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. 2020 Jul 8;8(7):e16521.
doi: 10.2196/16521.

A Retrospective Analysis of Provider-to-Patient Secure Messages: How Much Are They Increasing, Who Is Doing the Work, and Is the Work Happening After Hours?

Frederick North  1 , Kristine E Luhman  2 , Eric A Mallmann  3 , Toby J Mallmann  3 , Sidna M Tulledge-Scheitel  1 , Emily J North  4 , Jennifer L Pecina  5
Affiliations

A Retrospective Analysis of Provider-to-Patient Secure Messages: How Much Are They Increasing, Who Is Doing the Work, and Is the Work Happening After Hours?

Frederick North et al. JMIR Med Inform. .

Abstract

Background: Patient portal registration and the use of secure messaging are increasing. However, little is known about how the work of responding to and initiating patient messages is distributed among care team members and how these messages may affect work after hours.

Objective: This study aimed to examine the growth of secure messages and determine how the work of provider responses to patient-initiated secure messages and provider-initiated secure messages is distributed across care teams and across work and after-work hours.

Methods: We collected secure messages sent from providers from January 1, 2013, to March 15, 2018, at Mayo Clinic, Rochester, Minnesota, both in response to patient secure messages and provider-initiated secure messages. We examined counts of messages over time, how the work of responding to messages and initiating messages was distributed among health care workers, messages sent per provider, messages per unique patient, and when the work was completed (proportion of messages sent after standard work hours).

Results: Portal registration for patients having clinic visits increased from 33% to 62%, and increasingly more patients and providers were engaged in messaging. Provider message responses to individual patients increased significantly in both primary care and specialty practices. Message responses per specialty physician provider increased from 15 responses per provider per year to 53 responses per provider per year from 2013 to 2018, resulting in a 253% increase. Primary care physician message responses increased from 153 per provider per year to 322 from 2013 to 2018, resulting in a 110% increase. Physicians, nurse practitioners, physician assistants, and registered nurses, all contributed to the substantial increases in the number of messages sent.

Conclusions: Provider-sent secure messages at a large health care institution have increased substantially since implementation of secure messaging between patients and providers. The effort of responding to and initiating messages to patients was distributed across multiple provider categories. The percentage of message responses occurring after hours showed little substantial change over time compared with the overall increase in message volume.

Keywords: communication; electronic health records; electronic mail; nurse practitioners; nurses; patient messages; patient portal; patients; physician assistants; physicians; provider messages; secure messages.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Message counts by year.
Figure 2
Figure 2
Distinct patients generating a provider response or provider-initiated message by year.
Figure 3
Figure 3
Message counts per unique patient by year.
Figure 4
Figure 4
Message responses in primary care per provider by year.
Figure 5
Figure 5
Message responses in specialty care per provider by year.
Figure 6
Figure 6
Percentage staff distribution responding to patient messages by year.
Figure 7
Figure 7
Percentage provider message responses outside of Monday-Friday 8 AM to 5 PM by year.
See this image and copyright information in PMC

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