Summary
Background: Excitement around the adoption of electronic communication between physicians and
patients is tempered by the possibility of increased clinical and legal risk. If patients
do not read messages in a timely fashion, duplicative communication efforts may be
required and patient safety may be jeopardized.
Objective: We sought to assess the prevalence and risk profile of unread messages in a mature
patient portal.
Methods: We analyzed six years of messages (2005–2010) from physicians to patients to determine
the prevalence and associated characteristics of unread messages in a patient portal.
We focused on clinical messages, and excluded announcements. Because some physicians
sent clinical messages to groups of patients, we labeled messages sent to more than
5 patients as “outreach” messages and excluded them from general analyses. We performed
a chart review of 75 clinical messages to assess for harm.
Results: We found that 3% of clinical messages were unread after 21 days. Messages arriving
outside of business hours were slightly more likely to go unread (RR 1.15 95% CI 1.11–1.19).
Patients who were male (OR 1.14 CI 1.04–1.26) African American (OR 1.69 CI 1.29–2.22)
or Hispanic (OR 1.74 CI 1.17–2.59), or in the lowest income group (OR 1.72 CI 1.19–2.49)
were more likely to have unread messages. Chart review showed no evidence of harm,
but 13% of sampled unread messages were associated with potential delays in care.
Incidentally, we found 50% of the physician-initiated outreach messages were unread.
Conclusions: Overall, secure messaging appears a safe form of communication, but systems to notify
senders when messages are unread may have value. While most clinical messages were
read, many outreach messages were not, providing caution for relying on such systems
for information dissemination. Similar to other studies, differences by race and income
were observed and require further study.
Citation: Crotty BH, Mostaghimi A, O’Brien J, Bajracharya A, Safran C, Landon B. Prevalence
and Risk Profile Of Unread Messages To Patients In A Patient Web Portal. Appl Clin
Inf 2015; 6: 375–382
http://dx.doi.org/10.4338/ACI-2015-01-CR-0006
Keywords
Personal health records - email - communication - secure messaging - electronic health
records
