A Jay Holmgren, PhD Awarded UCSF RAP Grant


Congratulations to A Jay Holmgren, an Assistant Professor at CLIIR, for receiving the UCSF RAP grant for a project entitled: "Sustaining Digital Patient-Clinician Communication in the Post-COVID Period: Insights from National EHR Data."

The COVID-19 pandemic saw a rapid rise of digital technologies that enable patient-clinician communication which became an essential component of ambulatory care. While patients have been able to securely message with their clinician asynchronously for almost a decade (following the widespread adoption of electronic health records (EHRs)), patient-clinician messaging grew dramatically at the beginning of the pandemic and has persisted at high levels. Given the many benefits of this communication modality – including improved patient experience and better access to care – it is likely that increased use will continue post-pandemic.

However, a critical, unanswered question remains: how will this increase in digital patient-clinician messages impact care delivery organizations and the providers who practice within them? At the organization level, there are both financial and operational challenges to adapting to delivering care that includes a more prominent role for digital communication. If specific types of organizations, such as safety net clinics, bear a larger share of the national rise in patient-clinician messages, new models of care and payment may be required to sustain access in these settings. At the clinician level, this increase creates a predicament where providers feel pressured to work outside of work, potentially contributing to clinician burnout.

To answer this question of long-term impact, Dr. Holmgren will use a unique national dataset to examine organization-level changes in patient messaging volume from December 2019 through May 2021. He will seek to determine the distribution of the increase in messages across types of organizations and to understand where the time burden of patient messaging falls within organizations. The findings of this study will help shape policy efforts to maintain messaging capacity while avoiding EHR-driven clinician burnout and inform reimbursement decisions – if secure messaging remains a non-billable service, clinicians may be likely to dissuade patients from sending them. Moreover, understanding the impact of this increase will provide insight into how our health system supports digital patient interactions, an increasingly essential measure of quality of care.