How do you manage patients who send numerous MyChart (Electronic Health Record) messages?

Managing High-Volume MyChart Messagers

Establish clear written communication agreements with patients upfront that specify turnaround times, permissible message content, and escalation pathways—this proactive boundary-setting is the cornerstone of managing excessive electronic messaging. 1

Establish a Patient-Provider Communication Agreement

The most effective strategy is to negotiate and document expectations before messaging becomes problematic:

• Create a written agreement that patients sign during portal enrollment, with a copy placed in their chart 1
• Define turnaround time expectations: Set a standard 1-business-day response for non-urgent messages and 2-3 business days for routine inquiries 1
• Specify permissible transactions: Clearly delineate what can be handled via messaging (prescription refills, appointment requests, routine follow-up) versus what requires phone calls or office visits (urgent medical issues, complex clinical decisions) 1
• Establish forbidden topics: Consider restricting highly sensitive subjects (HIV status, mental health crises, workers compensation) from electronic messaging 1

Implement Automated Responses and Triage Systems

Configure your messaging system to manage volume efficiently:

• Set up automatic replies acknowledging receipt of all patient messages, stating expected response time and providing alternative contact information for urgent needs 1
• Activate out-of-office replies during absences with clear instructions on whom to contact for immediate assistance 1
• Designate staff for message triage: Have nursing or office staff filter and categorize messages before they reach you, redirecting administrative questions to appropriate personnel 1
• Require categorical subject headers: Instruct patients to specify message type in the subject line ("prescription," "appointment," "medical advice") to facilitate efficient routing 1

Set Clear Boundaries on Message Content

Proactively guide patients on appropriate messaging:

• Include escalation footers in all your replies inviting patients to call or schedule visits when messaging is insufficient 1
• Actively discourage email as a substitute for clinical examination when physical assessment is needed 1
• Request patient identification: Have patients include their full name and patient ID number in message bodies to prevent confusion 1

Address the Underlying Communication Needs

Recent evidence reveals that many secure messages are non-actionable acknowledgments, gratitude, or social interactions 2. For patients sending excessive messages:

• Recognize that experienced portal users often worry about imposing on physician time and lack clarity on when messaging is appropriate 3
• Provide "rules of engagement" training either at portal sign-up or through online tutorials to clarify appropriate use 3
• Consider that patients with multiple chronic conditions (particularly those under age 65) use messaging more frequently—this may reflect legitimate care coordination needs rather than inappropriate use 4

Common Pitfalls to Avoid

• Don't ignore the emotional content: Patients may express stronger sentiments via messaging than face-to-face; avoid sarcasm or harsh criticism in responses, as these messages are permanently archived 1
• Don't assume message receipt: For important medical advice, require patients to acknowledge receipt with a brief reply; when in doubt, confirm by telephone 1
• Don't allow messaging to replace necessary clinical encounters: Be explicit when physical examination or real-time discussion is required 1

Documentation Requirements

• Archive all message exchanges as progress notes in the patient's chart 1
• Document the communication agreement discussion in the medical record 1
• Send confirmation messages upon completing patient requests (prescription refills, records transfers) 1

The key insight is that most "problem" messaging stems from unclear expectations rather than patient manipulation. By establishing explicit boundaries upfront and providing structured guidance on appropriate use, you can manage volume while maintaining therapeutic relationships 3.