Department of Artificial Intelligence and Informatics, Mayo Clinic, Rochester, MN, United States.
Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States.
J Med Internet Res. 2022 Jan 11;24(1):e17273. doi: 10.2196/17273.
Patient-clinician secure messaging is an important function in patient portals and enables patients and clinicians to communicate on a wide spectrum of issues in a timely manner. With its growing adoption and patient engagement, it is time to comprehensively study the secure messages and user behaviors in order to improve patient-centered care.
The aim of this paper was to analyze the secure messages sent by patients and clinicians in a large multispecialty health system at Mayo Clinic, Rochester.
We performed message-based, sender-based, and thread-based analyses of more than 5 million secure messages between 2010 and 2017. We summarized the message volumes, patient and clinician population sizes, message counts per patient or clinician, as well as the trends of message volumes and user counts over the years. In addition, we calculated the time distribution of clinician-sent messages to understand their workloads at different times of a day. We also analyzed the time delay in clinician responses to patient messages to assess their communication efficiency and the back-and-forth rounds to estimate the communication complexity.
During 2010-2017, the patient portal at Mayo Clinic, Rochester experienced a significant growth in terms of the count of patient users and the total number of secure messages sent by patients and clinicians. Three clinician categories, namely "physician-primary care," "registered nurse-specialty," and "physician-specialty," bore the majority of message volume increase. The patient portal also demonstrated growing trends in message counts per patient and clinician. The "nurse practitioner or physician assistant-primary care" and "physician-primary care" categories had the heaviest per-clinician workload each year. Most messages by the clinicians were sent from 7 AM to 5 PM during a day. Yet, between 5 PM and 7 PM, the physicians sent 7.0% (95,785/1,377,006) of their daily messages, and the nurse practitioner or physician assistant sent 5.4% (22,121/408,526) of their daily messages. The clinicians replied to 72.2% (1,272,069/1,761,739) patient messages within 1 day and 90.6% (1,595,702/1,761,739) within 3 days. In 95.1% (1,499,316/1,576,205) of the message threads, the patients communicated with their clinicians back and forth for no more than 4 rounds.
Our study found steady increases in patient adoption of the secure messaging system and the average workload per clinician over 8 years. However, most clinicians responded timely to meet the patients' needs. Our study also revealed differential patient-clinician communication patterns across different practice roles and care settings. These findings suggest opportunities for care teams to optimize messaging tasks and to balance the workload for optimal efficiency.
患者-临床医生安全消息传递是患者门户中的一个重要功能，可使患者和临床医生及时就广泛的问题进行沟通。随着其日益普及和患者参与度的提高，现在是全面研究安全消息和用户行为以改善以患者为中心的护理的时候了。
本文旨在分析梅奥诊所罗切斯特院区多专科医疗系统中患者和临床医生发送的安全消息。
我们对 2010 年至 2017 年间发送的超过 500 万条安全消息进行了基于消息、发送方和线程的分析。我们总结了消息量、患者和临床医生人数、每位患者或临床医生的消息数，以及多年来消息量和用户数的趋势。此外，我们计算了临床医生发送消息的时间分布，以了解他们在一天中不同时间的工作量。我们还分析了临床医生对患者消息的回复时间延迟，以评估他们的沟通效率，并通过来回沟通轮次来评估沟通的复杂性。
在 2010 年至 2017 年期间，梅奥诊所罗切斯特院区的患者门户在患者用户数量和患者及临床医生发送的安全消息总数方面均有显著增长。“初级保健医生”“专科注册护士”和“专科医生”这三个临床医生类别承担了大部分消息量的增长。患者门户在每位患者和临床医生的消息数方面也呈现出增长趋势。“初级保健医生-执业护士或助理医生”和“初级保健医生”这两个类别每年的临床医生工作量最重。大多数临床医生的消息是在一天中的 7 点至 5 点之间发送的。然而，在 5 点至 7 点之间，医生发送了其当天消息量的 7.0%（95785/1377006），执业护士或助理医生发送了其当天消息量的 5.4%（22/408526）。临床医生在 1 天内回复了 72.2%（1272069/1761739）的患者消息，在 3 天内回复了 90.6%（1595702/1761739）的患者消息。在 95.1%（1499316/1576205）的消息线程中，患者与临床医生之间的来回沟通不超过 4 轮。
我们的研究发现，在 8 年的时间里，患者对安全消息传递系统的采用率和每位临床医生的平均工作量都在稳步增加。然而，大多数临床医生都能及时响应以满足患者的需求。我们的研究还揭示了不同实践角色和护理环境下患者与临床医生沟通模式的差异。这些发现为护理团队提供了优化消息传递任务和平衡工作负荷以实现最佳效率的机会。
