The Uneven Distribution Of Patient Portal Messages Across Patients And Physicians

Area of Science:

• Health Informatics
• Physician Workflow Analysis
• Digital Health Communication

Background:

• Patient-initiated electronic health record (EHR) portal messages represent a growing workload for physicians.
• The distribution patterns of these messages among patients and physicians are not well understood.
• Understanding message distribution is crucial for managing physician burden and informing reimbursement policies.

Purpose of the Study:

• To examine the distribution of patient-initiated medical advice request messages across patients and physicians.
• To identify patterns in message volume at both patient and physician levels.

Main Methods:

• Analysis of data from 487,442 patients at UCSF Health.
• Utilized national EHR metadata from 224,068 ambulatory care physicians in the US.
• Examined the distribution of asynchronous medical advice request messages.

Main Results:

• Message distribution was highly skewed at both patient and physician levels.
• The top 5% of patients at UCSF Health generated 52.8% of all messages.
• Primary care physicians received a median of 9.6 messages/week, with the top quartile receiving 53.3 messages/week.
• Higher physician visit volume correlated with fewer messages per visit.
• Increased message volume was linked to greater EHR work outside of clinical hours.

Conclusions:

• The significant skew in patient portal message distribution necessitates targeted interventions.
• Current reimbursement models may not adequately address the workload associated with asynchronous communication.
• Future strategies should consider the uneven burden of patient-initiated portal messages on physicians.