How organizations can help physicians spend less time managing portal messages

It’s no secret that patient portal message volume has increased since 2020. What began out of necessity during the public health emergency has since become a matter of convenience for patients with low-acuity care questions, prescription refill requests, and other concerns they’d rather not schedule an appointment to address.

Recent research from Health Affairs found that portal messaging isn’t evenly distributed for patients or physicians. While higher message volume is not surprisingly associated with additional physician “pajama time,” the same isn’t true for visit volume, indicating that organizations should consider practical steps to reframe when and how portals should be used. 

More portal messages, more “pajama time”

Health Affairs looked at portal usage at a national level and at one institution (University of California San Francisco). 

Findings from UCSF found that 5% of patients accounted for nearly 53% of all portal messages. This comes as little surprise. It’s roughly analogous with Peterson Center on Healthcare and KFF data on total health spending, which shows that 5% of patients account for about 49% of total spending. Patients with complex and costly care needs are more likely to communicate with their care teams more frequently.

National data indicated that primary care physicians typically receive less than 10 portal messages per week, though those in the top 25% receive more than 53. Not surprisingly, these practitioners spent more time outside of normal working hours working in their electronic health record (EHR). 

Candice Elam, a nurse practitioner writing on KevinMD, noted the time required to reply to portal messages quickly adds up. Ten minutes of “careful clinical work” per message easily turns into nearly two hours of uncompensated labor per day. It’s hard to quantify, though, as messages arrive (and get responses) in dribs and drabs, no differently than emails.

5 ways to help physicians manage portal use

The Health Affairs research came with an interesting wrinkle: Physicians with higher visit volume received fewer portal messages. At face value, this seems contradictory. Wouldn’t more patients mean more messages?

Diving into how organizations are “taming the in-basket,” as one paper put it, offers several clues for successfully managing incoming portal messages. (Additional advice comes from Elam’s post and American Medical Association patient portal best practices.)

Decide who should see what. Clarify which members of the care team should reply to certain messages. Administrative tasks that don’t require clinical judgment – routine refills, insurance questions, and appointment scheduling – don’t need to be routed to physicians.

Resist the temptation for lengthy replies. Many portal messages ask clinical questions that require a visit, whether in-person or virtual. Encouraging care teams to reply accordingly not only spares providers from penning a lengthy message (likely after hours); it also converts the message into a billable encounter.

Set boundaries. Just because patients have 24/7 access to portals doesn’t mean clinicians should, too. Make it clear that responses will be sent during predefined timeframes. This will preserve clinicians’ time and ease patient concerns about when they’ll see a response.

Eliminate the need for messages. Are patients eligible for long-term medication supplies and/or automatic refills? Do after-visit and discharge summaries address common FAQs? Is the portal’s link for self-scheduling appointments easy to find? These measures can help patients answer their own questions and avoid sending a message in the first place.

Document portal utilization. Track the portal messages that physicians get, when they respond, and how long the correspondence goes back and forth. This data will help determine whether boundaries need to be set, or best practices need to be refined.

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.