Characterizing the Patterns of Electronic Health Record-Integrated Secure Messaging Use: Cross-Sectional Study

Pediatric Clinical Staff Perspectives on Secure Messaging

BACKGROUND

Secure messaging (SM) is a communication feature within a patient portal that allows patients and clinical staff to exchange health-related information securely and confidentially.

PURPOSE

This study aimed to explore how pediatric clinical staff use SM, identify challenges in its implementation, and suggest quality improvements.

METHODS

A descriptive quantitative study was administered using an online survey in a large health care system. The Task, User, Representation, and Function framework guided the research.

RESULTS

The survey participants were moderately satisfied with the SM. Opportunities to design this system to be more efficient and maximize patient safety were identified.

CONCLUSION

Improving training and workflow can aid in incorporating SM into clinician's daily routines, focusing on enhancing user satisfaction. Future developments aimed at increasing usage and standardizing message content are crucial for encouraging adoption and ensuring patient safety.

Characterizing electronic messaging use among hospitalists and its association with patient volumes

BACKGROUND

Secure electronic messaging is increasingly being utilized for communications in healthcare settings. While it likely increases efficiency, it has also been associated with interruptions, high message volumes, and risk of errors due to multitasking.

OBJECTIVES

We aimed to characterize patterns of secure messaging among hospitalists to understand the volume of messages, message patterns, and impact on hospitalist workload.

METHODS

This was a retrospective cross-sectional study of Epic Secure Chat secure electronic messages received and sent by hospitalists from April 1 to April 30, 2023 at a large academic medical center. Number of conversations per day, number of chats sent and accessed per hour, and average minutes between when a chat was sent and accessed (lag time) were analyzed using a Pearson correlation coefficient test. Measures were plotted against patient volume and time of day.

RESULTS

Hospitalists sent or received an average of 130 messages per day with an average of 13 messages sent or received per hour. The median lag time was 39 s. There was a statistically significant correlation between hospital medicine morning census and number of conversations per day, number of chats sent per hour, and number of chats accessed per hour, but census did not impact lag time.

CONCLUSION

Secure messaging volumes may be higher than previously reported, which may affect hospitalist workload and workflow and have unintended effects on interruptions, multitasking, and medical errors. Additional work should be done to better understand local messaging patterns and opportunities to optimize volume of work and distractions.

Is there a difference in quality of photographs obtained using smartphones, compared to the photographs obtained via digital single-lens reflex camera?

OBJECTIVE

The purpose of this study was to compare the quality of photographs obtained with 3 different cameras: iPhone, Samsung, and digital single-lens reflex (DSLR), as assessed by oral and maxillofacial surgeons (OMS).

METHODS

This was an anonymous online survey study. The study population consisted of OMS in New Jersey, New York, Pennsylvania, and Massachusetts who were members of their state societies. The primary outcome variable was ratings on the quality of extraoral and intraoral photographs obtained with 3 different cameras. The predictor variable was the type of camera used to obtain the photographs: iPhone, Samsung, and DSLR camera. Descriptive statistics were computed. Spearman test was utilized to analyze correlation between the outcome variables.

RESULTS

The majority of respondents were from full time private practice (n = 84, 77.06%), followed by full time academia (n = 12, 11.01%). The Spearman test revealed negligible correlation between extraoral and intraoral photographs on the best quality rating (0.15, P = .13). Negligible correlation between extraoral and intraoral photographs were noted on the second best (0.15, P = .11), and least quality rating (0.09, P = .32).

CONCLUSION

Study results revealed that there is no difference between the quality of photographs obtained using smartphones, compared with the photographs obtained via a DSLR camera. Future discussions on an ideal application on smartphones would allow for consent and transfer of high-quality photographs via a secure messaging system between health care providers to address ethical concerns of confidentiality. (Oral Surg Oral Med Oral Pathol Oral Radiol YEAR;VOL:page range).

Secure Messaging and Telephone Use for Clinician-to-Clinician Communication

This cohort study investigates the association of use of text-based secured messaging with telephone use among resident physicians.

Contributors to Electronic Health Record-Integrated Secure Messaging Use: A Study of Over 33,000 Health Care Professionals

OBJECTIVES

 Electronic health record (EHR)-integrated secure messaging is extensively used for communication between clinicians. We investigated the factors contributing to secure messaging use in a large health care system.

METHODS

 This was a cross-sectional study that included 14 hospitals and 263 outpatient clinic locations. Data on EHR-integrated secure messaging use over a 1-month period (February 1, 2023, through February 28, 2023) were collected. A multilevel mixed effects model was used to assess the contribution of clinical role, clinical unit (i.e., specific inpatient ward or outpatient clinic), hospital or clinic location (i.e., Hospital X or Outpatient Clinic Building Y), and inpatient versus outpatient setting toward secure messaging use.

RESULTS

 Of the 33,195 health care professionals who worked during the study period, 20,576 (62%) were secure messaging users. In total, 25.3% of the variability in messaging use was attributable to the clinical unit and 30.5% was attributable to the hospital or clinic location. Compared with nurses, advanced practice providers, pharmacists, and physicians were more likely to use secure messaging, whereas medical assistants, social workers, and therapists were less likely (p < 0.001). After adjusting for other factors, inpatient versus outpatient setting was not associated with secure messaging use.

CONCLUSION

 Secure messaging was widely used; however, there was substantial variation by clinical role, clinical unit, and hospital or clinic location. Our results suggest that interventions and policies for managing secure messaging behaviors are likely to be most effective if they are not only set at the organizational level but also communicated and tailored toward individual clinical units and clinician workflows.

Implementation of an electronic health record-integrated instant messaging system in an academic health system

OBJECTIVES

Effective communication amongst healthcare workers simultaneously promotes optimal patient outcomes when present and is deleterious to outcomes when absent. The advent of electronic health record (EHR)-embedded secure instantaneous messaging systems has provided a new conduit for provider communication. This manuscript describes the experience of one academic medical center with deployment of one such system (Secure Chat).

METHODS

Data were collected on Secure Chat message volume from June 2017 to April 2023. Significant perideployment events were reviewed chronologically.

RESULTS

After the first coronavirus disease 2019 lockdown in March 2020, messaging use increased by over 25 000 messages per month, with 1.2 million messages sent monthly by April 2023. Comparative features of current communication modalities in healthcare were summarized, highlighting the many advantages of Secure Chat.

CONCLUSIONS

While EHR-embedded secure instantaneous messaging systems represent a novel and potentially valuable communication medium in healthcare, generally agreed-upon best practices for their implementation are, as of yet, undetermined.