title: Growth of Secure Messaging Through a Patient Portal as a Form of Outpatient Interaction across Clinical Specialties.
abstract: OBJECTIVE
  Patient portals are online applications that allow patients to interact with healthcare organizations. Portal adoption is increasing, and secure messaging between patients and healthcare providers is an emerging form of outpatient interaction. Research about portals and messaging has focused on medical specialties. We characterized adoption of secure messaging and the contribution of messaging to outpatient interactions across diverse clinical specialties after broad portal deployment.
  
  
  METHODS
  This retrospective cohort study at Vanderbilt University Medical Center examined use of patient-initiated secure messages and clinic visits in the three years following full deployment of a patient portal across adult and pediatric specialties. We measured the proportion of outpatient interactions (i.e., messages plus clinic visits) conducted through secure messaging by specialty over time. Generalized estimating equations measured the likelihood of message-based versus clinic outpatient interaction across clinical specialties.
  
  
  RESULTS
  Over the study period, 2,422,114 clinic visits occurred, and 82,159 unique portal users initiated 948,428 messages to 1,924 recipients. Medicine participated in the most message exchanges (742,454 messages; 78.3% of all messages sent), followed by surgery (84,001; 8.9%) and obstetrics/gynecology (53,424; 5.6%). The proportion of outpatient interaction through messaging increased from 12.9% in 2008 to 33.0% in 2009 and 39.8% in 2010 (p<0.001). Medicine had the highest proportion of outpatient interaction conducted through messaging in 2008 (23.3% of outpatient interactions in medicine). By 2010, this proportion was highest for obstetrics/gynecology (83.4%), dermatology (71.6%), and medicine (56.7%). Growth in likelihood of message-based interaction was greater for anesthesiology, dermatology, obstetrics/gynecology, pediatrics, and psychiatry than for medicine (p<0.001).
  
  
  CONCLUSIONS
  This study demonstrates rapid adoption of secure messaging across diverse clinical specialties, with messaging interactions exceeding face-to-face clinic visits for some specialties. As patient portal and secure messaging adoption increase beyond medicine and primary care, research is needed to understand the implications for provider workload and patient care.
authors.affiliation: Vanderbilt University Medical Center Department of Biomedical Informatics , Nashville, Tennessee ; Vanderbilt University Medical Center Department of Medicine , Nashville, Tennessee ; Vanderbilt University Medical Center Department of Pediatrics , Nashville, Tennessee.
authors.forename: R M
authors.initials: RM
authors.lastname: Cronin
authors.affiliation: Vanderbilt University Medical Center Department of Biomedical Informatics , Nashville, Tennessee.
authors.forename: S E
authors.initials: SE
authors.lastname: Davis
authors.affiliation: Vanderbilt University Medical Center School of Medicine , Nashville, Tennessee.
authors.forename: J A
authors.initials: JA
authors.lastname: Shenson
authors.affiliation: Vanderbilt University Medical Center Department of Biomedical Informatics , Nashville, Tennessee ; Vanderbilt University Medical Center Department of Biostatistics , Nashville, Tennessee.
authors.forename: Q
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Vanderbilt University Medical Center Department of Biomedical Informatics , Nashville, Tennessee ; Vanderbilt University Medical Center Department of Medicine , Nashville, Tennessee ; Vanderbilt University Medical Center Department of Pediatrics , Nashville, Tennessee.
authors.forename: S T
authors.initials: ST
authors.lastname: Rosenbloom
authors.affiliation: Vanderbilt University Medical Center Department of Biomedical Informatics , Nashville, Tennessee ; Vanderbilt University Medical Center Department of Pediatrics , Nashville, Tennessee ; Vanderbilt University Medical Center Department of Pediatric Surgery , Nashville, Tennessee.
authors.forename: G P
authors.initials: GP
authors.lastname: Jackson
mesh_terms: D000328:Adult; D002648:Child; D015331:Cohort Studies; D016494:Computer Security; D003695:Delivery of Health Care / Q000639:trends*; D057286:Electronic Health Records; D034742:Electronic Mail / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data*; D008875:Middle Aged; D010045:Outpatients; D012189:Retrospective Studies
keywords: Patient portal; consumer health informatics; patient engagement; secure messaging