Background: Secure messaging (SM) has become a predominant mode of in-hospital communication, offering efficiency but raising concerns about multitasking and cognitive load. Despite its ubiquity, little is known about SM’s impact on hospitalist workload or whether enhanced platform features can mitigate this burden. This project aimed to: 1) assess the association between SM and hospitalist-perceived workload using the NASA Task Load Index (TLX); 2) evaluate whether the use of enhanced SM features can reduce workload; and 3) examine whether these features influence the time spent between receiving and reading messages (receipt-read times).
Methods: We conducted a single-site, two-phase project (Nov 2024–Mar 2025) among physicians and advanced practice providers (APPs) on general medicine dyadic teams at an academic hospital. In the “default features” phase, clinicians used standard SM settings with interruptive desktop pop-up notifications enabled. In the “enhanced features” intervention phase, pop-ups were disabled and clinicians were strongly encouraged to use availability features (e.g., status icons, status messages).SM workload was measured by administering the TLX survey, a validated workload measurement tool. Differences in workload between phases were analyzed using unadjusted and adjusted regression models. Odds ratios for receipt-to-read times were also calculated, as were Pearson correlation coefficients to examine associations between workload scores and messaging volumes.
Results: Thirty-two clinicians participated in the default phase and 35 in the enhanced phase. Default-phase TLX scores were high (mean 62), indicating heavy workload. In the intervention phase, adjusted TLX scores decreased modestly by 11.2 points (p < 0.01), driven predominantly by reductions among physicians. When analyzed by subgroup, physicians experienced a clinically and statistically significant decrease in SM-related workload (–14.6 points, 95% CI –23.0 to –6.2, p < 0.01), whereas APP workload showed no meaningful change (–1.3 points, 95% CI –10.5 to 8.0, p = 0.79) (Table 1).Message volumes (~90 messages per day) and receipt-to-read times (mean 1.5 minutes) were unchanged across phases. A moderate correlation between messaging volume and workload was observed among physicians but not APPs (Figure 1). Uptake of enhanced features was high, with >70% of clinicians reporting intent to continue using them.
Conclusions: This project is among the first to offer early insights into the relationship between SM and hospitalist workload and to explore strategies to mitigate this burden. In this project, SM was associated with high workload for both physicians and APPs, with default phase scores exceeding the 75th percentile of typical medical task workloads. Enhanced platform features may modestly reduce SM-related workload for some clinicians but are unlikely to offset the broader cognitive demands of SM when implemented in isolation.
.png)
.png)