Representing RNs and MAs: Reflections on Patient Portal Messaging Experiences and the Future with AI
Abstract
BACKGROUND: Though meant to enhance health care delivery, the electronic health record (EHR) has evolved to be the predominant tool used amongst clinicians. The EHR is also intensifying stress among clinicians, especially with the growing volume of patient communications through patient portals messages (PPM, better known as the In-Basket).1 This academic health science center had an dramatic rise in PPM from 332,000 messages total between fiscal years (FY) 2014 to 2018 to 1.6 million messages in FY 2023 without additional staff. Generative artificial intelligence (AI) products and subsequent explosion of large language models may transform PPM responses.2–6 Discussions around AI's role in healthcare largely focus on licensed independent practitioners, leaving a gap of ambulatory staff experiences like ambulatory RNs and medical assistants (MAs).7,8
PURPOSE: The purpose was to explore ambulatory RNs’ and MAs’ experiences with patient portal messaging.
METHODS: This study was part of a larger, IRB-approved mixed methods study at an academic health center in the United States. The qualitative portion used thematic content analysis to analyze open ended free text responses.
RESULTS: There were a total of 289 survey respondents, (RNs= 130; MAs= 159), with 256 responding to open ended questions. Challenges encountered regarding PPM management included: large volume of messages (n=36), software concerns and time consuming (n=21). Emotions about PPMs before logging into the EHR were predominately negative (n=118) with anxiety (n=50), stress (n=34), and overwhelmed (n=29) most cited. Most participants reported negative feelings when the in-basket was not empty, with stress (n=73), overwhelmed (n=41), and anxiety (n=39) the most frequent emotions. When the in-basket is empty, most reported positive feelings (n=182), but several had never experienced an empty in-basket (n=60).
IMPLICATIONS: Ambulatory RNs and MAs are underrepresented in EHR research but are highly impacted by PPMs in a Team Based Care Model. Future research is needed to reflect and respond to the negative emotional responses towards PPMs. RN and MA representation is needed in additional research on the potential use of AI to relieve some of the administrative burden related to PPM responses.
Notes
Reference list included in attached slide deck.
Sigma Membership
Non-member
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Other
Research Approach
Mixed/Multi Method Research
Keywords:
Workforce, Implementation Science, Emerging Technologies, Patient Portal Messaging, Artificial Intelligence, Electronic Health Records
Recommended Citation
Lugtu, Carlene; Cortez, Cynthia Dorantes; Williams, Briana; and Lewis, Chrystal L., "Representing RNs and MAs: Reflections on Patient Portal Messaging Experiences and the Future with AI" (2025). Biennial Convention (CONV). 118.
https://www.sigmarepository.org/convention/2025/presentations_2025/118
Conference Name
48th Biennial Convention
Conference Host
Sigma Theta Tau International
Conference Location
Indianapolis, Indiana, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Date of Issue
2025-11-27
Funder(s)
Stanford Nurse Alumnae
Representing RNs and MAs: Reflections on Patient Portal Messaging Experiences and the Future with AI
Indianapolis, Indiana, USA
BACKGROUND: Though meant to enhance health care delivery, the electronic health record (EHR) has evolved to be the predominant tool used amongst clinicians. The EHR is also intensifying stress among clinicians, especially with the growing volume of patient communications through patient portals messages (PPM, better known as the In-Basket).1 This academic health science center had an dramatic rise in PPM from 332,000 messages total between fiscal years (FY) 2014 to 2018 to 1.6 million messages in FY 2023 without additional staff. Generative artificial intelligence (AI) products and subsequent explosion of large language models may transform PPM responses.2–6 Discussions around AI's role in healthcare largely focus on licensed independent practitioners, leaving a gap of ambulatory staff experiences like ambulatory RNs and medical assistants (MAs).7,8
PURPOSE: The purpose was to explore ambulatory RNs’ and MAs’ experiences with patient portal messaging.
METHODS: This study was part of a larger, IRB-approved mixed methods study at an academic health center in the United States. The qualitative portion used thematic content analysis to analyze open ended free text responses.
RESULTS: There were a total of 289 survey respondents, (RNs= 130; MAs= 159), with 256 responding to open ended questions. Challenges encountered regarding PPM management included: large volume of messages (n=36), software concerns and time consuming (n=21). Emotions about PPMs before logging into the EHR were predominately negative (n=118) with anxiety (n=50), stress (n=34), and overwhelmed (n=29) most cited. Most participants reported negative feelings when the in-basket was not empty, with stress (n=73), overwhelmed (n=41), and anxiety (n=39) the most frequent emotions. When the in-basket is empty, most reported positive feelings (n=182), but several had never experienced an empty in-basket (n=60).
IMPLICATIONS: Ambulatory RNs and MAs are underrepresented in EHR research but are highly impacted by PPMs in a Team Based Care Model. Future research is needed to reflect and respond to the negative emotional responses towards PPMs. RN and MA representation is needed in additional research on the potential use of AI to relieve some of the administrative burden related to PPM responses.
Description
This study explores the experiences of ambulatory registered nurses (RNs) and medical assistants (MAs) with patient portal messaging (PPM). Using thematic content analysis of 289 survey responses, challenges included high message volume and time-consuming software, leading to predominantly negative emotions. The findings highlight the need for increased representation of RNs and MAs in EHR research and the potential role of AI to mitigate administrative burdens associated with PPMs.