Surgical Endoscopy

, Volume 30, Issue 4, pp 1432–1440 | Cite as

Rapid growth in surgeons’ use of secure messaging in a patient portal

  • Jared A. Shenson
  • Robert M. Cronin
  • Sharon E. Davis
  • Qingxia Chen
  • Gretchen Purcell Jackson



Use of secure messaging through patient portals has risen substantially in recent years due to provider incentives and consumer demand. Secure messaging may increase patient satisfaction and improve outcomes, but also adds to physician workload. Most prior studies of secure messaging focused on primary care and medical specialties. We examined surgeons’ use of secure messaging and the contribution of messaging to outpatient interactions in a broadly deployed patient portal.


We determined the number of clinic visits and secure messages for surgical providers in the first 3 years (2008–2010) after patient portal deployment at an academic medical center. We calculated the proportion of outpatient interaction conducted through messaging for each specialty. Logistic regression models compared the likelihood of message-based versus clinic outpatient interaction across surgical specialties.


Over the study period, surgical providers delivered care in 648,200 clinic visits and received 83,912 messages, with more than 200 % growth in monthly message volume. Surgical specialties receiving the most messages were orthopedics/podiatry (25.1 %), otolaryngology (20.1 %), urology (10.8 %), and general surgery (9.6 %); vascular surgery (0.8 %) and pediatric general surgery (0.2 %) received the fewest. The proportion of outpatient interactions conducted through secure messaging increased significantly from 5.4 % in 2008 to 15.3 % in 2010 (p < 0.001) with all specialties experiencing growth. Heart/lung transplantation (74.9 %), liver/kidney/pancreas transplantation (69.5 %), and general surgery (48.7 %) had the highest proportion of message-based outpatient interaction by the end of the study.


This study demonstrates rapid adoption of online secure messaging across surgical specialties with significant growth in its use for outpatient interaction. Some specialties, particularly those with long-term follow-up, interacted with patients more through secure messaging than in person. As surgeons devote more time to secure messaging, additional research will be needed to understand the care delivered through online interactions and to develop models for reimbursement.


Patient portal Secure messaging Patient engagement Consumer health informatics Patient–provider communication Surgery 



Robert Cronin and Sharon Davis were supported by the 5T15LM007450-12 training grant from the National Library of Medicine.


Dr. Jackson receives salary support from funding given to Vanderbilt University Medical Center by West Health for a research project involving automated telephone call technologies. Mr. Shenson, Dr. Cronin, Ms. Davis, and Dr. Chen have no conflict of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.School of MedicineVanderbilt UniversityNashvilleUSA
  2. 2.Department of Biomedical InformaticsVanderbilt UniversityNashvilleUSA
  3. 3.Department of MedicineVanderbilt University Medical CenterNashvilleUSA
  4. 4.Department of BiostatisticsVanderbilt UniversityNashvilleUSA
  5. 5.Department of PediatricsVanderbilt University Medical CenterNashvilleUSA
  6. 6.Department of Pediatric SurgeryVanderbilt University Medical CenterNashvilleUSA

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