The Use of Secure Messaging in Medical Specialty Care
The benefits of improving communication between health care providers and patients outweigh secure messaging’s implementation challenges.
The reality has been the opposite. Secure messaging was found to be an additional type of communication, which could be completed more rapidly than a phone call or generating a results letter. The HCPs were also concerned that patients would attempt to use them as primary care providers (PCPs). However, as patients were able to view both their PCP and their specialty care provider in the drop-down menu, they were generally able to direct their questions appropriately.
At the Atlanta VAMC, 60% of the messages were completed by the provider, 29% by a clinical team member, and 11% by the triage staff from 2013 to 2014 (Figure 1). Some HCPs were concerned that once SM was in place, they would be inundated with messages. The reality seems to be that most patients use SM judiciously, and although they are comfortable in the knowledge that they can communicate directly with their HCP, the need is infrequent. The number of messages has slowly increased over the past year as more patients join MHV and SM (Table). Surprisingly, as the number of inbound messages increased, the percentage of escalated messages (messages not answered within 3 days) declined, indicating a learning curve as HCPs begin using SM.
There are 3 steps to patient enrollment in SM. The first is enrollment in MHV, which can be done either online or at the VAMC. The second step requires the patient to go to the VAMC and present identification to complete the IPA. Finally, the enrolled patients must opt-in to the program. Enrollment in MHV has steadily increased through advertising campaigns on the VAMC website, within the VAMC, and through HCPs and staff (Figure 2).
However, barriers still exist. Some patients do not have an Internet connection and are not computer savvy. Other patients express interest but put it off to another visit. Some patients have been confused about the additional step of IPA that is required for SM and stop at enrollment in MHV only.
Therefore the key challenges for implementing SM are facilitating MHV enrollment, IPA, and completion of the opt-in feature. To encourage participation, VISN 7 mailed postcards to all 33,000 patients who had undergone IPA but had not yet opted-in. The number of patients who opted-in quadrupled, demonstrating that this type of promotion is an effective recruitment tool.
Another ongoing challenge is developing a method to easily generate workload credit for the HCPs’ time spent using SM for patient care. This will be an important parameter to track, as the time spent on SM per provider is expected to increase. It has also been suggested that there be an out-of-office response for nonemergent messages and the assignment of a surrogate to handle incoming messages for HCPs who are on leave. An unforeseen example of a nonemergent message occurs when a patient replies “Thank you” to a message from an HCP. That message is then counted as a new message and must be viewed and completed like any other message. It can also become an escalated message, even though there is no important information being transmitted.
Conclusions
Secure messaging provides a simple means of rapid communication and feedback between HCPs and their patients. An e-mail notification is generated, HCPs access SM through the link, the reply is sent, and a CPRS note is automatically generated. That same communication would require a far more time-consuming and complicated process without SM: The patient must contact the service, usually the program assistant, and leave a message; that message would be passed on via voicemail or e-mail to the appropriate HCP; the provider would need to access the CPRS, phone the patient, discuss the issue if the patient is available, and then document the contact with a note in the CPRS. If the patient was unavailable, this process would require multiple phone calls.
With respect to patients, the benefits of SM are significant and include easy access to prescription refills and a quick response to questions about medications, dosages, or tests. Patients are able to change or cancel appointments, thereby avoiding no-shows. Frustration concerning the inability to reach the correct party or to speak with staff directly is reduced with SM, and overall communication between HCP and patient is streamlined.
Author disclosures
The authors report no actual or potential conflicts of interest with regard to this article.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the U.S. Government, or any of its agencies. This article may discuss unlabeled or investigational use of certain drugs. Please review complete prescribing information for specific drugs or drug combinations—including indications, contraindications, warnings, and adverse effects—before administering pharmacologic therapy to patients.
