Department of Operations, Business Analytics, and Information Systems, University of Cincinnati , Cincinnati , United States
Background: Secure messaging within electronic health records (EHRs) is the fastest-growing component of virtual care in the telehealth ecosystem. It is a cost-effective way to communicate medical advice and an alternative to an in-person, video, or tele-phone visits. Secure messaging is shown to have a positive effect on the management of chronic diseases. It can improve health awareness and literacy and also improve communication and care coordination. Healthcare providers have experienced a 200% increase in secure messages over the past few years, and in some cases, it is associated with avoidance of medical visits and burn-out among healthcare providers. Such paradoxical outcomes raise questions about the value of secure messages and whether they positively impact the quality of healthcare outcomes.
Objective: To conduct an empirical assessment and evaluate the extent to which and for whom secure messages improve the quality of healthcare.
Methods: EHRs of adult patients with type 2 diabetes mellitus and an active patient portal account who visited an academic medical center in the Midwest US between 2015 and 2020 were included in the analysis. Patients must have initiated a secure message, made a follow-up in-person appointment, and completed the CAHPS (Consumer Assessment of Healthcare Providers and Systems) patient satisfaction survey.
Results: The final regression analysis included 1,332 patients with no missing data. The results reveal a negative relationship between patients who discuss their secure messages during their encounters and patient satisfaction even after controlling for patient-specific (age, gender, and insurance), provider-specific (responsiveness), and medical conditions (average blood sugar and mean arterial pressure). The results also show a stronger negative effect for the underrepresented minorities (Blacks and Hispanics).
Summary: The negative relationship between secure message exchanges and patient satisfaction may stem from differences in providers’ subject matter expertise and their mental models that are incongruent with patients’ general health knowledge. This suggests that patients may struggle to understand the value of new information, assimilate it, and apply it. Furthermore, effective communication is fundamental to patient satisfaction, and healthcare providers may be challenged to instill greater understanding during their average 18-min encounters. The proliferation of digital divide research in healthcare indicates that Afro-Americans and Hispanic Americans are at a disadvantage; therefore, it is not unreasonable to suggest that the health literacy rate differs, possibly creating greater uncertainty and ambiguity. More research probing the role and value of secure messaging is needed as healthcare providers begin to charge patients for this telehealth service.
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