JMIR Publications

ABSTRACT

Background:

The growing volume of secure messaging within the patient portal has imposed significant demands on clinicians and contributed to burnout. Little is known about the characteristics of patients who comprise high-volume message senders, and we lack a nuanced understanding of patient messaging intensity beyond measures accounting for sheer volume.

Objective:

Our objective was to characterize older adult patients (65+) with high secure messaging volume, examining both patient characteristics and other aspects of their messaging intensity such as messaging frequency, length, and messaging use relative to patient portal logins and healthcare encounters.

Methods:

We analyzed electronic medical record (EMR) and patient portal data from a large academic health system, encompassing 16,023 older adults who sent 199,952 messages over a 12-month period. We developed five measures to account for secure messaging intensity. Our primary measure of messaging intensity was based on message volume; high-volume message senders were identified using outlier analysis based on patients’ aggregate number of messages sent during the observation period. Additional measures of messaging intensity included identifying individuals with concentrated periods of messaging, message length (character count), a ratio of messages to portal logins and a ratio of messages to healthcare encounters. We compared sociodemographic characteristics, health status, and messaging intensity of high-volume secure messaging senders to other message senders. We also identified patients who were classified as high-intensity message senders based on all five measures of messaging intensity (‘super-senders’).

Results:

Of 16,023 older adult patients who sent at least one message during the observation period, 1,298 (8.1%) were classified as high-volume message senders; these patients accounted for 39.7% of total messages. High-volume message senders, compared to all other message senders, were more likely to be White (80.4% vs. 72.5%, p < 0.001), have higher comorbidity scores (2.6 vs. 1.8, p <0.001), and higher incidence of cancer (35.8% vs. 22.8%, p<0.001) and dementia (8.3% vs. 6.1%, p < 0.002). High-volume message senders were also more likely to be identified as having concentrated periods of messaging, to send longer messages, and to send more messages in relation to patient portal logins and healthcare encounters. A small subgroup of patients classified as high-volume senders were also classified as high-intensity across all four of the other measures of messaging intensity (59/1,298; 4.5%), the ‘super senders’.

Conclusions:

High-volume message senders represent a small but distinct group of older patients who send a disproportionate share of messages to clinicians. Triangulating multiple measures of messaging intensity can help provide additional context about patient messaging behavior and help to identify patients that may most benefit from targeted outreach while potentially easing clinicians' inbox workload.