Patient Messaging

Patient messaging improves patient access, but often at the expense of provider time and workload from this “invisible” and generally uncompensated work. Patient message volumes have increased over the years and, in our last institutional physician wellness survey, were a driver of dissatisfaction. Effective management of patient messages involves coordination at multiple levels; find some tips below (thank you to the many folks who contributed to this!). An underlying theme of many of these suggestions is managing patient expectations regarding how patient messaging should be used.

Minimizing interruptions by the inbox:

Faculty level:

Having Haiku on our phones comes with some benefits, but alerts at all times of the day and night about patient messaging is not one of them. Did you know that you can turn off alerts for all sorts of inbox communications? By the way, a response within 48 business hours is what is expected of us, so we don’t need to check these on weekends. To do that, you select your profile on Haiku, select “notification settings” and from there you can turn off lots of Haiku notifications. Then you’ll only see the new messages/results/etc. when you check your inbox.

Division Director/Clinic Manager level:

Craft workflows around best practices and strategies that work for your division. This is particularly important for vacation inbox coverage as that tracks closely with burnout. Utilizing teaming for messages (having nurses or other staff do first pass at message responses or get more information, order entry, chart review, and documentation) is a best practice. Some of the resources at the end of this section go into the specifics of how to do this and what to delegate.

Chair level:

Consider staffing for team-based care models for answering messages. Consider allowing templated space for message-initiated telephone or in person visits.

Maximizing efficiency:

Clinician level

  1. Consider providing 90-day supply of medications with 4 refills.
  2. Order labs pre-visit to be discussed during visit and avoid result questions.
  3. Tell patients you will contact them only if tests are abnormal.

Division director/clinic manager level:

  1. Develop protocols for automated refills.
  2. Develop protocols for results from screening tests or other frequent processes.

Utilize Tools:

Clinician level

Create auto-responses to patient messages (either through a dotphrase, or through a quick action):

  • Thank you for your message. You will receive a response within 2 business days. A business day is Monday-Friday 8a-4p. Please use MyChart directly to request refills or schedule appointments instead of using provider messaging. The messaging feature is for non-urgent and relatively simple clinical questions (for example followup from a recent visit or clarification of an existing treatment plan). Your provider may request an appointment or telephone call rather than responding back to your question.

Include expectation setting in your signature line:

  • Signature, MD/DO Please allow 2 business days (Mon-Fri 8a-4p) for responses. Call 911 or go to the emergency department for emergencies.

Create dotphrases or quick actions for useful messages you find yourself sending often to patients:

  • Hello – This sounds like it could be too complicated to address by a MyChart message. One of the nurses will call you for more information or to confirm an appointment
  • Hello – I put that order in for you.
  • Hello – Let me look into your results and I will contact you only if abnormal.

When out of office, you can set a patient facing message to alert patients that you are away and they may receive a reply from someone else, or may have a delayed reply. This option is located in the window to set an out of office alert in Epic.

When messaging is abused:

In cases where patients are being inappropriate or abusive through MyChart messaging, practice administrators or clinic managers can initiate a process with legal services to assess and potentially limit a patient’s messaging privileges. We are not necessarily obligated to allow continued abuse or inappropriate messages.

For more reading and ideas:

This article by AAFP contains helpful dotphrases and suggestions for specific work flows. Primary care oriented.

This multimedia module by the AMA has many concrete suggestions on a wide variety of EHR related topics including messaging.