Secure Messaging Workload and the Effect of an Enhanced Workflow Intervention Among Hospitalist Clinicians

Secure messaging (SM) is a dominant form of in-hospital communication. Despite its ubiquity, little is known about SM's impact on workload or whether the use of enhanced SM features can mitigate workload.

(1) Assess the association between SM and hospitalist-perceived workload using the NASA Task Load Index (TLX); (2) evaluate whether an intervention utilizing enhanced SM features reduces perceived workload; (3) examine whether this intervention influences message read times.

Single-site, two-phase SM intervention project (Nov 2024-Mar 2025) at an academic hospital.

Thirty-two hospitalist clinicians participated in the default workflow phase and 35 participated in the enhanced intervention workflow phase. Each participant was enrolled for 2 days per phase (64 shifts in the default phase, 70 shifts in the enhanced phase).

During the default phase, hospitalists used standard SM settings with interruptive notifications enabled. In the enhanced phase, clinicians disabled SM notifications and used availability settings.

Differences in perceived hospitalist SM workload, as measured by weighted NASA-TLX scores, and response times were analyzed between phases using regression models. The correlation between messaging volumes and workload scores was analyzed using Pearson correlation.

Default phase TLX scores were high (mean 62), indicating heavy perceived workload. In the enhanced phase, adjusted TLX scores decreased modestly by 11.2 points (p < 0.01), driven by reductions in physician-reported workload. Messaging volumes and read times were unchanged. There was a low correlation between messaging volumes and workload scores across phases.

This project is among the first to offer early insights into the relationship between SM and hospitalist workload and to explore strategies to mitigate this burden. Enhanced SM platform features may modestly reduce SM-related workload for some clinicians but are unlikely to address the broader cognitive demands of SM when implemented in isolation.