SHM Converge Scientific Abstract ePoster Gallery-Content Analysis of Secure Electronic Messages in Hospital Medicine

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This qualitative content analysis examined secure electronic messages in hospital medicine to better understand non-urgent, non-actionable communication and its impact on workflow. Researchers analyzed a randomized 20% sample of Epic Secure Chat data from a single academic hospital in the Mountain West: 365 conversations containing 2,706 messages, drawn from one weekday and one weekend day in May–June 2023.<br /><br />The coding focused on message urgency, actionability, context, and content. Findings showed that most messages were clinical, non-urgent, and non-actionable. Of all messages, 99% were non-urgent, 66% were non-actionable, and only 34% were actionable. Lower-acuity content was common, including acknowledgement, gratitude, and completion notifications. These types of messages appear to be a major source of communication volume and may contribute to interruptions, task switching, and cognitive burden.<br /><br />Conversation contributors were mainly physicians, APPs, and RNs. Thematic analysis of notable conversations identified several patterns: emotion expressed through language and punctuation, transitions to phone calls or in-person discussions for more complex issues, email use for attachments, and near-miss events such as order errors, wrong-patient messaging, or missed action items.<br /><br />The authors suggest two major intervention targets: reducing low-acuity messages and minimizing interruptions through changes in message triaging and alert workflows. Future work should examine the perspectives of high-utilizing clinicians and how different triaging practices affect cognitive load. Strengths included a randomized sample and the fact that secure messaging was the institution’s primary communication method. Limitations included single-site data and the subjective nature of message coding.

Asset Subtitle

Michelle Knees

Meta Tag

Author List Angela Keniston, Evangeline Grobbel, Jessica Clawson, Lauren McBeth, Marisha Burden, Michelle Knees

Category Research

Concept Secure Messaging

Concept Qualitative Content Analysis

Concept Non-Urgent Message

Concept Non-Actionable Message

Concept Hospital Medicine

Distinguished Non-Finalist

Presenter Organization University of Colorado Anschutz School of Medicine

Presenting Author Michelle Knees

Track Communication

Keywords

secure messaging

hospital medicine

non-urgent communication

non-actionable messages

Epic Secure Chat

workflow interruptions

clinical communication

message triaging

cognitive burden

qualitative content analysis

Secure Messaging

Qualitative Content Analysis

Non-Urgent Message

Non-Actionable Message

Hospital Medicine