- Providers who want to drive patient engagement through patient portal secure messages may need to step up their own messaging habits, according to a recent study published in the Journal of Medical Internet Research.
Secure messages via the patient portal are one of many reasons why patient portals are lauded as such an integral part of patient engagement. Secure messages help build better patient-provider relationships through more frequent and convenient communication.
“Better patient-provider communication is important because their relationship is at the center of health care service delivery,” said a research team from Army-Baylor University. “A supportive patient-provider relationship has been shown to be associated with many positive outcomes, including increased patient compliance, decreased pain, and shortened recovery periods.”
However, is secure messaging useful for driving patient engagement if neither patients nor providers actively use it?
While secure messaging does offer patients an avenue to ask medical questions and build a relationship with their provider, these efforts are often all for naught. Patient portal and secure messaging benefits can only be realized when patients and providers are both meaningfully using the technology.
Patient portal and secure messaging uptake is low, the Army-Baylor researchers pointed out. One separate study found that secure messaging rates are as low as 10 to 30 percent amongst patient portal adopters.
For its part, CMS has even made patient engagement thresholds easier for the Medicare and Medicaid EHR Incentive Programs. Under Stage 2 Meaningful Use, providers only needed to exchange secure messages with one unique patient.
However, lowering the standard for secure message exchange and patient engagement is likely not the answer, the researchers suggested. Instead, providers must engage their patients using secure messaging. More provider messaging begets more patient messaging, the researchers asserted.
“Patients may lose interest in such resources if providers do not encourage the use of electronic tools or lead by example by becoming active users of the tools themselves,” the research team said.
“Furthermore, the way and degree to which providers generally engage in messaging may represent a marker of the level of approachability that is perceived by their patients during care,” the researchers continued. “Provider receptiveness to communication, an otherwise difficult-to-assess factor, might be indicated by the willingness of patients to initiate secure messages with their clinicians.”
In a retrospective analysis of 81,000 medical records from US army patients, the researchers confirmed that hypothesis.
The team looked at nearly 25 million secure message interactions between army patients and nearly 3,000 clinicians to find that strong clinician interaction via secure message correlated with meaningful patient engagement.
Patients with providers who regularly initiated conversations between patients were 60 percent more likely to regularly utilize secure messaging. Surprisingly, patients with providers who regularly responded to secure messages were 334 percent more likely to initiate a conversation.
Patients were also more likely to engage with secure messages when their providers did the same, potentially because patients perceived certain characteristics from provider messages.
Providers who made personal interactions via secure message functionalities – especially those who offered unique responses to queries – usually put forward a warmer attitude that appeared likely to deliver personalized medicine.
Conversely, clinician-initiated messages might have appeared less personal, more automated, or more like a check-box task, the researchers reasoned.
“We therefore theorize that patients’ willingness to initiate messages may stem from their appreciation of provider traits that, in turn, are associated with the provider’s propensity to robustly engage in different types of secure messaging,” the research team said.
“These traits might be more evident among clinicians who choose to personally respond to patient messages and do so at high rates,” the team continued. “Provider-response messaging may be more influential than provider-initiated messaging because provider-response messaging is likely a more personal type of messaging, tailored to each specific patient’s needs.”
However, the researchers cautioned there could be a flip side to these findings. Patients may become frustrated with providers who exclusively communicate via secure message, eventually perceiving these conversations as impersonal.
“Alternatively, it is possible that patients may initiate messages due to frustration with their ability to communicate with providers because their providers use secure messaging to avoid face-to-face and telephone encounters,” the researchers explained. “Provider messaging use therefore requires substantial further study in order to better understand how providers differ when stratified by secure messaging usage levels and types.”
Ultimately, these findings show a better path forward for meeting patient engagement requirements than lowering thresholds, the researchers asserted.
“Perhaps a more useful approach would be to require that providers demonstrate a minimum level of engagement with secure messaging and to sponsor studies that examine the factors associated with all use levels and types,” the team concluded.