It’s Not About The Box Improving Care at Group Health with People, Process and Technology

December 3, 2008

A conversation about secure messaging

Filed under: MyGroupHealth,Secure Messaging — Tags: , — Matt Handley @ 8:28 pm

Seth Scott, a doc at Olympia relatively new to GHP, took the time to send me a very thoughtful message about the challenges of using secure messaging – he has graciously agreed to have me share our conversation with you on the blog:
_____________________________________________
From:     Scott, Seth
Sent:    Wednesday, December 03, 2008 9:29 AM
To:    Handley, Matthew R.
Subject:    On secure messaging

Matt,

This is a philosophical sort of point, something I’ve been mulling over, in varying forms, for longer than just since the last associate program meeting:  the more I re-examine it, the more I realize what a mixed blessing secure messaging is.

I agree that in some instances, and moreover with certain personality types, secure messaging can reduce work and improve efficiency and satisfaction both, while improving quality of care.

That said, there are instances in which these resoundingly are not the outcomes, and these can be somewhat hard to predict, even for the so-called internet savvy.  I can’t speak in terms of numbers of patients, but for one population that I see (often a mixture of anxious/type A/technophile, although not always), secure messaging feels like treading water to me.  Very thick and tiring water, at best.  There are also people who just don’t know the medium and who are prone to greatly misunderstanding the tone of a message.  Exchanges occur, and despite my fairly reasonable sense of netiquette, the exchanges can at times create even more work and don’t “prevent” another encounter (they spawn more encounters).

Exchanges often go badly when the initial message is charged or otherwise “on the offensive,” ie, “why is it that group health won’t let me have my colonoscopy/DEXA scan/fifty irrational naturopath-recommended tests?”  This is only the grossest example, though, with which we are all familiar.  Not all are so easy to forsee.

Provider understanding of how to best close a thread (with appropriate etiquette), or even understanding that a thread ought to be closed, is highly variable.

I am not trying to fly in the face of your overall enthusiasm for online services, but I am just trying to add my opinion in temperance.  I think that my opinion counts with some weight, too — I am well in the front of the thirty-something technophilic generation of MDs.  I was in college when the web was born, and I type faster than anyone else in my clinic that I’ve witnessed, including clerical staff, and I treasure EPIC as a tool — I view myself as an outlier on the computer-comfortable end of the continuum.  I think that secure messaging is a great and useful tool.  But I believe it is a very specifically useful tool, and the limitations can take one some time to fully learn, even for me (having had my first internet-based misunderstandings in the late 80’s, on campus-run bulletin boards — in one sense, I’m a twenty year veteran of internet-based misunderstandings!)

I think it would be valuable for new-to-GHC providers to hear that note of caution, more briefly and well put than I have it here.  Also, formal discussion and consensus, perhaps, on the “times to opt out” of a message exchange might help some providers, both new and established.

– Seth Scott MD, OMC

and my reply….

Seth
I really appreciate you taking the time to reflect on the use of secure messaging – it is timely.  I pretty much agree with you on most all of these points. I find that many docs use secure messaging in a way that provides great service, but does not improve efficiency.  This really came out in the Rapid Process Improvement Workshop about virtual care. We have not done a good job of defining best practice, and while some use it to great effect, that is not reliably the case.  WE do know that it helps improve satisfaction with both the doc and GHC pretty reliably (but obviously with limitations).  One of the reasons that this evolution has been messy is because we were first, but it is now obviously time to do a more consistently better job.

The RPIW has worked to set some standards for use of both secure messaging and telephone visits – they are now testing their recommendation at a few clinics to make sure that they are sound – and that should help considerably.

The start of a conversation.  Would you be comfortable with my sharing our conversation on the Quality and Informatics blog?

Matt

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