Trends in Electronic Health Record Inbox Messaging During the COVID-19 Pandemic in an Ambulatory Practice Network in New England

Nath, Bidisha; Williams, Brian; Jeffery, Molly Moore; O'Connell, Ryan T.; Goldstein, Richard; Sinsky, Christine A.; Melnick, Edward R.

doi:10.1001/jamanetworkopen.2021.31490

Cited by 61 publications

(75 citation statements)

References 6 publications

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“…We observed similar dynamic patterns in PGMs on COVID-19, particularly, COVID-19 diagnosis and treatment, suggesting that patients actively used the portal messaging for addressing their concerns regarding the COVID-19 crisis [ 23 ]. Another previous study [ 26 ] was consistent with our findings, as they analyzed messages in an ambulatory practice network and determined that their inbox message usage patterns were also consistent with national trends. Patients sent portal messages mainly for COVID-19 symptom self-assessment and discussing COVID-19 tests and results.…”

Section: Discussionsupporting

confidence: 91%

“…Portz et al [ 25 ] observed a large increase of patient portal utilization for advance care planning. However, very few research studies examined the messaging component of the portal, an important function of patient portals for asynchronous communication between patients and providers, specifically for COVID-19–related care and issues [ 26 ]. Thus, in this study, we assessed portal messages associated with COVID-19 generated by patients from February 1 to August 31, 2020, at Mayo Clinic, a large multispecialty academic health system.…”

Section: Introductionmentioning

confidence: 99%

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Patient Portal Messaging for Asynchronous Virtual Care During the COVID-19 Pandemic: Retrospective Analysis

Huang¹,

Khurana²,

Mastorakos³

et al. 2022

JMIR Hum Factors

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Background During the COVID-19 pandemic, patient portals and their message platforms allowed remote access to health care. Utilization patterns in patient messaging during the COVID-19 crisis have not been studied thoroughly. In this work, we propose characterizing patients and their use of asynchronous virtual care for COVID-19 via a retrospective analysis of patient portal messages. Objective This study aimed to perform a retrospective analysis of portal messages to probe asynchronous patient responses to the COVID-19 crisis. Methods We collected over 2 million patient-generated messages (PGMs) at Mayo Clinic during February 1 to August 31, 2020. We analyzed descriptive statistics on PGMs related to COVID-19 and incorporated patients’ sociodemographic factors into the analysis. We analyzed the PGMs on COVID-19 in terms of COVID-19–related care (eg, COVID-19 symptom self-assessment and COVID-19 tests and results) and other health issues (eg, appointment cancellation, anxiety, and depression). Results The majority of PGMs on COVID-19 pertained to COVID-19 symptom self-assessment (42.50%) and COVID-19 tests and results (30.84%). The PGMs related to COVID-19 symptom self-assessment and COVID-19 test results had dynamic patterns and peaks similar to the newly confirmed cases in the United States and in Minnesota. The trend of PGMs related to COVID-19 care plans paralleled trends in newly hospitalized cases and deaths. After an initial peak in March, the PGMs on issues such as appointment cancellations and anxiety regarding COVID-19 displayed a declining trend. The majority of message senders were 30-64 years old, married, female, White, or urban residents. This majority was an even higher proportion among patients who sent portal messages on COVID-19. Conclusions During the COVID-19 pandemic, patients increased portal messaging utilization to address health care issues about COVID-19 (in particular, symptom self-assessment and tests and results). Trends in message usage closely followed national trends in new cases and hospitalizations. There is a wide disparity for minority and rural populations in the use of PGMs for addressing the COVID-19 crisis.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Patient Portal Messaging for Asynchronous Virtual Care During the COVID-19 Pandemic: Retrospective Analysis

Huang¹,

Khurana²,

Mastorakos³

et al. 2022

JMIR Hum Factors

View full text Add to dashboard Cite

show abstract

“…This is especially important given recent evidence identifying In-Basket messages in particular as a predictor of physician burnout, as well as other studies finding a significant increase in patient messages received by clinicians during the pandemic. 12 , 15 , 35 Policymakers and health system leaders should keep these new demands on clinician time in mind as they develop future reimbursement models and workflows, taking care not to exacerbate EHR-driven clinician burnout. 18 , 36 …”

Section: Discussionmentioning

confidence: 99%

Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use

Holmgren

Downing

Tang

et al. 2021

Journal of the American Medical Informatics Association

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Objective The COVID-19 pandemic changed clinician electronic health record (EHR) work in a multitude of ways. To evaluate how, we measure ambulatory clinician EHR use in the United States throughout the COVID-19 pandemic. Materials and Methods We use EHR meta-data from ambulatory care clinicians in 366 health systems using the Epic EHR system in the United States from December 2019 to December 2020. We used descriptive statistics for clinician EHR use including active-use time across clinical activities, time after-hours, and messages received. Multivariable regression to evaluate total and after-hours EHR work adjusting for daily volume and organizational characteristics, and to evaluate the association between messages and EHR time. Results Clinician time spent in the EHR per day dropped at the onset of the pandemic but had recovered to higher than prepandemic levels by July 2020. Time spent actively working in the EHR after-hours showed similar trends. These differences persisted in multivariable models. In-Basket messages received increased compared with prepandemic levels, with the largest increase coming from messages from patients, which increased to 157% of the prepandemic average. Each additional patient message was associated with a 2.32-min increase in EHR time per day (P < .001). Discussion Clinicians spent more total and after-hours time in the EHR in the latter half of 2020 compared with the prepandemic period. This was partially driven by increased time in Clinical Review and In-Basket messaging. Conclusions Reimbursement models and workflows for the post-COVID era should account for these demands on clinician time that occur outside the traditional visit.

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“…This is unsurprising given the substantial baseline number of inbox type messages PCPs receive, which has risen even further during the COVID-19 pandemic. 19 This frequently led to incomplete responses to requests from ADCs. Other research in home and community-based services validates this.…”

Section: Discussionmentioning

confidence: 99%

A qualitative analysis of communication workflows between adult day service centers and primary care providers

Zhong

Boafo

Brody

et al. 2021

Journal of the American Medical Informatics Association

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Objectives Our study documented communication workflows across adult day care centers (ADCs) and primary care providers (PCPs) around complex needs of persons living with dementia (PLWD). We also identified barriers and facilitators to productive communication in clinical decision support and clinical information systems. Materials and Methods We conducted 6 focus groups with ADC staff (N = 33) and individual semistructured interviews with PCPs (N = 22) in California. The eHealth Enhanced Chronic Care Model was used to frame the directed qualitative content analysis. Results Our results captured cumbersome and ineffective workflows currently used to exchange information across PCPs and ADCs. Stakeholders characterized current communication as (1) infrequent, (2) delayed, (3) incomplete, (4) unreliable, (5) irrelevant, and (6) generic. Conversely, communication that was bidirectional, relevant, succinct, and interdisciplinary was needed to elevate the standard of care for PLWD. Discussion and Conclusion ADCs possess a wealth of information that can support clinical decision-making across community-based providers involved in the care of PLWD, especially PCPs. However, effective information exchange is mired by complicated workflows that rely on antiquated technologies (eg, facsimile) and standard templates. Current information exchange largely focuses on satisfying regulatory guidelines rather than supporting clinical decision-making. Integrating community-based services into the health care continuum is a necessary step in elevating the standard of care for PLWD. In the absence of interoperable electronic health records, which may not be financially viable for ADCs, other options, such as mobile health, should be explored to facilitate productive information exchange of personalized relevant information.

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Trends in Electronic Health Record Inbox Messaging During the COVID-19 Pandemic in an Ambulatory Practice Network in New England

Cited by 61 publications

References 6 publications

Patient Portal Messaging for Asynchronous Virtual Care During the COVID-19 Pandemic: Retrospective Analysis

Patient Portal Messaging for Asynchronous Virtual Care During the COVID-19 Pandemic: Retrospective Analysis

Assessing the impact of the COVID-19 pandemic on clinician ambulatory electronic health record use

A qualitative analysis of communication workflows between adult day service centers and primary care providers

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