Lee Joy L, Matthias Marianne S, Huffman Monica, Frankel Richard M, Weiner Michael
Division of General Internal Medicine and Geriatrics, Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Center for Health Services Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA.
JAMIA Open. 2020 Dec 5;3(4):576-582. doi: 10.1093/jamiaopen/ooaa051. eCollection 2020 Dec.
Secure messaging has become an integrated function of patient portals, but misuse of secure messaging by both patients and clinicians can lead to miscommunication and errors, such as overlooked urgent messages. We sought to uncover variations in clinician approaches and responses to messaging with patients.
In this two-part study, 20 primary care clinicians (1) composed message responses to five hypothetical patient vignettes and messages and (2) were subsequently interviewed for their perspectives on appropriate circumstances for secure messaging. Messages and interviews were analyzed for themes.
Clinicians have different experiences with, and perceptions of, secure messaging. The messages the clinicians wrote were uniformly respectful, but differed in degrees of patient-centeredness and level of detail. None of the clinicians found their messaging workload to be unmanageable. From the interviews, we found divergent clinician perspectives about when to use secure messaging and how to respond to emotional content.
Clinicians have different opinions about the appropriateness of secure messaging in response to specific medical issues. Our results noted a desire and need for greater guidance about secure messaging. This aspect of informatics education warrants greater attention in clinical practice.
We summarize the types of issues raised by the participants yet to be addressed by existing guidelines. Further guidance from hospitals, professional societies, and other institutions that govern clinician behavior on the appropriateness and effectiveness of delivering care through secure messaging may aid clinicians and patients.
安全消息传递已成为患者门户的一项集成功能，但患者和临床医生对安全消息传递的滥用可能导致沟通不畅和错误，例如忽视紧急消息。我们试图揭示临床医生与患者进行消息传递的方式和反应的差异。
在这项分为两部分的研究中，20名初级保健临床医生（1）针对五个假设的患者案例和消息撰写消息回复，（2）随后就安全消息传递的适当情况接受访谈。对消息和访谈进行主题分析。
临床医生在安全消息传递方面有不同的经历和看法。临床医生撰写的消息都很尊重患者，但在以患者为中心的程度和细节水平上存在差异。没有临床医生认为他们的消息传递工作量无法管理。从访谈中，我们发现临床医生在何时使用安全消息传递以及如何回应情感内容方面存在不同观点。
临床医生对于针对特定医疗问题使用安全消息传递的适当性有不同意见。我们的结果表明需要关于安全消息传递的更多指导。信息学教育的这一方面在临床实践中值得更多关注。
我们总结了参与者提出的现有指南尚未解决的问题类型。医院、专业协会和其他规范临床医生通过安全消息传递提供护理的适当性和有效性行为的机构提供的进一步指导可能会帮助临床医生和患者。
