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. 2017 Sep 1;24(5):942-949.
doi: 10.1093/jamia/ocx021.

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

Stephanie L Shimada  1   2   3 , Beth Ann Petrakis  1 , James A Rothendler  1 , Maryan Zirkle  4 , Shibei Zhao  1 , Hua Feng  1 , Gemmae M Fix  1 , Mustafa Ozkaynak  5 , Tracey Martin  6 , Sharon A Johnson  7 , Bengisu Tulu  7 , Howard S Gordon  8   9 , Steven R Simon  1 , Susan S Woods  10
Affiliations

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

Stephanie L Shimada et al. J Am Med Inform Assoc. .

Abstract

Objective: We sought to understand how patients and primary care teams use secure messaging (SM) to communicate with one another by analyzing secure message threads from 2 Department of Veterans Affairs facilities.

Methods: We coded 1000 threads of SM communication sampled from 40 primary care teams.

Results: Most threads (94.5%) were initiated by patients (90.4%) or caregivers (4.1%); only 5.5% were initiated by primary care team members proactively reaching out to patients. Medication renewals and refills (47.2%), scheduling requests (17.6%), medication issues (12.9%), and health issues (12.7%) were the most common patient-initiated requests, followed by referrals (7.0%), administrative issues (6.5%), test results (5.4%), test issues (5.2%), informing messages (4.9%), comments about the patient portal or SM (4.1%), appreciation (3.9%), self-reported data (2.8%), life issues (1.5%), and complaints (1.5%). Very few messages were clinically urgent (0.7%) or contained other potentially challenging content. Message threads were mostly short (2.7 messages), comprising an average of 1.35 discrete content types. A substantial proportion of issues (24.2%) did not show any evidence of being resolved through SM. Time to response and extent of resolution via SM varied by message content. Proactive SM use by teams varied, but was most often for test results (32.7%), medication-related issues (21.8%), medication renewals (16.4%), or scheduling issues (18.2%).

Conclusions: 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.

Keywords: message content; patient-doctor communication; personal health records; primary health care; secure messaging.

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Figures

Figure 1.
Figure 1.
Percentage of messages by sender type.
Figure 2.
Figure 2.
Mean hours (including evenings, holidays, and weekends) from patient message to first response and to thread resolution by message type (only messages fully resolved, partially resolved, or acknowledged within SM are included).
See this image and copyright information in PMC

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