Exploring professionals' experiences with secure messaging in Dutch outpatient clinics: emerging differences in use...

Secure digital messaging is a two-way communication channel that gained ground in healthcare over the past decade. While a direct channel between patients and providers may support patients, professionals' work pressure makes it imperative that patient-provider communication remains efficient. Thus far, there is little insight into how the use of digital messaging between outpatients and professionals varies across medical specialties and how professionals experience effects on their workload and patient empowerment.

We conducted a two-stage, cross-specialty study in a Dutch hospital. Stage one analyzed differences in outpatient clinics' (n = 25) messaging frequencies over a 16-month period. In stage two, across seven outpatient clinics, purposively selected to maximize variation, we interviewed 15 professionals and coded these data for use types and professionals' experiences, followed by a focus group to check the findings.

While overall use increased, use frequencies varied across specialties from 228 to 31,319 over the 16-month period. The number of messages per patient ranged between 1 and 274. Eight patient-provider use types emerged: asking and answering administrative questions, asking and answering medical questions, medical updates, sending out information, enquiries about patient updates, and social updates. Most use types were experienced as partial substitutes for phone calls, emails, or both. Only social updates were seen to constitute a complementary form of patient-driven communication. Professionals experienced messaging as inefficient when synchronicity was required and for acute questions. For chronic patient streams of internal medicine specialties, higher frequencies and more use types were reported and greater usefulness was experienced than for surgical patient streams, which was unrelated to patient numbers. The interviewed professionals felt that messaging empowered patients but increased their workload. This increase depended on how messaging use was coordinated and patient expectations managed.

Professionals may welcome messaging for patient empowerment, but in our study did so less for substitution-based efficiency effects. In chronic care settings-where communication between patients and providers is seen as integral to care delivery-messaging may be valued despite the potential for increased workload. In contrast, in surgical settings, messaging may be viewed as an additional, non-reimbursable service rather than a core care component.