Using secure messaging for communication between physicians and other health professionals is seen by many as a possible path to more efficient workflows through the elimination of highly interruptive telephone calls, but a study published in JAMA Network Open suggests that this may not be true.
“We found that increased secure messaging use was associated with increased telephone use, suggesting that perhaps secure messaging is being used alongside the telephone instead of as a replacement,” said Sunny Lou, MD, PhD, the study’s lead author and an anesthesiologist with the Washington University School of Medicine.
The study examined how 1,057 resident physicians at Barnes-Jewish Hospital in St. Louis communicated and found that, each month, they sent or received a median of 148 secure messages and used a median of 166 telephone minutes.
The study, conducted between August 2022 and early 2023, was supported by an award from the AMA EHR Use Research Grant Program.
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Nearly 10 million messages in 6 months
The study builds on previous research conducted at 14 hospitals and 263 outpatient clinics affiliated with Washington University and BJH Healthcare in the St. Louis area that 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 that study, it was found that 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.
That study “focused on describing messaging behaviors, i.e., how many messages, who is messaging whom,” Dr. Lou said. “This paper attempts to look at the relationship between secure messaging use and other forms of communication—namely telephone in this case.”
She also cautioned that it’s possible that the results of the newer study were “confounded by some clinical settings simply having higher overall need for communication; we did our best to adjust for this, but the possibility of residual confounding exists.”
Similarly, while the researchers did stratify results by physician specialty, Dr. Lou recommended against highlighting differences between specialties.
“This study focused on resident physicians, so the specialty-specific stratification may be due to the way these particular residency programs choose to handle clinical communication responsibilities, which likely won’t generalize to other institutions,” she explained.
More guidance needed?
After adjusting for gender, individual preferences and clinical work setting, “months with increased secure messaging use also had increased telephone use,” the researchers wrote.
“This result is consistent with prior research showing that the use of new workplace communication channels may not mitigate the use of existing channels, highlighting the possibility that secure messaging may be associated with worsened communication burden and interruptions when not used thoughtfully,” the study added. “Although secure messaging has potential advantages, further research is needed to understand clinician communication preferences and the best strategies for secure messaging use to minimize burden.”
Suggestions for thoughtful use of communication channels could be useful.
“There is a need for national guidelines or standards for secure messaging use,” Dr. Lou said.
“Ideally, secure messaging would be used only for nonurgent communication, so clinicians can appropriately triage secure messages to minimize potential interruptions to their workflow,” she added. “There likely needs to be improved education on what types of communication are most appropriate for each communication modality.”
Dr. Lou also noted that future research will look at trying to evaluate the impact of secure messaging on EHR use and physician burden.
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