4338/ACI-2014-12-RA-0117. eCollection 2015.

Growth of Secure Messaging Through a Patient Portal as a Form of Outpatient Interaction across Clinical Specialties

R M Cronin  1 , S E Davis  2 , J A Shenson  3 , Q Chen  4 , S T Rosenbloom  1 , G P Jackson  5
Affiliations

Growth of Secure Messaging Through a Patient Portal as a Form of Outpatient Interaction across Clinical Specialties

R M Cronin et al. Appl Clin Inform. .

Abstract

Objective: Patient portals are online applications that allow patients to interact with healthcare organizations. Portal adoption is increasing, and secure messaging between patients and healthcare providers is an emerging form of outpatient interaction. Research about portals and messaging has focused on medical specialties. We characterized adoption of secure messaging and the contribution of messaging to outpatient interactions across diverse clinical specialties after broad portal deployment.

Methods: This retrospective cohort study at Vanderbilt University Medical Center examined use of patient-initiated secure messages and clinic visits in the three years following full deployment of a patient portal across adult and pediatric specialties. We measured the proportion of outpatient interactions (i.e., messages plus clinic visits) conducted through secure messaging by specialty over time. Generalized estimating equations measured the likelihood of message-based versus clinic outpatient interaction across clinical specialties.

Results: Over the study period, 2,422,114 clinic visits occurred, and 82,159 unique portal users initiated 948,428 messages to 1,924 recipients. Medicine participated in the most message exchanges (742,454 messages; 78.3% of all messages sent), followed by surgery (84,001; 8.9%) and obstetrics/gynecology (53,424; 5.6%). The proportion of outpatient interaction through messaging increased from 12.9% in 2008 to 33.0% in 2009 and 39.8% in 2010 (p<0.001). Medicine had the highest proportion of outpatient interaction conducted through messaging in 2008 (23.3% of outpatient interactions in medicine). By 2010, this proportion was highest for obstetrics/gynecology (83.4%), dermatology (71.6%), and medicine (56.7%). Growth in likelihood of message-based interaction was greater for anesthesiology, dermatology, obstetrics/gynecology, pediatrics, and psychiatry than for medicine (p<0.001).

Conclusions: This study demonstrates rapid adoption of secure messaging across diverse clinical specialties, with messaging interactions exceeding face-to-face clinic visits for some specialties. As patient portal and secure messaging adoption increase beyond medicine and primary care, research is needed to understand the implications for provider workload and patient care.

Keywords: Patient portal; consumer health informatics; patient engagement; secure messaging.

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Conflict of interest statement

Conflict of Interest

Gretchen Jackson reports salary support from funding provided to VUMC by West Health for projects not related to the submitted work. All other authors have no reported conflicts of interest related to the research.

Figures

Fig. 1
Fig. 1
Number of (A) message threads, (B) message baskets (C) patients using messaging, (D) outpatient clinic encounters, and (E) the messaging percentage as a form of outpatient interaction per month.
Fig. 2
Fig. 2
Specialty usage of secure messaging. The plots below present the (A) total number of message threads, (B) the total number of outpatient clinic encounters and (C) messaging percentage of outpatient interactions per specialty per month.
Fig. 3
Fig. 3
This figure presents the generalized estimating equation with logit link in a plot of messaging probability by specialty.
See this image and copyright information in PMC

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