Date of Publication


Project Team

DNP Advisor: Margaret Aitken, DNP, AGNP, ANP-BC; Site Mentor: James Williamson, MHA, Site Supervisor, Adult Primary Care


Optimizing Secure Patient Messaging Workflow in a Vermont Primary Care Clinic

Kim O’Leary, DNPc, RN

DNP Advisor: Margaret Aitken, DNP, AGNP, ANP-BC

Site Mentor: James Williamson, MHA, Site Supervisor, Adult Primary Care

Background: Secure patient messaging is a popular tool designed for non-urgent questions, yet patients sometimes use it to relay urgent concerns. As office workflows tend to prioritize responses to other methods of communication, this presents a potentially unsafe situation in which clinical staff may not respond to these urgent messages in a timely manner.

Purpose: To develop a methodology to improve the timeliness, effectiveness, and safety of secure patient messaging workflow within one primary care office in suburban Vermont.

Methods: Clinical staff were surveyed at baseline to assess attitudes towards messaging workflow. Staff were redeployed to focus exclusively on secure messaging, patient education materials were developed, incoming messages were audited, and RN stress levels were assessed daily. Post implementation surveys with staff assessed effectiveness of pilot.

Results: Pre-implementation surveys revealed staff concerns that there is insufficient time to adequately address secure messages. An initial daily message audit revealed many unresolved messages with a small, but concerning, number of messages that were of urgent nature and inappropriate for secure messaging. Post-implementation surveys showed a clear improvement in staff attitudes toward efficiency, timeliness and safety of secure messaging workflow. Message audits showed marked improvement in timely responses and reduction in urgent messages received by the office.

Conclusions: This project identified challenges and facilitators in the secure messaging workflow. Findings of the project suggest best practice for clinical staff to optimize their secure messaging workflow in responding to patients in a timely, efficient and safe manner.

Keywords: secure messaging, clinic, workflow, patient, communication, patient portal, electronic health record, email

Document Type