More Than a Message: Death by a 1000 'Chats'.

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Not reported — no empirical data presented

• Primary Outcome: No quantitative primary outcome reported. The central thesis is that excessive EHR-based secure messaging (e.g., Epic Chat) causes fragmented attention, disrupted clinical reasoning, miscommunication, and potential patient harm for ID consultants.

• Nnt Or Sensitivity: Not applicable — no intervention trial conducted; no diagnostic or prognostic metrics reported

• Confidence Interval: Not reported

Clinical Application

The proposed strategies — defining message triage criteria, batching responses, protecting dedicated focus time, and teaching messaging etiquette — are low-cost and operationally feasible in most hospital environments. However, implementation requires cultural change at the team and institutional level, which is inherently difficult to mandate. Resistance from referring teams accustomed to rapid chat responses may limit uptake. Integration into junior doctor and registrar training programmes is feasible and represents a practical entry point. Australian public and private hospitals are increasingly adopting Epic and other integrated EHR platforms with built-in secure messaging functionality (e.g., St Vincent's Health Australia, Northern Health, and several NSW Health Local Health Districts). The concerns raised are directly applicable to Australian ID consultants and other specialist services operating under similar consultation models. The RACGP and ACEM have not yet issued formal guidance on EHR messaging etiquette or safe communication thresholds. The Australian Commission on Safety and Quality in Health Care (ACSQHC) National Safety and Quality Health Service (NSQHS) Standards address clinical communication (Standard 6) but do not specifically regulate asynchronous EHR messaging. There is no PBS or TGA relevance. The Medical Board of Australia's Good Medical Practice guidelines on documentation and communication may have indirect medicolegal relevance to the issues raised. Australian hospital credentialing and orientation programmes could incorporate the messaging etiquette principles described. Hospital-based specialist consultants, particularly those in high-demand consultation services such as Infectious Diseases, who receive large volumes of asynchronous EHR messages from multiple referring teams simultaneously. Also relevant to hospital administrators, clinical informatics teams, and medical educators responsible for communication training.

Abstract

Secure electronic messaging within the electronic health record (EHR), such as Epic Chat, has transformed communication in hospitals by enabling rapid, asynchronous communication. Yet for Infectious Diseases (ID) consultants, the constant barrage of messages comes at a cost: fragmented attention, disrupted clinical reasoning, and potential patient harm. Messages that are repetitive, trivial, or casually worded can also fuel miscommunication and even medicolegal risk. As this type of messaging becomes increasingly prevalent in clinical practice, we must establish clearer boundaries and a cultural shift that values purposeful communication. Practical strategies include defining what requires chat versus direct phone or in-person conversation, batching responses, protecting focus time, and teaching messaging etiquette. To optimize patient care and protect clinician well-being, we must be intentional about when and how we communicate.

References

1. 1.Wooten, D., Hendrix, C., & Nordman, J. (2026). More than a message: Death by a 1000 'chats'. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciag094