- Secure messaging via the patient portal has presented a new frontier for patient-provider communication. What was previously discussed via telephone calls or during in-person follow-up appointments can now be done digitally, helping to streamline the interaction.
Regulatory requirements have spurred the widespread adoption of patient portal secure messaging. In 2015, 63 percent of hospitals had adopted the technology, according to the ONC. Sixty-four percent of office-based physicians could also secure message with their patients in 2015, the agency reported.
As more clinicians adopt secure messaging capabilities, they will need to learn how to integrate the technology into their clinical workflows and communication strategies.
Patients have long been used to communicating with their providers in person or via the telephone. Clinicians will need to create a new set of expectations for patients to engage in successful secure messaging.
Create a message answering timeline
Clinicians and patients may find themselves at odds when it comes to how quickly the clinician will answer a patient’s secure messaging query. Research has indicated that 37 percent of patients grow frustrated with staff who are unresponsive to patient portal messages, while clinicians have expressed concern about patients growing impatient using the portal.
In these cases, it will be helpful for clinicians to be up-front with patients about their message answering timeline. Clinicians cannot answer each secure message in real-time, nor should they be expected to. Instead, clinicians must set an expectation with their patient populations so patients can understand that clinicians are not necessarily ignoring them.
Many clinicians rope off one or two designated times to answer secure messages. This helps clinicians organize their workflows and create a certain expectation with patients. Patients sending messages in the morning can anticipate that their provider will return the message during lunch, for example.
Patients who are used to contacting their providers via the telephone may need to get used to this new timeline, according to 2016 research published in the Journal of the American Board of Family Medicine.
“A patient may expect to receive a quicker response when telephoning their physician compared with sending an electronic message,” the researchers reported.
While that expectation may be true, it is the clinician’s job to reassure patients that the longer wait time is okay. Medication updates or questions about a care management plan likely do not need an immediate answer. Clinicians should explain this to patients and note that it is okay for these questions to wait in the portal inbox until the clinician’s designated message answering time.
Clinicians must also be responsible for teaching patients about which concerns should not wait. Patients experiencing alarming, urgent, or potentially life-threatening symptoms should not rely on secure messaging. These patients instead should seek immediate medical attention or, where appropriate, call the provider.
Create expectations for message content
Clinicians must also work to reconcile empathetic communication and the rise of patient portal secure messaging. While secure messaging is supplementing and in some cases replacing in-person communication, clinicians must still ensure they are messaging in a sensitive manner.
Healthcare professionals must therefore practice good judgment when electing to communicate via secure message. Clinicians should not send upsetting news via secure message in lieu of empathetic patient-provider communication.
Complicating matters is patients’ preferences for receiving test results via the patient portal and secure message. Providers should not make a standard rule excluding test results from secure messaging; instead, they should recognize the nuances in patient preferences.
Data from a 2017 study in the American Journal of Managed Care showed that 98 percent of patients like receiving notice about lab results via secure message, and 100 percent want to look at those results on the patient portal. Seventy-seven percent of patients said they prefer the timeliness of the patient portal, rather than waiting for a phone call or visiting the office.
Eighty-two percent of patients said they don’t mind receiving abnormal test results online. Despite this, the researchers recommended clinicians still have discretion when delivering potentially bad news.
“The lack of face-to-face interaction with laboratory staff, and of their personal encouragement, may result in the failure of patients with abnormal lab results to plan for their next treatment steps,” the researchers pointed out.
Instead, clinicians need to set an expectation with the patient. Clinicians should ask patients about their preferences prior to administering an important test, and then deliver the results accordingly.
When patients do elect to receive abnormal test results digitally, clinicians should always send secure messages equipping patients with the knowledge and support necessary to handle that potentially bad news.
Support chronic care self-management
Clinicians can anticipate that some of the most active patient portal users will be managing some form of a chronic illness. These patients are likely to lean on secure messaging frequently, using it as a tool to stay in touch with their clinicians as patients try to manage an illness on their own.
That secure messaging relationship can also go the other way. Providers can use the technology to check in with their chronic care patients, issuing prompts to participate in healthy behaviors or to engage with a specific self-management strategy.
A study from May 2017 showed that making provider secure messages very personalized yielded better chronic care self-management. When secure messages leveraged EHR data to make prompts personalized to specific patient conditions, patients were more likely to heed that suggestion or prompt.
The researchers, who hailed from Columbia University, found that this strategy was effective for underprivileged pregnant women in New York City. The secure messages that used specific information from the patient EHR made prompts more actionable and helped patients better engage with their own healthcare.
These results have larger implications, the researchers said. EHR-informed secure messages can be effective in other areas of medicine.
“Based on these results, we recommend exploring the use of other pieces of information from the EHR to push information to patients,” lead researcher Adrianna Arcia explained. “For example, if the procedure codes in the EHR indicate that a patient just got stitches, they could automatically receive instructions on how to care for their wound.”
Secure messages are also excellent tools for talking about medication management. Patients managing a chronic illness can update their medication progress, alert clinicians of any adverse side effects, or make any other necessary requests for adjustment.
These messages are documented, making it easier for clinicians to make effective changes. Additionally, they are more timely than periodic in-person check-ins.
Successfully integrating secure messaging into the patient-provider relationship is going to require a new approach for providers and a new set of expectations for patients. It is up to both parties to be clear about their needs and their habits for this renewed relationship to work.
Clinicians must set a standard message response timeline, tap into patient preferences for messaging content, and reframe chronic care management plans to utilize secure messaging to make the most of the tool.