Researchers are just beginning to examine the burgeoning use of EHR-integrated secure messaging in health care settings, and it appears that everyone is using it—but it’s not clear what they’re using it for and what impact it’s having on patient care.
A six-month study conducted at 14 hospitals and 263 outpatient clinics affiliated with Washington University and BJH Healthcare in the St. Louis area saw a 29% jump in median daily message volume between the first two weeks of the study in July 2022 and the last two weeks in January 2023.
In the first two weeks, almost 54,000 messages were sent daily, compared with almost 70,000 a day in the last two weeks, according to the study published in the Journal of Medical Internet Research and supported by the AMA EHR Use Research Grant program.
In all, almost 33,000 users sent more than 9.6 million messages in six months using Epic’s Secure Chat messaging platform, which had been rolled out across all clinical sites in 2019.
According to study lead author Sunny Lou, MD, PhD, “one of the main points of the paper” was the discovery that “everyone” is using secure messaging as 74 different types of health care professionals used secure messaging during the study.
“It’s not just doctors, not just nurses or advanced practice providers, but therapists are using it, case managers, social workers, medical assistants, people doing patient transport and patient placement,” said Dr. Lou, an anesthesiologist with the Washington University School of Medicine. “It seemingly has become widely adopted across health care, or at least, across our health care organization.”
Key data points include:
- The largest proportion of inpatient messages was from nurses to physicians, 20% of messages, followed by physicians to nurses, 13%.
- The largest proportion of outpatient messages was from physicians to nurses, 16% of messages, followed by medical assistants to other medical assistants, 11%.
- The median length of messages was 41 characters, with inpatient pharmacists and outpatient social workers sending the longest messages, of 66 and 65 characters, respectively.
The research comes in the context of an EHR-driven surge in physician clerical burdens. AMA-funded research has shown that for every eight hours that office-based physicians have scheduled with patients, they spend more than five hours in the EHR.
Growth is organic
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Dr. Lou described the growth as organic because secure messaging became widely adopted without any organizational directive ordering or suggesting that staff use it.
Future research should identify how secure messaging is being used and if there are strong positive effects for patient safety, improved communication or for tasks such as getting patients discharged efficiently, she said.
“What’s most striking is how little we know about this tool that seems to be largely adopted,” Dr. Lou said. “There's relatively little understood about what consequences this has had, what is the effect of people doing all this communication on people's work?”
Messages are EHR “breadcrumbs”
Dr. Lou and colleagues wrote that “the main strength of this study is its scope,” but she cautioned against generalizing its findings across other health systems. That having been said, she also noted that a study published in JAMA Network Open by researchers with the New York University Grossman School of Medicine had similar findings.
An invited commentary discussing the two studies published in JAMA Network Open referred to the examination of secure-message logs as “tracing the latest breadcrumbs of the electronic health record” and noted their potential to improve quality and health equity.
“Analyses of patterns and content of secure messages could help facilitate at-scale identification of areas for improved team functioning, delivery of clinical care, and design of EHR tools,” says the commentary, written by physicians from the University of Michigan and the University of California, San Fransisco.
They also suggested that analyses of secure-messaging content could be used for quality improvement efforts, “such as identifying instances of unclear or ambiguous communication regarding orders or clinical decisions” and which care team members “are bearing the greatest burden of the EHR in their clinical work.”
