3Qs for QI | An Interview with Dr. Michelle Knees
Jul 12, 2025
Article Overview
In this debate article about secure messaging, we explore the promise and pitfalls of secure messaging platforms in hospital medicine. Our Point-Counterpoint format presents both perspectives, including one that celebrates efficiency, collaboration, and safety, and one that warns about cognitive overload, communication breakdowns, and burnout. We conclude with a shared rebuttal advocating for thoughtful implementation.
Tell us about your approach to this project.
This project began with a recognition that hospitalists have strong, and often conflicting, feelings about secure messaging. As researchers and frontline clinicians, our co-author team brought diverse perspectives and practical experience from across academic medical centers. We aimed to create a balanced, evidence-informed conversation that acknowledged both the benefits and drawbacks of secure messaging platforms. Rather than taking a single stance, we structured the paper as a Point-Counterpoint to allow for critical discussion and contrast. This format not only reflected the current debate in the field but also created space for a nuanced, collaborative rebuttal that offers practical, system-level solutions.
Why is this work important?
As patient complexity and acuity continue to rise, the need for efficient communication has never been greater. To address this need, hospital-based communication has undergone a seismic shift, with secure messaging largely replacing pagers for routine communications. While secure messaging offers clear benefits in efficiency, it has also led to a dramatic increase in message volume, raising concerns about constant interruptions, reduced focus, and clinician burnout. This work is important because it not only highlights these challenges but also places them within the broader context of health system design. As more institutions adopt secure messaging, we urgently need clear guidelines to optimize its use and ensure that tools intended to support do not inadvertently compromise patient care or clinician well-being.
How do you think this will impact healthcare?
Secure messaging is almost certainly here to stay. We hope this paper will push institutions to be more intentional about how they implement and govern secure messaging, including advocating for institutional guidelines, urgency labeling, and frontline feedback loops as we continue to think about communication redesign. By highlighting both risks and opportunities, we aim to steer the field toward safer, more efficient, and human-centered communication. Ultimately, this conversation is about more than messaging. It’s about how we protect attention, preserve cognitive bandwidth, and deliver the best possible care in increasingly complex hospital environments.