1111 — Patient Aligned Care Team (PACT) Experiences with Secure Messaging at Two Early Adopter Facilities

Shimada SL, Center for Healthcare Organization and Implementation Research; Petrakis BA, Center for Healthcare Organization and Implementation Research; Zirkle M, Patient-Centered Outcomes Research Institute; Rothendler JR, Center for Healthcare Organization and Implementation Research; Zhao S, Center for Healthcare Organization and Implementation Research; Feng H, Center for Healthcare Organization and Implementation Research; Fix GM, Center for Healthcare Organization and Implementation Research; Simon SR, Center for Healthcare Organization and Implementation Research; Gordon HS, Jesse Brown Veterans Affairs Medical Center; Woods SS, Maine VA Medical Center

Objectives:
To understand how patients and PACT are utilizing My HealtheVet Secure Messaging (SM) by analyzing message content, handling, and resolution.

Methods:
We assessed 1,000 message threads initiated between January and March 2013 at two VA Medical Centers that were early adopters of SM. We sampled threads from teams based on variations in SM volume and percentage of SM completed by providers. Messages in each thread were coded for a number of factors including message content and tone, message triage by the PACT members, and timeliness and quality of PACT response.

Results:
The majority of message threads (93.4%) were initiated by Veterans or family caregivers, and only 6.6% were initiated by a PACT member. The majority of patient messages were focused on medication renewal and refill requests (47.5% of threads), scheduling issues (17.6%), medication issues unrelated to renewals/refills (13.2%), and health issues (11.6%). Patients also used SM to request referrals (7.2%), address administrative concerns (6.3%), request test results (5.5%), ask about testing (5.4%), inform their clinical teams about relevant information (4.9%), discuss My HealtheVet or SM usage (4.0%). A small number of SM could be considered chatty (2.2%) or confusing (1.5%), but very few contained offensive or threatening language (0.2%), or clinically urgent content inappropriate for SM (0.7%). There were some differences in message content across the two sites, as well as in timeliness of response. Average time until the first response from a clinical team member was 31.3 hours, and messages were addressed within 55.8 hours, on average, although this varied greatly (15.5 hours to 110.5 hours) by type of patient request. PACT-initiated messages were most likely to be about test results (27.3%) or medication renewals and refills (24.2%).

Implications:
Despite provider concerns, very few messages contained clinically urgent content inappropriate for SM. There is variation across teams and across sites in message handling and response timeliness, suggesting room for more effective handling of SM. Proactive use of SM by teams remains low.

Impacts:
Educating providers on the most effective ways to use SM, including better triaging of messages and more proactive use of SM by PACT, may further improve SM-based communication with patients.