Appl Clin Inform 2015; 06(02): 288-304
DOI: 10.4338/ACI-2014-12-RA-0117
Research Article
Schattauer GmbH

Growth of Secure Messaging Through a Patient Portal as a Form of Outpatient Interaction across Clinical Specialties

R.M. Cronin
1   Vanderbilt University Medical Center Department of Biomedical Informatics, Nashville, Tennessee
2   Vanderbilt University Medical Center Department of Medicine, Nashville, Tennessee
3   Vanderbilt University Medical Center Department of Pediatrics, Nashville, Tennessee
,
S.E. Davis
1   Vanderbilt University Medical Center Department of Biomedical Informatics, Nashville, Tennessee
,
J.A. Shenson
4   Vanderbilt University Medical Center School of Medicine, Nashville, Tennessee
,
Q. Chen
1   Vanderbilt University Medical Center Department of Biomedical Informatics, Nashville, Tennessee
5   Vanderbilt University Medical Center Department of Biostatistics, Nashville, Tennessee
,
S.T. Rosenbloom
1   Vanderbilt University Medical Center Department of Biomedical Informatics, Nashville, Tennessee
2   Vanderbilt University Medical Center Department of Medicine, Nashville, Tennessee
3   Vanderbilt University Medical Center Department of Pediatrics, Nashville, Tennessee
,
G.P. Jackson
1   Vanderbilt University Medical Center Department of Biomedical Informatics, Nashville, Tennessee
3   Vanderbilt University Medical Center Department of Pediatrics, Nashville, Tennessee
6   Vanderbilt University Medical Center Department of Pediatric Surgery, Nashville, Tennessee
› Author Affiliations
Further Information

Correspondence to:

Robert M. Cronin
Department of Biomedical Informatics
Vanderbilt University Medical Center
2525 West End Blvd., Suite 1475
Nashville, TN, 37232, USA

Publication History

received: 19 December 2014

accepted: 03 March 2015

Publication Date:
19 December 2017 (online)

 

Summary

Objective: Patient portals are online applications that allow patients to interact with healthcare organizations. Portal adoption is increasing, and secure messaging between patients and health-care providers is an emerging form of outpatient interaction. Research about portals and messaging has focused on medical specialties. We characterized adoption of secure messaging and the contribution of messaging to outpatient interactions across diverse clinical specialties after broad portal deployment.

Methods: This retrospective cohort study at Vanderbilt University Medical Center examined use of patient-initiated secure messages and clinic visits in the three years following full deployment of a patient portal across adult and pediatric specialties. We measured the proportion of outpatient interactions (i.e., messages plus clinic visits) conducted through secure messaging by specialty over time. Generalized estimating equations measured the likelihood of message-based versus clinic outpatient interaction across clinical specialties.

Results: Over the study period, 2,422,114 clinic visits occurred, and 82,159 unique portal users initiated 948,428 messages to 1,924 recipients. Medicine participated in the most message exchanges (742,454 messages; 78.3% of all messages sent), followed by surgery (84,001; 8.9%) and obstetrics/gynecology (53,424; 5.6%). The proportion of outpatient interaction through messaging increased from 12.9% in 2008 to 33.0% in 2009 and 39.8% in 2010 (p<0.001). Medicine had the highest proportion of outpatient interaction conducted through messaging in 2008 (23.3% of out-patient interactions in medicine). By 2010, this proportion was highest for obstetrics/gynecology (83.4%), dermatology (71.6%), and medicine (56.7%). Growth in likelihood of message-based interaction was greater for anesthesiology, dermatology, obstetrics/gynecology, pediatrics, and psychiatry than for medicine (p<0.001).

Conclusions: This study demonstrates rapid adoption of secure messaging across diverse clinical specialties, with messaging interactions exceeding face-to-face clinic visits for some specialties. As patient portal and secure messaging adoption increase beyond medicine and primary care, research is needed to understand the implications for provider workload and patient care.

Citation: Cronin RM, Davis SE, Shenson JA, Chen Q, Rosenbloom ST, Jackson GP. Growth of secure messaging through a patient portal as a form of outpatient interaction across clinical specialties. Appl Clin Inf 2015; 6: 288–304

http://dx.doi.org/10.4338/ACI-2014-12-RA-0117


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Conflict of Interest

Gretchen Jackson reports salary support from funding provided to VUMC by West Health for projects not related to the submitted work. All other authors have no reported conflicts of interest related to the research.

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Correspondence to:

Robert M. Cronin
Department of Biomedical Informatics
Vanderbilt University Medical Center
2525 West End Blvd., Suite 1475
Nashville, TN, 37232, USA

  • References

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  • 24 Quinn CC, Clough SS, Minor JM, Lender D, Okafor MC, Gruber-Baldini A. WellDoc mobile diabetes management randomized controlled trial: change in clinical and behavioral outcomes and patient and physician satisfaction. Diabetes Technol Ther 2008; 10 (03) 160-168.
  • 25 Nordqvist C, Hanberger L, Timpka T, Nordfeldt S. Health professionals’ attitudes towards using a Web 2.0 portal for child and adolescent diabetes care: qualitative study. J Med Internet Res 2009; 11 (02) e12.
  • 26 Ma C, Warren J, Phillips P, Stanek J. Empowering patients with essential information and communication support in the context of diabetes. Int J Med Inf 2006; 75 (08) 577-596.
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  • 28 Hess R, Bryce CL, Paone S, Fischer G, McTigue KM, Olshansky E, Zickmund S, Fitzgerald K, Siminerio L. Exploring challenges and potentials of personal health records in diabetes self-management: implementation and initial assessment. Telemed J E-Health Off J Am Telemed Assoc 2007; 13 (05) 509-517.
  • 29 Agrawal A, Mayo-Smith MF. Adherence to computerized clinical reminders in a large healthcare delivery network. Stud Health Technol Inform 2004; 107 Pt 1 111-114.
  • 30 Grant RW, Wald JS, Poon EG, Schnipper JL, Gandhi TK, Volk LA, Middleton B. Design and implementation of a web-based patient portal linked to an ambulatory care electronic health record: patient gateway for diabetes collaborative care. Diabetes Technol Ther 2006; 8 (05) 576-586.
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  • 33 Sarkar U, Lyles CR, Parker MM, Allen J, Nguyen R, Moffet HH, Schillinger D, Karter AJ. Use of the Refill Function Through an Online Patient Portal is Associated With Improved Adherence to Statins in an Integrated Health System. Med Care 2014; 52 (03) 194-201.
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