Technology-mediated communication between patients and primary care clinicians and staff: Ambiguity in secure messaging

Health information technology, i.e. secure messaging, can support high-quality, efficient care. Secure messaging - encrypted communication between patient and clinician or staff, similar to email - can facilitate patient-reported information and communication, but its fit with clinical workflow is not understood. Fifteen primary care clinicians and staff were interviewed and observed over 35 hours to understand the impact of secure messaging on ambiguity within the care delivery workflow. We developed a general workflow diagram for secure messaging, and identified three types of ambiguity relating to workflow, content of communication, and multiple points of data entry. While the use of secure messaging can help to clarify and document patient information, it can also increase ambiguity, particularly relating to the organization of work and workflow. Understanding how to design and implement technology to support multiple stakeholders, including patients, while considering the work system is a major area for future research.