Qualitative Assessment of Physician Experiences Using Secure Messaging for Diabetes Management (Preprint)
Authors: Kragen Ben , Zaidi Maryum , Shimada Stephanie L , Gerber Ben S , Lozier Cecilia , Chilingerian Jon A 
Published: January 2025

BACKGROUND

The COVID-19 pandemic initiated an unprecedented increase in demand for remote management of type 2 diabetes using secure messaging, or patient-provider text-based communication. Prior research on secure messaging has described the content of messages sent for type 2 diabetes management and demonstrated its impact on clinical outcomes. Additional research is needed to understand providers’ perspectives on the benefits and challenges of using secure messaging to communicate with patients about specific clinical tasks that support diabetes management.

OBJECTIVE

To investigate physicians’ experience using secure messaging to communicate with patients about type 2 diabetes management.

METHODS

We interviewed a sample of endocrinologists and internists who have used secure messaging to communicate with adult patients about type 2 diabetes management. Semi-structured interviews were used to solicit physicians’ experience using secure messaging for six specific tasks that support diabetes management; refilling prescriptions, answering non-urgent medical questions, scheduling appointments, discussing test results, making referral requests, and discussing visit follow up. Interviews were conducted until we achieved saturation of themes for these six tasks. Data was coded and analyzed using the Framework Method.

RESULTS

Ten physicians were interviewed; six internists and four endocrinologists. Physicians reported spending between two and five hours per day messaging with patients. They observed that secure messaging increased the frequency and timeliness of communication, which improved care coordination and facilitated care delivery between visits. This served as a time-efficient way to iterate specific components of treatment plans, including discussing test results, visit follow-up, scheduling, and prescription refill. Physicians were frustrated with the unstructured nature of secure messages. Patients wrote messages that were often disorganized, confusing, or did not have enough information for the provider to take action. In many cases, poorly structured secure messages resulted in lengthy back-and-forth communications between patients and physicians, which sometimes required a phone call or office visit to resolve.

CONCLUSIONS

Physicians reported that secure messaging supports a longitudinal model of care, where patients can iterate their treatment plan between visits. For tasks with well-defined information boundaries, like scheduling and prescription refill, physicians reported that secure messaging improved the time-efficiency of care delivery. Providers experienced challenges using secure messaging for more complex tasks and often reported not receiving sufficient clinical information. We identified a demand for workflow technologies to process incoming secure messages and fill information gaps so that the messages that reach physicians’ inboxes are clear and have sufficient information for physicians to make a decision about how to proceed with treatment.