High Utilizers of MyChart Electronic Patient Portal Messaging in A Head and Neck Surgery Clinic

One legacy of the COVID-19 pandemic has been an increase in electronic health record (EHR) patient-generated messages to providers, which has increased the amount of time providers spend on EHR tasks. We sought to evaluate clinical and demographic variables associated with high EHR patient message generation in a head and neck oncologic surgery (HNS) clinic.

A randomized 20% sample of unique outpatient visits to the HNS service at a tertiary academic medical center from July to December 2023 was retrospectively reviewed. Patient-generated EHR messages to providers for 6 months following the index visit date were categorized by quintiles, with high-utilizers defined as the top quintile.

High-utilizers sent a greater number of messages (mean, 27.6 [range: 8-110] vs. 3.2 [1-7], p < 0.001). On multivariable regression analysis, high-utilizers were less likely to be elderly (OR = 0.13 [95% CI 0.04-0.52]), single (OR = 0.44 [0.19-0.98]), and more likely to have malignancy (OR = 2.27 [1.27-4.04]), advanced comorbidity (OR = 5.33 [1.71-16.53]), surgical treatment (OR = 3.16 [1.78-5.58]), and a specific provider (OR = 4.20 [1.21-14.53]). Sex, payor status, location, and new vs. established patient status were not associated with high-utilization.

Within an academic HNS practice, patients with malignant disease, comorbidity, surgical patients, and those who saw a specific provider were more likely to be high-utilizers, while older patients were less likely to use EHR messaging. These data suggest that some patient populations require more personalized and frequent support to address communication needs and raise concern about the ability of elderly patients to use electronic communications, who may have unmet needs.

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