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Patient Portal Messaging Minus the Excessive Administrative Burden

The ability for patients to message their physicians securely and privately through health systems' online portals has made it easier for patients to communicate their needs and concerns, but it's also added to physicians' overall administrative burden, according to the findings of an abstract presented in April at the AAN Annual Meeting.

“Recent studies have shown that the high volume of messages increases physician workload and contributes to burnout, with the length of the message specifically described as a contributing factor," said Barbara Gordon-Kundu, MD, a fourth-year neurology resident at Yale School of Medicine.

Dr. Gordon-Kundu conducted a retrospective review of patient portal messages to the neurology department through Yale's Epic MyChart platform from Jan. 1 through June 30, 2022. She found 10,118 total messages from 2,646 patients, with length ranging from one to 1,500 characters. “In total, it was something like 280,000 words," she said. “If one person sat down to read through all these messages, it would have taken 24 hours straight."

Dr. Gordon-Kundu wanted to determine whether shortening the permitted message length from 1,500 characters to 750 characters could help optimize communication and set reasonable expectations for both the patient writing the message and the provider responding to it.

“There were clear outliers from the average message length," she said. “I found that if we set a 750-character limit, that would affect only 8 percent of the messages, but it would lead to a disproportionate reduction in workload, reducing 11 percent of the text that physicians had to review."

If patients want to write a longer message, Dr. Gordon-Kundu said, the system could be configured to suggest that the portal is for brief questions to a provider and that longer questions may be more appropriate to discuss during a visit, with an ability to refer patients to the scheduling portal.

“Our system is now working on on-demand scheduling, in which the system could take you directly to appointment availability, and we hope it will help reduce the burden on physicians while supporting patients in communicating effectively," she said.

The flood of patient portal communications is a case of “beware what you wish for," said Neil A. Busis, MD, FAAN, clinical professor in the department of neurology, clinical director of the neurology telehealth program, and associate chair of neurology for technology and innovation at NYU Langone Health. 

“The good news is that patients have a new way to speak with doctors rather than playing phone tag or being HIPAA-noncompliant with emails. The bad news, of course, is the excess work of answering the messages themselves," he said. "Studies like this explore whether or not there are limitations we can place into the system to make the work less onerous for physicians while not being detrimental to patient contact. One way to do this is time limits. At least one system I know of says that you cannot use the portal to communicate with your physician if you have not seen the provider for a certain length of time; you must schedule a visit, because the last time you saw them was so long ago. Another method is character limits, as this study addresses."

The findings from Dr. Gordon-Kundu's study are a positive sign, Dr. Busis said. “This was a simple, elegant way to approach the question, and they found that the 750-character limit only affects 8 percent of messages but decreases overall character count by 11 percent. Of course, there are a lot of assumptions here, as they didn't specifically show any decreased workload, but it's a nice, logical start to answering the question of how to manage portal messages in a way to keep the patient satisfied while not overloading the physician."

“It's certainly possible that some patients will just choose to write two messages of 750 characters apiece," Dr. Busis added. “But the idea of automating the medical record is to make it easier to do the right thing, and I think this study points in that direction."

​Dr. Gordon-Kundu disclosed that an immediate family member has received personal compensation for serving as an employee of Ceretype. In addition, she has received consulting fees and has stock in Hyperfine.

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