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Top tips for successful patient portal secure messaging

Patient portal inbox management is key to supporting secure messaging while protecting against administrative burden.

If you’re a clinician with your inbox open for patient portal secure messaging, you need to make sure you have a good inbox management strategy in place.

Coming up against strong patient demand for secure direct messaging and unabating levels of administrative burden and provider burnout, healthcare practitioners need to consider the boundaries that will help them keep their workloads in balance.

Patient portal messaging has long been a pillar of patient engagement. The secure messaging functions embedded in patient portals have proven useful for engaging patients at home, answering questions, and even doing smaller tasks like booking appointments or refilling prescriptions.

But since the COVID-19 pandemic, patient portal messaging has reached a nexus point, with more patients than ever messaging their providers using the tool. According to one 2023 report in JAMIA, patient portal messaging has increased by 157 percent from pre-pandemic times.

That could be considered a good thing, as patients are now using a key modality for managing their care remotely. Patients who message using the portal are inherently more engaged in their care, and using the secure messaging tool helps to get patients answers to their healthcare questions.

But as providers know all too well, the influx of patient portal messaging has also come with a rise in their workloads. According to the JAMIA article, each additional patient portal message was linked with a 2.32-minute increase in EHR time each day. This comes as the growing administrative burden contributes to healthcare’s workforce shortage woes.

Caught between the need to support good patient engagement and care management and to take care of their own professional well-being, healthcare providers should consider key strategies that make it easier for them to manage their patient portal secure messaging inboxes.

Manage expectations & set a timeline

Perhaps most essential to managing the patient portal inbox is setting expectations with the patient. When patients are clear about when, how, and why their providers will answer their inquiries, they can more reasonably wait out their provider response times.

There are a few different expectations clinicians should lay out for patients regarding portal messaging, the foremost being response timeline. It would be fruitful for providers to tell patients how long they can expect to wait before they hear back on a patient portal message. This approach requires clinicians to stick to this timeline when possible.

It may also be fruitful for providers to outline who is most likely to respond to their patient portal messages, as well as the best use cases for the secure messaging function.

Right now, providers cannot or are not taking advantage of these strategies. According to one 2020 JAMA Network Open article, providers are taking their patient portal messages home with them, while others find time to multitask during the day.

Clinician leaders can help their departments with setting reasonable timelines for patient portal responses by offering support for clinicians that have relatively longer timelines, offering message triage systems (to be discussed below), and giving staff members time in the clinic to answer patient portal messages.

Consider strategies to triage patient portal messages

As patient portal inbox volumes grow, healthcare organizations are considering triage systems to ensure providers do not absorb the bulk of the administrative burden. Rather, lower-level providers are reviewing portal messages and bubbling more complex inquiries up to physicians.

When a patient inquiry comes in through the patient portal, a medical assistant (MA), nurse manager, or other non-physician provider might review the message and respond where appropriate. When a message contains a more complex inquiry, the reviewer will forward the message to the lead provider, often a physician.

This system can remove some of the message burden off physicians, but healthcare organizations should build their triage systems to ensure equity. Recent data indicated that some triage systems leave Black and Hispanic patients less likely to hear back from a physician than their White counterparts.

While patient portal message responses from nurses and MAs may be effective, it will be key to ensure implicit bias is not coloring how the organization filters its messages.

Patient portal triage systems can also be supplemented by emerging technologies like AI. Some large language models (LLMs) can parse through patient portal messages and forward the inquiry to the appropriate staff member.

In some cases, generative AI tools like ChatGPT can generate a response. These responses should still undergo provider review before being sent to the patient, but early studies have shown that gen AI can promote patient health literacy and provider empathy.

Like with human message triaging, the healthcare AI community must ensure LLMs and other tools used to triage messages also do not perpetuate bias.

Assess billing options for time-intensive portal messages

In recognition of providers’ growing EHR inboxes, Medicare has begun allowing clinicians to bill for the time it takes them to answer messages. CPT codes 99421-99423 allow healthcare providers to bill for answering patient portal messages when writing those responses takes more than five minutes of provider time over a seven-day period.

Those billing codes are a key recognition that patient portal secure messages do take up providers’ time and add to their administrative burden. However, some industry leaders have questioned whether those bills would become the patient’s financial responsibility and, consequently, deter some patients from sending secure messages.

Currently, there’s scant evidence that patients incur significant charges for sending patient portal messages. Data from the Peterson-KFF Health Systems Tracker showed that 82 percent of patients receive no out-of-pocket bill for sending a patient portal message. When patients do get a bill, the average charge is $25.

What’s more, data has shown that healthcare providers are rarely billing for answering patient portal messages, with CPT codes 99421-99423 representing just a fraction of a percent of all evaluation & management (E&M) billing codes for Medicare. Researchers do not have information about why patient portal messaging bills are few and far between, indicating that future research will be key for understanding how clinicians use these codes.

Promote patient education & discharge notes

The best offense is a good defense, and the best way providers can limit the number of patient portal messages they must answer is to ensure patients have enough information about their health and well-being when they leave the care encounter.

This means practicing strong patient education, offering patient education materials to take home for further review, and writing complete and clear discharge notes.

Of course, those things are easier said than done.

Healthcare providers may consider using top patient education strategies, including patient teach-back and patient show-back, and should ensure they loop in any caregivers who will help patients manage their care at home.

With the understanding that patients forget half of what they hear during a clinical encounter, providers should also focus on the educational materials patients already say they want to access. Paper and digital education aids, plus detailed clinical notes and discharge summaries, will be essential to supporting patient engagement after the encounter.

As always, clinicians should be mindful of patient health literacy levels and assess patient education tools for patient understanding. When writing clinical notes, it would be prudent to avoid using too much medical jargon, which has been confirmed to confuse some patients. AI is proving a useful tool in translating medical jargon in clinical notes.

Still, patient portal messaging is an inevitability, whether the patient is messaging to book an appointment or to ask about new symptoms that arise. Keeping the patient portal inbox open is essential to patient engagement in healthcare’s digital age.

As providers square up against virtual patient communications and their own needs for less administrative burden, creating a clear action plan for managing patient portal secure messages will be key.

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