title: Patient-provider secure messaging in VA: variations in adoption and association with urgent care utilization.
abstract: BACKGROUND
  The Veterans Health Administration has implemented patient to clinical team electronic asynchronous secure messaging (SM). This disruptive technology has the potential to support continuous, coordinated quality care, but limited evidence supports this connection.
  
  
  OBJECTIVE
  The objective of this paper is to (1) measure SM implementation and identify facility characteristics associated with higher rates of adoption and (2) understand the association of SM use and noncontinuity care [ie, urgent care (UC)] utilization rates.
  
  
  METHODS
  We conducted a retrospective cohort study of 132 VA facilities implementing SM in primary care. We used a combination of cross-sectional survey data on predictors of SM implementation and longitudinal data (July 2010-June 2012) on use of SM and UC.
  
  
  RESULTS
  Human resources (coordinator and staff/volunteer availability to directly assist Veterans), computer resources (computers and computer rooms for Veterans), and leadership support for coordinators were associated with increased SM adoption rates. Higher SM use was associated with lower UC rates; early adopters of SM achieved a greater decrease in UC utilization over time than later adopters.
  
  
  CONCLUSIONS
  In this exploratory analysis of early SM implementation in VA, we found a path of associations linking SM and reductions in UC utilization. These results suggest a need for further examination of the relationship between SM and its effects on health care utilization patterns.
authors: Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA 01730, USA. stephanie.shimada@va.gov
authors: Stephanie L
authors: SL
authors: Shimada
authors: Timothy P
authors: TP
authors: Hogan
authors: Sowmya R
authors: SR
authors: Rao
authors: Jeroan J
authors: JJ
authors: Allison
authors: Ann L
authors: AL
authors: Quill
authors: Hua
authors: H
authors: Feng
authors: Barrett D
authors: BD
authors: Phillips
authors: Kim M
authors: KM
authors: Nazi
authors: Susan T
authors: ST
authors: Haidary
authors: Thomas K
authors: TK
authors: Houston
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001292:Attitude to Computers; D016494:Computer Security; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D033181:Information Dissemination / Q000379:methods*; D016014:Linear Models; D008297:Male; D008491:Medical Informatics Applications; D011369:Professional-Patient Relations; D011787:Quality of Health Care; D012189:Retrospective Studies; D013685:Telecommunications / Q000639:trends*; D014481:United States; D014493:United States Department of Veterans Affairs