Secure messaging (SM) is becoming a common way for hospitalists to communicate, but most existing literature focuses on usage patterns and implementation science, without clear understanding of the benefits and challenges users may be encountering. IHQSE Faculty Michelle Knees, DO and team led a mixed methods study involving surveys and focus groups with hospitalists from 24 academic institutions, finding that, while SM enhances communication efficiency, it also increases multitasking, cognitive load, and alters interpersonal dynamics. The study underscores the need for clear institutional guidelines for SM use and emphasizes the importance of collaborating with frontline workers to improve communication practices. We spoke with Dr. Knees to discuss some of the advantages and challenges for SM and what implications these findings may have on the way providers communicate in the future. 

1. Tell us about your approach to this project?

There is already literature looking at single site experiences with secure messaging (SM), including implementation practices and messaging volumes, but we wanted to better understand how hospitalists are engaging with this technology and to learn how SM is impacting hospitalist work and communication practices. This study used a mixed-methods approach to explore academic hospitalists' perspectives on SM within hospital settings. We combined quantitative data from a survey with qualitative insights gathered through virtual focus groups. This method allowed us to gain a comprehensive understanding of hospitalists' views on SM, capturing both the benefits and challenges of it as a communication tool. 

2. Why is this work important? 

This research is essential as it addresses a critical component of healthcare: effective clinician communication. Poor communication contributes to medical errors and compromises patient safety. By understanding hospitalists' experiences with SM, the study highlights how SM can improve communication speed and accessibility but also reveals potential drawbacks, such as increased messaging volumes, multitasking, and cognitive load. Identifying these issues can lead to the development of standardized guidelines and policies, ultimately contributing to better care coordination, clinician satisfaction, and patient outcomes.

3. How do you think this will impact healthcare?

The findings of this study have significant implications for healthcare, particularly in enhancing hospital communication strategies. As SM becomes increasingly integrated into clinical workflows, healthcare institutions must be able to anticipate how it will impact frontline staff workflow. Institutions need to create and effectively implement strategies which preserve closed-loop communication techniques, minimize unnecessary messaging volumes, and allow staff to quickly triage messaging urgency without interrupting other clinical work. If institutions don’t proactively address these issues when implementing SM systems, patient care may be affected.  However, we firmly believe that electronic health record vendors can work with institutions and frontline healthcare workers to design secure messaging symptoms which prioritize efficiency, reduce cognitive load, and, most importantly, allow for safer patient care.

Read the full study publication in the Journal of Hospital Medicine.