Abstract
Background/Aims All Kaiser Permanente regions have implemented secure email functionality. Regional policies, workflows, and provider best practices have been established regarding secure email encounters with patients. This Phase I study explores effective practices of primary care physicians (PCPs) handling email traffic with patients, provides evidence regarding current secure email workflow and volumes, and estimates physician workloads related to daily secure email encounters with patients.
Methods A combination of methods was used: 1. Structured interviews with 27 PCPs with a high volume of secure email encounters with patients; 2. Descriptive and correlation analysis of daily secure email volume and provider response time; 3. Estimation of actual physician workloads related to secure email with patients, based on observed volume and time spent per email; and 4. Approximate randomization to estimate expected workload adjusted by PCP panel size, kp.org registration rate, and number of clinical work days.
Results Preliminary results of this Phase I study indicate that, before adjusting for panel size, regional averages for physicians’ daily volume of secure email encounters with patients ranged from 1 to 9. Few physicians have high volumes (10–20 per day) of email encounters with patients. Interviews with 27 high-volume physicians revealed two models for managing email traffic: direct physician response and team triage (74%). Some doctors respond quickly to minimize repeat emails/phone follow-ups from patient; others fear that rapid responses will generate higher email volume. First-response times are correlated with email volume in some regions, but average physician response times are not correlated with the volume of email encounters. Preliminary results from approximate randomization provided insight into associations between physician email encounter practices and patient satisfaction with access and communication.
Conclusions Practices for handling secure emails with patients varied across physicians and regions. The data did not confirm all high-volume physician perceptions regarding relationships between volume and turnaround times. The majority of physicians was not overwhelmed by the workload related to secure email with patients, and patient satisfaction was associated with higher email volumes.
