Secure Text Messaging in Healthcare: Latent Threats and Opportunities to Improve Patient Safety

Hagedorn, Philip; Singh, Ankush; Luo, Brooke; Bonafide, Christopher P.; Simmons, Jeffrey M.

doi:10.12788/jhm.3305

Cited by 11 publications

(8 citation statements)

References 18 publications

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“…Given the potential advantages and concerns surrounding secure messaging use described above, further research is needed on the impact of secure messaging on clinician efficiency, workflow, cognitive burden, and downstream effects for patient care and clinician wellness, as emphasized by the American Medical Informatics Association’s 25×5 campaign to reduce EHR burden [ 43 ]. In addition, no standardized guidelines exist for secure messaging use or deployment [ 16 ], and additional research is needed to understand the messaging policies (such as establishing etiquette and guidelines for appropriate use and best practices for education on these topics) and platform features (such as batched alerts, priority indicators, improved notification design, or generative artificial intelligence) that best enhance clinical care and minimize the potential negative effects of secure messaging use [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Characterizing the Patterns of Electronic Health Record–Integrated Secure Messaging Use: Cross-Sectional Study

Baratta,

Harford,

Sinsky

et al. 2023

J Med Internet Res

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Background Communication among health care professionals is essential for the delivery of safe clinical care. Secure messaging has rapidly emerged as a new mode of asynchronous communication. Despite its popularity, relatively little is known about how secure messaging is used and how such use contributes to communication burden. Objective This study aims to characterize the use of an electronic health record–integrated secure messaging platform across 14 hospitals and 263 outpatient clinics within a large health care system. Methods We collected metadata on the use of the Epic Systems Secure Chat platform for 6 months (July 2022 to January 2023). Information was retrieved on message volume, response times, message characteristics, messages sent and received by users, user roles, and work settings (inpatient vs outpatient). Results A total of 32,881 users sent 9,639,149 messages during the study. Median daily message volume was 53,951 during the first 2 weeks of the study and 69,526 during the last 2 weeks, resulting in an overall increase of 29% (P=.03). Nurses were the most frequent users of secure messaging (3,884,270/9,639,149, 40% messages), followed by physicians (2,387,634/9,639,149, 25% messages), and medical assistants (1,135,577/9,639,149, 12% messages). Daily message frequency varied across users; inpatient advanced practice providers and social workers interacted with the highest number of messages per day (median 19). Conversations were predominantly between 2 users (1,258,036/1,547,879, 81% conversations), with a median of 2 conversational turns and a median response time of 2.4 minutes. The largest proportion of inpatient messages was from nurses to physicians (972,243/4,749,186, 20% messages) and physicians to nurses (606,576/4,749,186, 13% messages), while the largest proportion of outpatient messages was from physicians to nurses (344,048/2,192,488, 16% messages) and medical assistants to other medical assistants (236,694/2,192,488, 11% messages). Conclusions Secure messaging was widely used by a diverse range of health care professionals, with ongoing growth throughout the study and many users interacting with more than 20 messages per day. The short message response times and high messaging volume observed highlight the interruptive nature of secure messaging, raising questions about its potentially harmful effects on clinician workflow, cognition, and errors.

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Section: Discussionmentioning

confidence: 99%

Characterizing the Patterns of Electronic Health Record–Integrated Secure Messaging Use: Cross-Sectional Study

Baratta,

Harford,

Sinsky

et al. 2023

J Med Internet Res

View full text Add to dashboard Cite

show abstract

“…To our knowledge, only a few studies have examined this topic, and they have similarly shown a marked increase in message volume and interruptions 10 and raised concerns regarding alarm fatigue and the potential for missing urgent messages. 15 These issues can have negative consequences for patient safety.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Another recent article identified more challenges, including alarm fatigue leading to delayed or incorrect responses, shift in communication away from critical face-to-face communication, and communication failures due to message errors. 15 These issues can have a detrimental effect on patient safety and clinical workflow. 16 The purpose of this study was to describe pediatric residents' and nurses' perspectives on STMS use and impact at a quaternary care children's hospital.…”

Section: Introductionmentioning

confidence: 99%

Resident and nurse perspectives on the use of secure text messaging systems

Aziz

Barber

Singh

et al. 2022

Journal of Hospital Medicine

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Background As hospitals shift away from pagers and towards secure text messaging systems (STMS), limited research exists on the drawbacks of such systems. Preliminary data show that introduction of STMS can lead to a dramatic increase in interruptions, which may contribute to medical errors. Objective This study aimed to investigate residents' and nurses' experiences with STMS at a quaternary care children's hospital. Design This was a qualitative study with focus groups. Setting and Participants Participants were pediatric residents and nurses at Lucile Packard Children's Hospital. Intervention Focus groups were audio recorded, transcribed verbatim, and coded by 2 independent coders. Codes were discussed until consensus was reached. Main Outcome and Measures Data was analyzed through a thematic, descriptive content analysis approach. Themes were developed alongside a framework of teamwork, patient safety, and clinician well‐being. Results Three resident focus groups (n = 14) and three nurse focus groups (n = 21) were held. Six themes were identified: (1) STMS can facilitate teamwork through multiple communication modalities and technological features. (2) STMS can negatively impact teamwork by decreasing face‐to‐face communication and frontline decision‐making. (3) STMS can promote patient safety through closed‐loop communication and ready access to team members. (4) STMS can negatively impact patient safety through alarm fatigue, interruptions, and miscommunication. (5) STMS can positively impact clinician well‐being through satisfaction and relationship building. (6) STMS can negatively impact clinician well‐being through increased stress related to communication volume. Conclusion Use of STMS in the hospital setting has many advantages as well as drawbacks. With appropriate guidelines and training designed to mitigate the drawbacks, STMS have the potential to be valuable means of communication for healthcare team members.

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“…Although there are many benefits of secure messaging [20,34], there are also several challenges to using chat for patient management communication. Risks include the development of alarm fatigue, the liability associated with critical communications, and communication errors that may occur [10]. Physical therapy departments would be wise to develop guidelines for the use of secure chat to safeguard patients against harm and reduce redundancy in communication.…”

Section: Evolving Physical Therapy Care Provisionmentioning

confidence: 99%

Adapting Physical Therapy Practice for the “Short-Stay” Total Joint Arthroplasty Patient: A Commentary

Camillieri

2023

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Secure Text Messaging in Healthcare: Latent Threats and Opportunities to Improve Patient Safety

Abstract: E3ipants about the shortcomings of text messaging and allows the facilitator to segue into the "dos and don'ts" of text messaging and when a phone call might be more appropriate.

Cited by 11 publications

References 18 publications

Characterizing the Patterns of Electronic Health Record–Integrated Secure Messaging Use: Cross-Sectional Study

Characterizing the Patterns of Electronic Health Record–Integrated Secure Messaging Use: Cross-Sectional Study

Resident and nurse perspectives on the use of secure text messaging systems

Adapting Physical Therapy Practice for the “Short-Stay” Total Joint Arthroplasty Patient: A Commentary

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