JMIR Publications

ABSTRACT

Background:

Email securely exchanged between patient and clinician offers the promise of improved access to care and indirectly, improved health outcomes. Yet research to date is mixed on who—among both patients and clinicians—are using secure messaging.

Objective:

Using data from two large nationally representative cross-sectional surveys, we compared the prevalence of secure messaging use among patients and their access to the functionality through their physicians. We also explored the clinical practice and physician characteristics, and patient sociodemographic characteristics, associated with use.

Methods:

We conducted regression analyses to identity statistical associations between self-reported secure messaging use and access and patient, practice, and physician characteristics from the National Health Interview Survey (NHIS) and the National Ambulatory Medical Care Survey (NAMCS). NHIS data collected between 2013 and 2018, with approximately 150,000 adult individuals, were used to evaluate patient characteristics associated with email communication with clinicians. The NAMCS data included more than 10,000 physicians who reported on secure messaging use between 2013 and 2016 and provided context on physician specialty, use of certified health IT, and practice size and ownership associated with secure messaging access and use.

Results:

By 2016, two-thirds of ambulatory care visits were conducted by a physician who reported using secure messaging, up from 40.7 percent in 2013. The percent of U.S. residents who reported sending an email to their clinician, however, only increased from 7.2 to 16.7 percent between 2013 and 2018. We observed a strong positive association between certified health IT use and secure messaging use (OR=11.46). Individuals who were black, had lower levels of education, Medicaid or other public payer insurance, or who were uninsured, had reduced odds for using email to communicate with clinicians. No differences were seen in secure messaging use based on physician specialty, but significant differences were observed by practice size (OR=0.46 in solo practices vs non-solo practices) and practice ownership (p<0.01 for the different categories).

Conclusions:

This study is the first to use two large nationally representative surveys to produce longitudinal estimates on the access and use of patient-clinician email communication in the U.S. The survey findings complement each other; one provides the patient perspective of their use and the other indicates potential patient access to secure messaging based on the use of the functionality by the physicians providing treatment. This study provides nationally representative data on the characteristics of patients and physicians who have access to and are using secure messaging. This information can be used to target interventions to promote adoption and use of secure messaging.