title: An analysis of patient-provider secure messaging at two Veterans Health Administration medical centers: message content and resolution through secure messaging.
abstract: OBJECTIVE
  We sought to understand how patients and primary care teams use secure messaging (SM) to communicate with one another by analyzing secure message threads from 2 Department of Veterans Affairs facilities.
  
  
  METHODS
  We coded 1000 threads of SM communication sampled from 40 primary care teams.
  
  
  RESULTS
  Most threads (94.5%) were initiated by patients (90.4%) or caregivers (4.1%); only 5.5% were initiated by primary care team members proactively reaching out to patients. Medication renewals and refills (47.2%), scheduling requests (17.6%), medication issues (12.9%), and health issues (12.7%) were the most common patient-initiated requests, followed by referrals (7.0%), administrative issues (6.5%), test results (5.4%), test issues (5.2%), informing messages (4.9%), comments about the patient portal or SM (4.1%), appreciation (3.9%), self-reported data (2.8%), life issues (1.5%), and complaints (1.5%). Very few messages were clinically urgent (0.7%) or contained other potentially challenging content. Message threads were mostly short (2.7 messages), comprising an average of 1.35 discrete content types. A substantial proportion of issues (24.2%) did not show any evidence of being resolved through SM. Time to response and extent of resolution via SM varied by message content. Proactive SM use by teams varied, but was most often for test results (32.7%), medication-related issues (21.8%), medication renewals (16.4%), or scheduling issues (18.2%).
  
  
  CONCLUSIONS
  The majority of messages were transactional and initiated by patients or caregivers. Not all content categories were fully addressed over SM. Further education and training for both patients and clinical teams could improve the quality and efficiency of SM communication.
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA.|Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.|Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Bedford, MA, USA.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Shimada
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA.
authors.forename: Beth Ann
authors.initials: BA
authors.lastname: Petrakis
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA.
authors.forename: James A
authors.initials: JA
authors.lastname: Rothendler
authors.affiliation: Portland VA Medical Center, Department of Veterans Affairs, Portland, OR, USA.
authors.forename: Maryan
authors.initials: M
authors.lastname: Zirkle
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA.
authors.forename: Shibei
authors.initials: S
authors.lastname: Zhao
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA.
authors.forename: Hua
authors.initials: H
authors.lastname: Feng
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA.
authors.forename: Gemmae M
authors.initials: GM
authors.lastname: Fix
authors.affiliation: College of Nursing, University of Colorado, Denver, CO, USA.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ozkaynak
authors.affiliation: VISN1, Department of Veterans Affairs, Bedford, MA, USA.
authors.forename: Tracey
authors.initials: T
authors.lastname: Martin
authors.affiliation: School of Business, Worcester Polytechnic Institute, Worcester, MA, USA.
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Johnson
authors.affiliation: School of Business, Worcester Polytechnic Institute, Worcester, MA, USA.
authors.forename: Bengisu
authors.initials: B
authors.lastname: Tulu
authors.affiliation: Center for Innovation for Complex Chronic Healthcare, Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, IL, USA.|Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA.
authors.forename: Howard S
authors.initials: HS
authors.lastname: Gordon
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Simon
authors.affiliation: VA Maine Healthcare System, Connected Care Office, Veterans Health Administration, Augusta, ME, USA.
authors.forename: Susan S
authors.initials: SS
authors.lastname: Woods
mesh_terms: D003142:Communication; D016494:Computer Security; D034742:Electronic Mail; D006787:Hospitals, Veterans; D006801:Humans; D062527:Meaningful Use; D010817:Physician-Patient Relations; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: message content; patient-doctor communication; personal health records; primary health care; secure messaging