Impact of Secure Electronic Health Record Chat on Physician Communication in the Emergency Department.

INTRODUCTION

Effective communication in the emergency department (ED) is essential for safe patient care. Electronic health record (EHR)-integrated secure messaging may improve communication workflows, but limited evidence exists comparing clinician satisfaction across modalities in the ED. This study evaluated physician satisfaction with an EHR-integrated secure messaging tool compared to existing communication methods for non-emergent communication.

METHODS

We conducted an electronic pre-post survey study at an urban academic ED following implementation of an EHR-integrated secure messaging tool in October 2024. The primary outcome was overall communication satisfaction pre-post implementation. We also compared nursing communication satisfaction and repeat consult order proportions. Survey domains (ease of use, efficiency, timeliness, clarity, overall satisfaction) were graded using a four-point forced-choice Likert scale.

RESULTS

Response rates were 35% (33/95) pre-implementation and 36% (34/95) post-implementation. Although face-to-face communication maintained superior clarity ratings, secure chat received significantly higher overall satisfaction than phone communication (median 3 [IQR 3-4] vs 2 [2-3], P < .001) and higher ratings than the existing consult workflow across all domains (all P ≤ .03). Overall nursing communication satisfaction shifted toward higher scores post-implementation (median 3 [3-4] vs 3 [2-3], P = .03). Repeat consult order proportion decreased from 22% to 18% (risk difference, -3.5%; 95% CI, -4.5% to -2.5%; P < .001).

CONCLUSION

Electronic health record-integrated secure messaging demonstrated high user satisfaction among emergency physicians and may reduce repeat consultant communications. Secure chat provides a complementary communication channel in the ED setting.