Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Apr 28, 2023
Date Accepted: Aug 29, 2023
Characterizing the Patterns of EHR-integrated Secure Messaging Use: A Cross-sectional Study
ABSTRACT
Background:
Communication among healthcare providers is essential for the delivery of safe clinical care. Secure messaging has rapidly emerged as a new mode of asynchronous communication. Despite its popularity, relatively little is known about how clinicians use secure messaging and how such use contributes to communication burden.
Objective:
To characterize the use of an EHR-integrated secure messaging platform across 14 hospitals and 263 outpatient clinics within a large healthcare system
Methods:
Metadata on the use of the Epic Systems Secure Chat platform was prospectively collected for 6 months (July 2022-January 2023). Information was retrieved on message volume, response times, message characteristics, the users sending and receiving messages, their roles, and work settings (inpatient versus outpatient).
Results:
32,881 users sent a total of 9,639,149 messages during the study. There was a 31% increase in weekly message volume. The largest users of secure messaging were nurses (40% of total messages), physicians (25%), and medical assistants (12%). Daily message frequency varied across users: inpatient advanced practice providers and social workers interacted with the highest number of messages per day (median 19). Conversations were predominantly between two users (81%), with a median of 2 conversational turns and a median response time of 2.4 minutes. The largest proportion of inpatient messages was from nurses to physicians (20%) and physicians to nurses (13%), while the largest proportion of outpatient messages was from physicians to nurses (16%) and medical assistants to other medical assistants (11%).
Conclusions:
Secure messaging was widely used by a diverse range of healthcare providers, with ongoing growth throughout the study and many users interacting with 20+ messages per day. The short message response times and high messaging volume observed highlight the interruptive nature of secure messaging, raising questions about its potential downstream effects on clinician workflow, cognition, and errors. Clinical Trial: N/A
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