Patient-generated secure messages and eVisits on a patient portal: are patients at risk?

J Am Med Inform Assoc. 2013 Nov-Dec;20(6):1143-9. doi: 10.1136/amiajnl-2012-001208. Epub 2013 May 23.


Background: Patient portals are becoming increasingly common, but the safety of patient messages and eVisits has not been well studied. Unlike patient-to-nurse telephonic communication, patient messages and eVisits involve an asynchronous process that could be hazardous if patients were using it for time-sensitive symptoms such as chest pain or dyspnea.

Methods: We retrospectively analyzed 7322 messages (6430 secure messages and 892 eVisits). To assess the overall risk associated with the messages, we looked for deaths within 30 days of the message and hospitalizations and emergency department (ED) visits within 7 days following the message. We also examined message content for symptoms of chest pain, breathing concerns, and other symptoms associated with high risk.

Results: Two deaths occurred within 30 days of a patient-generated message, but were not related to the message. There were six hospitalizations related to a previous secure message (0.09% of secure messages), and two hospitalizations related to a previous eVisit (0.22% of eVisits). High-risk symptoms were present in 3.5% of messages but a subject line search to identify these high-risk messages had a sensitivity of only 15% and a positive predictive value of 29%.

Conclusions: Patients use portal messages 3.5% of the time for potentially high-risk symptoms of chest pain, breathing concerns, abdominal pain, palpitations, lightheadedness, and vomiting. Death, hospitalization, or an ED visit was an infrequent outcome following a secure message or eVisit. Screening the message subject line for high-risk symptoms was not successful in identifying high-risk message content.

Keywords: eHealth; eVisit; patient portal; safety; secure message.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Communication
  • Electronic Mail*
  • Emergency Treatment*
  • Female
  • Humans
  • Internet
  • Male
  • Minnesota
  • Patient Access to Records*
  • Patient Safety
  • Primary Health Care
  • Retrospective Studies