Background: With the advent of the Electronic Medical Record (EMR), documentation occupies up to 50% of doctors’ time1 and prior work has revealed that internal medicine residents spend more than four hours daily on documentation2. Secure messaging (SM) has been recently integrated into the inpatient EMR system, allowing healthcare team members to directly message physicians; however, its impact on hospitalists’ workflow remains unstudied. Prior work in the outpatient setting has shown a heavy burden of secure messaging on primary care providers with a disproportionate toll on female identifying physicians3–5. The primary aim of this study is to examine the impact of secure messaging on internal medicine (IM) residents during a hospitalist rotation. Secondarily, we explored potential gender-based differences in utilizing the secure messaging feature.

Methods: We retrospectively examined a one-month period of secure messaging activity among inpatient IM residents on a hospitalist rotation at a large academic hospital. We gathered data regarding the duration of time engaged in EMR, time engaged in SM interactions, the volume of messages sent, and the work hours defined as time logged in as “First Contact”. We utilized excel to provide descriptive statistics. This study was determined to be exempt by the IRB.

Results: We assessed EMR and SM usage among eight IM residents during a four-week period. Each resident worked a one-week block averaging 12.4 daily hours. On average, residents spent 38.2% of their day in the EMR (range 31.7 – 46.8%), with SM accounting for 16.6% of EMR time (range 13.9 – 21.1%). They sent an average of 98.1 SM messages per day (range 74 – 155) and took 24.2 minutes (range 5.7 – 74.3 minutes) to respond to a received message. The study lacked the power to detect gender-based differences in SM engagement.

Conclusions: This pilot study has uncovered a notable time burden associated with the use of secure messaging (SM) within the Electronic Medical Record (EMR) system among Internal Medicine residents on a hospitalist rotation, a finding that adds a dimension to our understanding of technology’s impact on physicians. Although the current scope of the study does not allow for a robust analysis of gender-based differences, we are proactively broadening our research parameters to include faculty hospitalists and an extended time period.These findings confirm prior work revealing the growing impact of documentation on physician workflow and underscore the importance of thoughtful implementation of new communication tools in healthcare settings. Future research should include the impact of SM on hospitalist workflow and explore the broader implications for patient care and quality improvement.