Pros and Cons of Messaging Patients Through the EHR

There are many things I never learned in medical school that I've had to discover on the job. Things like an immunization that prevents cervical cancer or that appendicitis can be treated with antibiotics. There are also non-medical skills that are very impactful to my practice that I've learned on the fly. This includes dealing with emails from patients and virtual visits.

Our EHR allows us to securely message our patients via an online portal. It functions like email in which patients can generate new messages. Think of all the ways that a phone call or face-to-face conversation is different than an email and you can imagine the myriad of effects, good and bad, of this new tool.

First, the good. I am a writer not a talker and would much, much prefer to write down an explanation rather than talk through it on the phone. Therefore, writing a message to a patient is easier for me than trying to reach them by phone. Technological enhancements even allow me to forward date a message so I can automatically send patients a follow up to an appointment. My patients can enter their blood pressure results and glucose readings electronically which will pop into my in-basket at predetermined intervals. I can respond to these readings instantly with a quick note such as "blood pressures are looking good – stay on the same dose of your Lisinopril" or "I'm concerned about your blood sugars. What's been going on?"
 

Then there are the less ideal elements. Much like emails fail to convey the context in which a message was meant, electronic messaging through the EMR can misrepresent the intended message. It is easy to say things via email that you would never consider saying in a conversation, so I will sometimes get stream-of-consciousness frustrated rants from patients that are difficult to generate a respectful response to. Additionally, just like email, there is an expectation of near instantaneous response. Waiting a day to reply feels rude in an era of text messaging and instant access. This makes electronic patient messages one more task, although not truly urgent, to complete.

Overall, I am a fan of electronic messaging with my patients. I think the benefits do outweigh the hiccups, and I appreciate being able to leverage this tool to help me take better care of my patients. However, like any technological advancement there are two main factors that are often not considered before implementation. The first is the behavior change that ensues. As I mentioned above, patients compose messages that are inappropriate and rude and which become part of the permanent medical record. This is predictable because it is exactly what happens with email. Quick messages can generate quick responses, so a nurse may find it easier to just forward a message from a patient that would've gone through some type of triage and evaluation had the same message been generated by a phone call.

The second factor is expectations. What is expected by the recipient and sender may not be clear to the other, leading to confusion and concern. Is it sufficient to send a message with a result to my patient or do I need to check to make sure they actually read it? Do I answer my phone messages, refill requests, or patient messages first?

Just like any new clinical innovation, technology requires trial and error, discovery, and refinement. While technology makes our lives as physicians easier, getting used to it can be a frustrating process.