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How to Manage Secure Direct Messages, Patient Portal Inboxes

Clinicians are developing workarounds to manage patient portal inboxes as secure direct message guidelines remain elusive for patients.

Secure direct messaging and patient portal communication has been a boon for patient-provider relationships, but have forced many clinicians to develop a web of workflow fail-safes to help them managing busy inboxes, according to a new report published in JAMA Network Open.

The secure direct messaging function, a stalwart on patient portals, has helped patient-provider relationships blossom, giving patients the ability to contact their providers outside the clinic walls. Using patient portal messages, patients can see easier access to care, may get answers to medical questions without having to make the trek to the clinic, and can obtain refills to prescriptions, experts say.

But there have been some observed downsides the technology, according to the report authors, who hailed from the Permanente Medical Group, which includes Kaiser Permanente.

“The growth of electronic health record use may be causing unintended effects on clinical practice and physician well-being,” the research team wrote.

“In some practices, physicians spend more than half their time on computer activities, with high electronic message volumes associated with burnout symptoms. The trend toward secure portal messaging has created a need for new skills in primary care practice, and traditional medical training has not fully prepared today’s physicians with these skills.”

A set of 24 qualitative interviews conducted with primary care providers and department chiefs, all with an average 16 years of professional medical experience, confirmed that fact. Patient portal secure messages can cause some stress on providers, and providers are developing new workflows to get around that stress.

Specifically, the interviewees reported a positive impact on patient-provider relationships at the hands of patient portal messaging. However, they also said increased use of secure direct messaging technology has changed the expectations patients have for those relationships.

Providers find that patients want faster response to patient portal messages, a timeline many providers said creates added pressure on their already stressful jobs.

Individual primary care providers have developed their own workflows for alleviating some of that stress, including multitasking during the workday between responding to messages and other documenting or clinical duties. Primary care providers also said they’ll answer messages at home or enlist the help of medical assistants to respond to some messages.

Department chiefs, who are in charge of teams of providers, have enlisted some of their own overarching strategies. Commonly cited tactics include reserving clinic time for inbox management, creating a system for inbox coverage when a clinician is on vacation or otherwise out of the office, physician peer training, and team-based care that tackles inbox management.

These strategies suggest a need for better inbox management and patient-provider communication training, the researchers pointed out.

“Our findings suggest that PCPs are continually investing time in learning new skills and helping their patients, MAs, and themselves learn to use electronic messaging effectively and efficiently,” they wrote. “This suggests that structured programs to facilitate the transfer of technological and communication skills among physicians may help new PCPs more quickly become adept at inbox management.”

Of course, these structured programs need nuance, the researchers wrote. What is an effective strategy for one provider may not be for another.

“No single strategy emerged as the dominant solution to inbox management in this study. Individual PCPs reported diverse approaches,” the researchers noted. “For example, some delegated as much as possible to their MAs, whereas others felt unable to do this.”

This poses a difficult balance to strike, the researchers acknowledged. Organizational policies and training for patient-provider communication need to take into account unique provider needs and preferences while also ensuring for a consistent, positive patient experience, they said. Future studies should look into the effectiveness of individuals inbox management and patient-provider communication strategies.

Other experts have touted their own strategies for managing hectic patient portal inboxes. Foremost, medical professionals advise clinicians to set clear expectations with their patients regarding patient portal response times and depth of response. They also recommend providers be upfront with patients about who may be answering the message – whether it will be the provider or a medical assistant.

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