Assessing the Impact of Discontinuing Patient-Physician Secure Messaging on Physician Inbox Workload

Abstract: Messaging technologies such as text messaging, email, and secure messaging have traditionally been used in healthcare for administrative tasks like scheduling and reminders. Since the COVID-19 pandemic, however, secure messaging between patients and clinicians has emerged as a growing mode of healthcare service delivery. At Women's College Hospital (WCH), an ambulatory academic hospital in Toronto, secure messaging was implemented to facilitate patient-clinician communication for medical concerns. Despite initial benefits, several clinics within WCH raised concerns regarding message volume, workload, and workflow disruption. Consequently, secure messaging for medical advice requests was discontinued in selected clinics in December 2021. This change presents a unique opportunity to examine the impact of ceasing secure messaging for medical advice requests in a real-world healthcare setting. Objective: This study aims to (i) examine whether discontinuing secure messaging for medical advice requests impacts overall physician inbox workload, and (ii) determine whether the shutdown of this function has led to shifts in patient messaging through alternative communication channels. Methods: Signal data and electronic health record (EHR) data from January 2021 to December 2022 were analyzed. An interrupted time series analysis was conducted to assess changes in physician workload before and after the discontinuation of secure messaging for medical advice requests. Expected Outcomes: Preliminary findings showed most clinics do not receive consistent messages for medical requests. These analyses indicated that nurses handled a large share of patient messages in several clinics and that physicians often sent more outgoing than incoming messages. Overall, discontinuing secure messaging likely reduced physicians' direct inbox workload, but only modestly due to redistribution among clinical staff and shifts to alternative communication channels.