ArticleJournal of general internal medicine2025
Association of EHR-Integrated Secure Messaging Use with Clinician Workload and Attention Switching.
Article in Journal of general internal medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
8 citing papers in PubMed.
- Perceptions of Secure Messaging and Patient Safety: Results of an Interprofessional Survey.Hospital pediatrics · 2026Article
- Association Between Electronic Health Record-Based Nursing Workload and Turnover: Retrospective Cohort Study.JMIR nursing · 2026Article
- Secure Messaging Workload and the Effect of an Enhanced Workflow Intervention Among Hospitalist Clinicians.Journal of general internal medicine · 2026Article
- A scoping review of studies on secure messaging through patient portals: persistent challenges and potential solutions.npj health systems · 2026Article
- Algorithmic Identification of the Daily Primary Frontline Clinician during Inpatient Medicine Encounters Using EHR Audit Log Data.Applied clinical informatics · 2026Article
- Article
- Association Between Conversational Multitasking and Clinician Work Behaviors at a Large US Health Care System: Cohort Study.Journal of medical Internet research · 2025Observational
- Networked Behaviors Associated With a Large-Scale Secure Messaging Network: Cross-Sectional Secondary Data Analysis.JMIR medical informatics · 2025Article
Corrections and comments
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Authors and funding
7 authors.
Funding
Abstract
backgroundSecure messaging use for clinician-to-clinician communication has grown rapidly in recent years.
objectiveTo examine the association between secure messaging use, electronic health record (EHR) time, and frequency of attention switching among clinicians primarily working in an inpatient setting.
designRetrospective cohort study.
participantsAttending physicians, trainee physicians, and advanced practice providers who worked in an inpatient setting during a 3-month period (February-April, 2023) from 14 hospitals within a large midwestern health system. MAIN MEASURES: Secure messaging use (i.e., Epic Secure Chat) was measured as the total number of messages sent or received between clinicians, aggregated at the clinician-day level. The primary outcomes were EHR time (a measure for workload) and the frequency of patient switching (a measure for cognitive burden) within the EHR. Linear mixed-effect models were used to examine the association between daily secure messaging volume and the primary outcomes, adjusting for age, gender, patient load, and correlations within clinicians and clinical service assignments. KEY
resultsA total of 3996 clinicians (2174 [54%] female, median age 38 years [IQR 33, 48]) with 103,285 clinical work days, > 145 million audit log actions, and ~ 4.5 million secure messages were included. Median secure messaging volume was 9 (IQR 0, 51) messages per day, median EHR time was 250.5 min (IQR 140.3, 377.4) per day, and median number of patient switches was 79 (IQR 35, 147) per day. An increase in secure messaging volume from the 25th to 75th percentile was associated with a 25.5 min (95% CI 24.8, 26.2, p < 0.001) increase in EHR time and 18.1 (95% CI 17.6,18.6, p < 0.001) additional patient switches.
conclusionsSecure messaging use was associated with increased EHR time and frequency of attention switching. The results suggest that secure messaging use is associated with clinician work behaviors, potentially contributing to increased workload and cognitive burden.
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