K. M. Riera1, J. R. Robinson1, K. J. Van Arendonk1, D. Fabbri2, G. P. Jackson1 1Vanderbilt University Medical Center,Pediatric Surgery,Nashville, TN, USA 2Vanderbilt University Medical Center,Biomedical Informatics,Nashville, TN, USA
Introduction: Patient portals are online applications that allow patients and their caregivers to interact with healthcare systems. Secure patient-provider messaging is one of the most popular functions of patient portals. Prior work has shown that surgeons deliver substantial medical care to adult patients through portal messaging. Adoption of this technology by pediatric surgical patients and providers in a broadly deployed patient portal has not been studied.
Methods: We obtained all message threads (i.e., sets of messages exchanged between portal users and healthcare providers) initiated on behalf of patients and exchanged with pediatric surgical providers through the Vanderbilt University Medical Center patient portal from June 1 to December 31, 2014. Messages sent for patients of age 21 years and younger were included in analysis to examine the period of transition to adulthood. We collected patient demographics, providers’ surgical specialties, and message content for each thread. We determined the total number of messages in each thread and number of individual messages sent by patients themselves, surrogates (i.e., parents or guardians), delegates (i.e., other individuals authorized to communicate on behalf of the patient), and providers.
Results: During the study period, 292 message threads were sent to pediatric surgical providers on behalf of pediatric patients. These threads contained a total of 1679 individual messages, 520 patient or caregiver and 1159 provider messages, with an average of 5.8 (SD 5.0) messages per thread and range of 1 to 56 messages per thread. The majority of threads were about male (176, 60.3%) and white (239, 81.8%) patients. Median patient age was 6.0 years (IQR 3-14 years). Messages were sent more frequently regarding younger patients (p = 0.001). Table 1 shows messaging volumes by surgical specialty. Specialties receiving the most message threads were otolaryngology (123; 42.1%), and general surgery (35; 12.0%). Specialties exchanging the largest average number of messages per thread were cardiac surgery (6.9; SD 11.5), and otolaryngology (6.6; SD 4.5). Most message threads involved rich interactions with delivery of substantial care including management of new problems, ordering of tests, changes to treatment regimens, and patient and family education.
Conclusion: Pediatric surgical specialists deliver substantial care through secure messages in patient portals, but messaging volumes vary across specialties. Institutions adopting patient portals should consider effects on provider workload and models for compensation of online care. Our ongoing research is evaluating the semantic content of messages and determining the complexity of medical care delivered through portal messages.
