Multidisciplinary perspectives on secure messaging in the hospital: Physicians, advanced practice clinicians, and nurses

BACKGROUND: Secure messaging (SM) is increasingly utilized for in-hospital communications. Studies thus far describe high message volumes resulting from this transition and present related calls to action to mitigate SM-related task switching and cognitive load. However, there is limited data on multidisciplinary perspectives regarding SM use. OBJECTIVES: We aimed to describe physician, advanced practice clinician (APCs), and nursing perspectives on SM use in the hospital. METHODS: Semi-structured focus groups were conducted in April - June 2024 with medicine nurses and hospitalist APCs and physicians at a large academic medical center. Participant identification occurred through convenience sampling, and focus groups delved into utilization, experiences, and opportunities for improvement related to SM. A rapid qualitative thematic analysis was performed to identify themes and subthemes. Matrices were derived from templated focus group summaries with asynchronous and synchronous discussions among all team members to achieve consensus. RESULTS: There were twenty-eight participants (9 nurses, 9 APCs, 10 physicians). Themes included: (1) SM increases accessibility and care coordination while also generating high message volumes and interruptions that may contribute to care team tensions; (2) perceptions and usage of messaging vary based on clinical role alongside shared experiences across disciplines; and (3) confusion and ambiguity surround messaging functionalities and standards. CONCLUSIONS: Clinicians widely described tensions associated with high-volume, interruptive messaging. SM enhanced accessibility and coordination, though it also introduced new challenges. As these communication modalities are incorporated, understanding the benefits and consequences of SM is imperative for creating evidence-based workflows that foster safe, efficient, and effective communication.