Portal message utilization in orthopedic spine surgery: patterns, predictors, and financial implications

Area of Science:

• Orthopedic Surgery
• Health Informatics
• Digital Health Communication

Background:

• Electronic patient portals (EPPs) are key for patient-provider communication.
• Their specific use and impact in orthopedic spine surgery remain unclear.
• This study investigates EPP utilization patterns and associated burdens.

Purpose of the Study:

• To quantify message volume and content in orthopedic spine surgery EPPs.
• To identify demographic factors predicting high EPP utilization.
• To estimate the administrative and financial impact of EPP messaging.

Main Methods:

• Retrospective review of 833 new patients over 6 months.
• Categorization of portal messages by timeframe and subject.
• Analysis of demographic predictors for high-volume (≥4 messages) users.
• Identification of billable encounters based on CMS criteria and revenue estimation.

Main Results:

• A total of 548 messages were sent; 5.2% of patients were high-volume users.
• Common topics included scheduling, imaging, and postoperative concerns.
• White/Caucasian patients were overrepresented among high-volume users, while Black/African American patients were underrepresented.
• Only 4.6% of messages met CMS billing criteria, with an estimated median lost revenue of $7,501.

Conclusions:

• EPP use in orthopedic spine surgery is highly skewed, with a small patient group dominating message volume.
• Portal messaging poses a significant administrative challenge with limited billable encounters.
• Observed racial disparities necessitate further investigation into equitable digital patient engagement.