Robinson Jamie R, Valentine Alissa, Carney Cathy, Fabbri Daniel, Jackson Gretchen P
Department of Pediatric Surgery, Vanderbilt Children's Medical Center, Nashville, Tennessee; Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.
Surgical Outcomes Center for Kids, Vanderbilt Children's Medical Center, Nashville, Tennessee.
J Surg Res. 2017 Jun 15;214:93-101. doi: 10.1016/j.jss.2017.02.077. Epub 2017 Mar 8.
Patient portals are online applications that allow patients to interact with healthcare organizations and view information. Portal messages exchanged between patients and providers contain diverse types of communications, including delivery of medical care. The types of communications and complexity of medical decision-making in portal messages sent to surgeons have not been studied.
We obtained all message threads initiated by patients and exchanged with surgical providers through the Vanderbilt University Medical Center patient portal from June 1 to December 31, 2014. Five hundred randomly selected messages were manually analyzed by two research team members to determine the types of communication (i.e., informational, medical, logistical, or social), whether medical care was delivered, and complexity of medical decision-making as defined for outpatient billing in each message thread.
A total of 9408 message threads were sent to 401 surgical providers during the study period. In the 500 threads selected for detailed analysis, 1293 distinct issues were communicated, with an average of 2.6 issues per thread. Medical needs were communicated in 453 message threads (90.6%). Further, 339 message threads (67.8%) contained medical decision-making. Overall complexity of medical decision-making was straightforward in 210 messages (62%), low in 102 messages (30%), and moderate in 27 messages (8%). No highly complex decisions were made over portal messaging.
Through patient portal messages, surgeons deliver substantial medical care with varied levels of medical complexity. Models for compensation of online care must be developed as consumer and surgeon adoption of these technologies increases.
患者门户网站是允许患者与医疗机构互动并查看信息的在线应用程序。患者与医疗服务提供者之间交换的门户网站消息包含多种类型的通信，包括医疗服务的提供。发送给外科医生的门户网站消息中的通信类型和医疗决策的复杂性尚未得到研究。
我们获取了2014年6月1日至12月31日期间患者发起并通过范德比尔特大学医学中心患者门户网站与外科医疗服务提供者交换的所有消息线程。两名研究团队成员对500条随机选择的消息进行了人工分析，以确定通信类型（即信息性、医疗性、后勤性或社会性）、是否提供了医疗服务以及每条消息线程中为门诊计费定义的医疗决策的复杂性。
在研究期间，共向401名外科医疗服务提供者发送了9408条消息线程。在选择进行详细分析的500条线程中，传达了1293个不同的问题，每条线程平均有2.6个问题。453条消息线程（90.6%）传达了医疗需求。此外，339条消息线程（67.8%）包含医疗决策。医疗决策的总体复杂性在210条消息中为简单（62%），在102条消息中为低（30%），在27条消息中为中等（8%）。通过门户网站消息未做出高度复杂的决策。
通过患者门户网站消息，外科医生提供了大量医疗服务，医疗复杂性程度各异。随着消费者和外科医生对这些技术的采用增加，必须开发在线医疗补偿模式。
