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Electronic messaging has the potential to improve care and strengthen patient relationships, but without clear expectations and boundaries, it also has the potential to erode work-life balance for clinicians.

Fam Pract Manag. 2022;29(6):5-9

This content conforms to AAFP criteria for CME.

Author disclosures: no relevant financial relationships.

Patient electronic messaging refers to the mode of secure communication that generally takes place via HIPAA-compliant, confidential, web-based communication platforms connected to electronic health records (EHRs). Patients, physicians, staff, or other providers can initiate messages anywhere internet access is available. The COVID-19 pandemic dramatically increased the number of patient electronic messages and the number of new users.1 In our health care system, from March 2020 to 2022, unique users of electronic messaging increased from approximately one in four patients to one in three. We also saw a doubling of total individual patient-initiated electronic messages, from approximately 11,000 to 22,000 per month in a system of 70,000 patients.

Although electronic messaging is the fastest-growing mode of patient communication, satisfaction with the technology varies. According to a retrospective analysis of 5,971 patients and 267 clinicians in 16 clinics in northern California, patients were extremely satisfied with electronic messaging, but physicians and staff were only generally satisfied even though electronic messages are associated with reductions in telephone call volumes,2 improvements in patient outcomes,3 and increases in overall patient satisfaction.4 Patients who use messaging most frequently have higher numbers of complex chronic diagnoses and more outpatient visits.5 As demand for timely electronic communication increases, intentional management strategies are becoming essential for clinicians. Message utilization has tremendous potential to improve care and strengthen patient-clinician relationships. However, it also has the potential to erode work-life balance for clinicians.6

With this in mind, we have reviewed and identified current best practices for electronic message management. These 12 practical tips are not meant to be taken as inflexible rules. We recognize there will be clinical exceptions; however, we hope these tips will empower primary care physicians and care teams to review and improve their patient electronic messaging habits. The overall goals are improved communication, effective teamwork, efficient workflow, and patient and clinical team satisfaction.


  • Electronic messaging has the potential to improve patient outcomes and strengthen the patient-clinician relationship; however, it also has the potential to erode work-life balance for clinicians.

  • Efficient message management starts with establishing team expectations for common message types and following best practices, such as using standardized text templates and keeping responses brief.

  • Setting boundaries around electronic messaging helps patients understand when this mode of communication is most appropriate and when a face-to-face or other type of visit is needed.

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