Characteristics of Office-Based Providers Associated with Secure Electronic Messaging Use: Achieving Meaningful Use

As providers shift from traditional healthcare delivery models to patient-centered care, the federal government continues to support those efforts by promoting the use of health information technology (HIT), and in particular, electronic health records (EHRs). These efforts were catalyzed by the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act (ARRA) in 2009 that mandated all public and private healthcare providers adopt and demonstrate meaningful use of EHRs. One critical EHR functionality that can contribute to achieving meaningful use stage 2 is exchanging secure messages with patients. Secure electronic messaging (SM) is asynchronous communication which promotes patient-provider communication, patient-provider interaction, and better coordination of care beyond the examination room. Many studies have supported SM as a function that contributes to improving efficiencies by allowing providers to address a variety of routine health issues that would otherwise require return office visits or phone calls. Specifically, prescription refills, medication instructions, specialist referrals, appointment scheduling, and answering frequently asked questions, which are common occurrences for primary care practices. Despite the benefits of adopting SM, and its role in satisfying meaningful use, only sixty-four percent of providers in 2015 reported having the capabilities to exchange secure messages with patients, which represents an increase of over fifty percent from 2013.

This study uses the 2015 Medical Organizations Survey (MOS) collected by the Agency for Healthcare Research and Quality (AHRQ) to identify characteristics of office-based providers used as a usual source of care (USC) associated with SM use. Using MOS survey weighted means we find that in 2015, 89 percent of patients whose USC practices had electronic health records (EHRs) saw a practice that exchanged SM. Using logistic regression of SM use on practice and patient characteristics, we find that patients whose USC reported being patient-centered medical homes (PCMHs) or used other health information technology (HIT) were more likely to have seen a USC practice that also used SM. Patients with an independent group or solo USC were less likely to have seen practices with SM relative to patients whose USC practice was hospital owned. Our results suggest that the organizational characteristics of USC practices can significantly affect whether patients of that practice are able to use SM to communicate with their provider, and in turn realize the benefits SM for their care management. Further, our findings suggest that practice size and ownership structure have a large role in determining whether a practice adopts SM, and that adopting SM is correlated with the use of other HIT and attaining PCMH certification. Understanding the relationship between practice organization/behavior and adoption of new HIT can inform future policies that better address barriers to HIT adoption.