Division of Biology and Biomedical Sciences, Washington University School of Medicine, St Louis, Missouri, United States.
Institute for Informatics, Data Science, and Biostatistics, Washington University School of Medicine, St Louis, Missouri, United States.
Appl Clin Inform. 2024 May;15(3):612-619. doi: 10.1055/s-0044-1787756. Epub 2024 Jul 24.
Electronic health record (EHR)-integrated secure messaging is extensively used for communication between clinicians. We investigated the factors contributing to secure messaging use in a large health care system.
This was a cross-sectional study that included 14 hospitals and 263 outpatient clinic locations. Data on EHR-integrated secure messaging use over a 1-month period (February 1, 2023, through February 28, 2023) were collected. A multilevel mixed effects model was used to assess the contribution of clinical role, clinical unit (i.e., specific inpatient ward or outpatient clinic), hospital or clinic location (i.e., Hospital X or Outpatient Clinic Building Y), and inpatient versus outpatient setting toward secure messaging use.
Of the 33,195 health care professionals who worked during the study period, 20,576 (62%) were secure messaging users. In total, 25.3% of the variability in messaging use was attributable to the clinical unit and 30.5% was attributable to the hospital or clinic location. Compared with nurses, advanced practice providers, pharmacists, and physicians were more likely to use secure messaging, whereas medical assistants, social workers, and therapists were less likely ( < 0.001). After adjusting for other factors, inpatient versus outpatient setting was not associated with secure messaging use.
Secure messaging was widely used; however, there was substantial variation by clinical role, clinical unit, and hospital or clinic location. Our results suggest that interventions and policies for managing secure messaging behaviors are likely to be most effective if they are not only set at the organizational level but also communicated and tailored toward individual clinical units and clinician workflows.
电子健康记录（EHR）集成的安全消息传递被广泛用于临床医生之间的沟通。我们调查了在大型医疗保健系统中促进安全消息传递使用的因素。
这是一项横断面研究，包括 14 家医院和 263 个门诊诊所。收集了在一个月（2023 年 2 月 1 日至 2 月 28 日）期间使用 EHR 集成的安全消息传递的数据。使用多级混合效应模型评估临床角色、临床科室（即特定的住院病房或门诊诊所）、医院或诊所位置（即医院 X 或门诊大楼 Y）以及住院与门诊环境对安全消息传递使用的贡献。
在研究期间工作的 33195 名医疗保健专业人员中，有 20576 人（62%）是安全消息传递用户。消息传递使用的变异性有 25.3%归因于临床科室，30.5%归因于医院或诊所位置。与护士相比，高级实践提供者、药剂师和医生更有可能使用安全消息传递，而医疗助理、社会工作者和治疗师则不太可能使用（ < 0.001）。在调整其他因素后，住院与门诊环境与安全消息传递使用无关。
安全消息传递得到了广泛应用；然而，临床角色、临床科室和医院或诊所位置的差异很大。我们的研究结果表明，如果管理安全消息传递行为的干预措施和政策不仅在组织层面制定，而且还传达并针对个别临床科室和临床医生的工作流程进行调整，那么这些措施和政策可能最有效。
