Rapid Growth in the Use of Secure Messaging in a Patient Portal by Surgical Providers

Gretchen P Jackson, MD, PhD, Sharon E Davis, MS, Jared E Shenson, Qingxia Chen, PhD, Robert M Cronin, MD. Vanderbilt University

Background: Adoption of secure patient-provider messaging through online patient portals has increased substantially in recent years due to Affordable Care Act incentives and consumer demand. Secure messaging is an evolving form of outpatient interaction through which clinical care is delivered; it can enhance communication, increase patient satisfaction, and improve outcomes, but may also increase physician workload. Most research about secure messaging and patient portals has been conducted in primary care and medical specialties, and little is known about their use by surgeons.

Methods: We characterized the adoption of secure messaging through a patient portal by surgical providers and measured the growth of secure messaging as a form of outpatient interaction across surgical specialties. We specifically studied messaging use because this portal function can be attributed to a specific specialty, and its use across specialties can be adjusted by the volume of traditional outpatient encounters (i.e., clinic visits). We determined the number of surgical clinic visits and patient-initiated secure messages sent to surgical specialties in the first three years (2008 to 2010) after deployment of a patient portal in adult and pediatric specialties at an academic medical center. We calculated the proportion of all outpatient interactions (i.e., clinic visits or secure message threads) done through secure messaging over time and used logistic regression models to compare the likelihood of message-based versus clinic outpatient interaction across surgical specialties.

Results: Over the study period, surgical providers delivered care in 648,200 clinic visits and received 83,912 portal messages: 12,070 in 2008; 31,404 in 2009; and 40,438 in 2010. A large number of unique portal users (n=19,605) and surgical providers (n=412) participated in these message exchanges. Surgical specialties receiving the most messages were otolaryngology (16,877; 20.1%), orthopedics (14,278; 17.0%), urology (9,075; 10.8%), and general surgery (8,082; 9.6%), while vascular surgery (680; 0.8%), pediatric surgery (179; 0.2%), and burn surgery (5; < 0.1%) received the fewest. The proportion of outpatient interaction conducted through secure messaging increased significantly from 5.4% in 2008 to 12.5% in 2009 and 15.1% in 2010 (p<0.001). The proportion of surgical outpatient interaction done through secure messaging increased for all specialties and was highest for heart and lung transplantation (75.1%); kidney, pancreas and liver transplantation (69.5%); and general surgery (48.7%) in 2010. Heart and lung transplantation experienced the most rapid growth in the proportion of outpatient interaction through secure messaging, followed by general surgery which experienced faster growth than all other specialties (p<0.01).

Conclusions: This study demonstrates rapid adoption of secure messaging by a spectrum of surgical providers as well as significant growth in the use of secure messaging for outpatient interaction. In only three years after widespread portal deployment, the volume of secure messaging exceeded face-to-face clinic encounters for some surgical specialties. As patient portal adoption increases, surgeons can expect to participate in growing numbers of online interactions, especially in specialties with long-term follow up, such as transplantation. Additional research is needed to understand the types of care delivered through patient portals and to develop models for reimbursement of online care.