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Prevalence and Risk Profile Of Unread Messages To Patients In A Patient Web Portal
12 January 2015
accepted: 17 April 2015
19 December 2017 (online)
Background: Excitement around the adoption of electronic communication between physicians and patients is tempered by the possibility of increased clinical and legal risk. If patients do not read messages in a timely fashion, duplicative communication efforts may be required and patient safety may be jeopardized.
Objective: We sought to assess the prevalence and risk profile of unread messages in a mature patient portal.
Methods: We analyzed six years of messages (2005–2010) from physicians to patients to determine the prevalence and associated characteristics of unread messages in a patient portal. We focused on clinical messages, and excluded announcements. Because some physicians sent clinical messages to groups of patients, we labeled messages sent to more than 5 patients as “outreach” messages and excluded them from general analyses. We performed a chart review of 75 clinical messages to assess for harm.
Results: We found that 3% of clinical messages were unread after 21 days. Messages arriving outside of business hours were slightly more likely to go unread (RR 1.15 95% CI 1.11–1.19). Patients who were male (OR 1.14 CI 1.04–1.26) African American (OR 1.69 CI 1.29–2.22) or Hispanic (OR 1.74 CI 1.17–2.59), or in the lowest income group (OR 1.72 CI 1.19–2.49) were more likely to have unread messages. Chart review showed no evidence of harm, but 13% of sampled unread messages were associated with potential delays in care. Incidentally, we found 50% of the physician-initiated outreach messages were unread.
Conclusions: Overall, secure messaging appears a safe form of communication, but systems to notify senders when messages are unread may have value. While most clinical messages were read, many outreach messages were not, providing caution for relying on such systems for information dissemination. Similar to other studies, differences by race and income were observed and require further study.
Citation: Crotty BH, Mostaghimi A, O’Brien J, Bajracharya A, Safran C, Landon B. Prevalence and Risk Profile Of Unread Messages To Patients In A Patient Web Portal. Appl Clin Inf 2015; 6: 375–382
- 1 Slack WV. A 67-year-old man who e-mails his physician. JAMA 2004; 292 (18) 2255-2261.
- 2 Adler KG. Web portals in primary care: an evaluation of patient readiness and willingness to pay for online services. J Med Internet Res 2006; 8 (04) e26.
- 3 White CB, Moyer CA, Stern DT, and Katz SJ. A content analysis of e-mail communication between patients and their providers: patients get the message. J Am Med Inform Assoc 2004; 11 (04) 260-267.
- 4 Anand SG, Feldman MJ, Geller DS, Bisbee A, Bauchner H. A content analysis of e-mail communication between primary care providers and parents. Pediatrics 2005; 115 (05) 1283-1288.
- 5 Sittig DF. Results of a content analysis of electronic messages (email) sent between patients and their physicians. BMC Med Inform Decis Mak 2003; 3 (01) 11.
- 6 Kane B, Sands DZ. Guidelines for the clinical use of electronic mail with patients. The AMIA Internet Working Group, Task Force on Guidelines for the Use of Clinic-Patient Electronic Mail. J Am Med Inform Assoc 1998; 5 (01) 104-111.
- 7 North F, Crane SJ, Stroebel RJ, Cha SS, Edell ES, Tulledge-Scheitel SM. Patient-generated secure messages and eVisits on a patient portal: are patients at risk?. J Am Med Inform Assoc 2013; 20 (06) 1143-1149.
- 8 Byrne JM, Elliott S, Firek A. Initial experience with patient-clinician secure messaging at a VA medical center. J Am Med Inform Assoc 2009; 16 (02) 267-270.
- 9 Bodenheimer T, Grumbach K. Electronic technology: a spark to revitalize primary care?. JAMA 2003; 290 (02) 259-264.
- 10 Margolius D, Bodenheimer T. Transforming primary care: from past practice to the practice of the future. Health Aff (Millwood) 2010; 29 (05) 779-784.
- 11 Rohrer JE, North F, Angstman KB, Oberhelman SS, Meunier MR. Timely response to secure messages from primary care patients. Qual Manag Health Care 2013; 22 (02) 161-166.
- 12 Halamka JD, Mandl KD, Tang PC. Early experiences with personal health records. J Am Med Inform Assoc 2008; 15 (01) 1-7.
- 13 Weingart SN.. D. Rind, Z. Tofias, and D.Z. Sands. Who uses the patient internet portal? The PatientSite experience. J Am Med Inform Assoc 2006; 13 (01) 91-95.
- 14 Yamin CK. et al. The digital divide in adoption and use of a personal health record. Arch Intern Med 2011; 171 (06) 568-574.
- 15 US Census Bureau. American Community Survey. 2010 [cited 2013 Jan 1]. Available from: http://www.census.gov/acs/www/.
- 16 Slack WV. Claude Shannon and communication theory. MD Comput 1997; 14 (04) 262-264.
- 17 Shannon CE, Weaver W. The Mathematical Theory of Communication. University of Illinois Press; 1971
- 18 Osborn CY. et al. MyHealthAtVanderbilt: policies and procedures governing patient portal functionality. J Am Med Inform Assoc 2011; 18 (Suppl. 01) i18-i23.
- 19 Nazi KM. The personal health record paradox: health care professionals’ perspectives and the information ecology of personal health record systems in organizational and clinical settings. J Med Internet Res 2013; 15 (04) e70.
- 20 Bohmer RM. Managing the new primary care: the new skills that will be needed. Health Aff (Millwood). 2010; 29 (05) 1010-1014.
- 21 Krist AH. et al. Electronic health record functionality needed to better support primary care. J Am Med Inform Assoc. 2014 Jan 15.