The Uneven Distribution Of Patient Portal Messages Across Patients And Physicians

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Abstract
Responding to patient-initiated portal messages is a growing source of work for physicians, yet little is known about how these messages are distributed across patients and physicians. Understanding the distribution is critical for developing interventions to reduce burden and for designing reimbursement policy. Using data from 487,442 patients at University of California San Francisco (UCSF) Health and national electronic health record (EHR) metadata from 224,068 ambulatory care physicians in the US, we examined the distribution of patient-initiated medical advice request messages across patients and physicians. The distribution was highly skewed at both the patient and physician levels. The top 5 percent of UCSF Health patients accounted for 52.8 percent of all messages. Among physicians nationally, primary care physicians received a median of 9.6 messages per week, whereas the top quartile received 53.3 messages per week. Physicians with higher visit volume received fewer messages per visit, and higher message volume was associated with greater EHR work outside of work. These findings highlight the need for targeted interventions and payment models that account for the uneven distribution of asynchronous portal-based care.

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