Patient centeredness in electronic communication: evaluation of patient-to-health care team secure messaging

Timothy P. Hogan, Tana M. Luger, Julie E. Volkman, Mary Rocheleau, Nora Mueller, Anna M. Barker, Kim M. Nazi, Thomas K. Houston, Barbara G. Bokhour

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages. Objective: Recognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages. Methods: We conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads. Results: Of the 711 messages coded from the 384 messaging threads, 52.5% (373/711) were sent by patients and 47.5% (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6%, 308/373 vs 89.1%, 301/338), were neutral in tone (70.2%, 262/373 vs 82.0%, 277/338), and respectful in nature (25.7%, 96/373 vs 33.4%, 113/338). Secure messages from health care team members sometimes appeared hurried (25.4%, 86/338) but also displayed friendliness or warmth (18.9%, 64/338) and reassurance or encouragement (18.6%, 63/338). Most patient messages involved either providing or seeking information; however, the majority of health care team member messages involved information provision in response to patient questions. Conclusions: This evaluation is an important step toward understanding the content and socioemotional tone that is part of the secure messaging exchanges between patients and health care team members. Our findings were encouraging; however, there are opportunities for improvement. As health care organizations seek to supplement traditional encounters with virtual care, they must reexamine their use of secure messaging, including the patient centeredness of the communication, and the potential for more proactive use by health care team members.

Original languageEnglish (US)
Article numbere82
JournalJournal of medical Internet research
Volume20
Issue number3
DOIs
StatePublished - Mar 2018
Externally publishedYes

Fingerprint

Patient Care Team
Communication
Veterans Health
Patient-Centered Care
United States Department of Veterans Affairs
Delivery of Health Care
Health Facilities
Health Personnel

Keywords

  • Electronic mail
  • Health communication
  • Patient portals
  • Patient-centered care
  • Veterans

ASJC Scopus subject areas

  • Health Informatics

Cite this

Patient centeredness in electronic communication : evaluation of patient-to-health care team secure messaging. / Hogan, Timothy P.; Luger, Tana M.; Volkman, Julie E.; Rocheleau, Mary; Mueller, Nora; Barker, Anna M.; Nazi, Kim M.; Houston, Thomas K.; Bokhour, Barbara G.

In: Journal of medical Internet research, Vol. 20, No. 3, e82, 03.2018.

Research output: Contribution to journalArticle

Hogan, TP, Luger, TM, Volkman, JE, Rocheleau, M, Mueller, N, Barker, AM, Nazi, KM, Houston, TK & Bokhour, BG 2018, 'Patient centeredness in electronic communication: evaluation of patient-to-health care team secure messaging', Journal of medical Internet research, vol. 20, no. 3, e82. https://doi.org/10.2196/jmir.8801
Hogan, Timothy P. ; Luger, Tana M. ; Volkman, Julie E. ; Rocheleau, Mary ; Mueller, Nora ; Barker, Anna M. ; Nazi, Kim M. ; Houston, Thomas K. ; Bokhour, Barbara G. / Patient centeredness in electronic communication : evaluation of patient-to-health care team secure messaging. In: Journal of medical Internet research. 2018 ; Vol. 20, No. 3.
@article{3a250daaa46b4ba8880809692764304b,
title = "Patient centeredness in electronic communication: evaluation of patient-to-health care team secure messaging",
abstract = "Background: As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages. Objective: Recognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages. Methods: We conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads. Results: Of the 711 messages coded from the 384 messaging threads, 52.5{\%} (373/711) were sent by patients and 47.5{\%} (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6{\%}, 308/373 vs 89.1{\%}, 301/338), were neutral in tone (70.2{\%}, 262/373 vs 82.0{\%}, 277/338), and respectful in nature (25.7{\%}, 96/373 vs 33.4{\%}, 113/338). Secure messages from health care team members sometimes appeared hurried (25.4{\%}, 86/338) but also displayed friendliness or warmth (18.9{\%}, 64/338) and reassurance or encouragement (18.6{\%}, 63/338). Most patient messages involved either providing or seeking information; however, the majority of health care team member messages involved information provision in response to patient questions. Conclusions: This evaluation is an important step toward understanding the content and socioemotional tone that is part of the secure messaging exchanges between patients and health care team members. Our findings were encouraging; however, there are opportunities for improvement. As health care organizations seek to supplement traditional encounters with virtual care, they must reexamine their use of secure messaging, including the patient centeredness of the communication, and the potential for more proactive use by health care team members.",
keywords = "Electronic mail, Health communication, Patient portals, Patient-centered care, Veterans",
author = "Hogan, {Timothy P.} and Luger, {Tana M.} and Volkman, {Julie E.} and Mary Rocheleau and Nora Mueller and Barker, {Anna M.} and Nazi, {Kim M.} and Houston, {Thomas K.} and Bokhour, {Barbara G.}",
year = "2018",
month = "3",
doi = "10.2196/jmir.8801",
language = "English (US)",
volume = "20",
journal = "Journal of Medical Internet Research",
issn = "1439-4456",
publisher = "Journal of medical Internet Research",
number = "3",

}

TY - JOUR

T1 - Patient centeredness in electronic communication

T2 - evaluation of patient-to-health care team secure messaging

AU - Hogan, Timothy P.

AU - Luger, Tana M.

AU - Volkman, Julie E.

AU - Rocheleau, Mary

AU - Mueller, Nora

AU - Barker, Anna M.

AU - Nazi, Kim M.

AU - Houston, Thomas K.

AU - Bokhour, Barbara G.

PY - 2018/3

Y1 - 2018/3

N2 - Background: As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages. Objective: Recognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages. Methods: We conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads. Results: Of the 711 messages coded from the 384 messaging threads, 52.5% (373/711) were sent by patients and 47.5% (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6%, 308/373 vs 89.1%, 301/338), were neutral in tone (70.2%, 262/373 vs 82.0%, 277/338), and respectful in nature (25.7%, 96/373 vs 33.4%, 113/338). Secure messages from health care team members sometimes appeared hurried (25.4%, 86/338) but also displayed friendliness or warmth (18.9%, 64/338) and reassurance or encouragement (18.6%, 63/338). Most patient messages involved either providing or seeking information; however, the majority of health care team member messages involved information provision in response to patient questions. Conclusions: This evaluation is an important step toward understanding the content and socioemotional tone that is part of the secure messaging exchanges between patients and health care team members. Our findings were encouraging; however, there are opportunities for improvement. As health care organizations seek to supplement traditional encounters with virtual care, they must reexamine their use of secure messaging, including the patient centeredness of the communication, and the potential for more proactive use by health care team members.

AB - Background: As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages. Objective: Recognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages. Methods: We conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads. Results: Of the 711 messages coded from the 384 messaging threads, 52.5% (373/711) were sent by patients and 47.5% (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6%, 308/373 vs 89.1%, 301/338), were neutral in tone (70.2%, 262/373 vs 82.0%, 277/338), and respectful in nature (25.7%, 96/373 vs 33.4%, 113/338). Secure messages from health care team members sometimes appeared hurried (25.4%, 86/338) but also displayed friendliness or warmth (18.9%, 64/338) and reassurance or encouragement (18.6%, 63/338). Most patient messages involved either providing or seeking information; however, the majority of health care team member messages involved information provision in response to patient questions. Conclusions: This evaluation is an important step toward understanding the content and socioemotional tone that is part of the secure messaging exchanges between patients and health care team members. Our findings were encouraging; however, there are opportunities for improvement. As health care organizations seek to supplement traditional encounters with virtual care, they must reexamine their use of secure messaging, including the patient centeredness of the communication, and the potential for more proactive use by health care team members.

KW - Electronic mail

KW - Health communication

KW - Patient portals

KW - Patient-centered care

KW - Veterans

UR - http://www.scopus.com/inward/record.url?scp=85047767372&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85047767372&partnerID=8YFLogxK

U2 - 10.2196/jmir.8801

DO - 10.2196/jmir.8801

M3 - Article

C2 - 29519774

AN - SCOPUS:85047767372

VL - 20

JO - Journal of Medical Internet Research

JF - Journal of Medical Internet Research

SN - 1439-4456

IS - 3

M1 - e82

ER -