Electronic Patient Portal Use in Dermatology Increasing

Physician using a computer
Physician using a computer
Electronic medical records (EMR) patient portal messaging was quantified from 2016 to 2020.

The percentage of electronic medical records (EMR) patient portal messaging increased annually at a dermatologic surgery clinic from 2016 to 2020 compared with practitioner clinic encounters, and many of the messages could be considered billable, researchers reported in a study published in the Journal of the American Academy of Dermatology.

The study authors analyzed EMR patient portal messaging (EPIC MyChart messages) from the dermatologic surgery clinic of 1 academic institution from 2016 through 2020. They also retrospectively reviewed the content of 44,500 patient portal messages from November 2020 to December 2020.

The MyChart messages were grouped into 2 main categories—automated messages from provider to patient and medical advice requests from patient to provider. The investigators considered encounters in which physicians or nursing staff managed a patient concern and gave pertinent medical advice outside the relevant global period as potentially billable.

The ratio of patient portal messages per clinic visit increased each year in the study period, beginning with a rate of 0.31 in 2016 to 1.20 in 2020. The total number of patient clinic encounters also increased in the same period until declining in 2020 owing to the COVID19 pandemic.

Among 500 messages that were reviewed, 58.6% were from men (median age, 53 to 65 years [SD 14.1]), and 63.2% were automated messages involving medical history questionnaires, appointment changes, and laboratory results.

Of the 500 messages, 36.8% were patient-initiated medical advice encounters, and an average of 3.5 (SD 2.18) total messages from the patient, care team, and physician occurred within each message encounter. Of the 184 encounters, 39.1% had a direct physician response to the messages, and 47.3% included direct and/or indirect physician involvement. A number of the messages were sent outside of business hours or included a telephone call.

Many encounters met the criteria to be considered billable, according to the study authors. Of the 184 messages, 25.5% were sent within the surgery global period, and 32.1% were classified as billable encounters outside the global period.

For dermatologic surgery practices with 2 physicians, 32.1% of patient-initiated encounters would be considered billable outside the global period and included a clinician making medical diagnoses, managing patients’ problems, or suggesting alternate treatment.

“While these encounters were not billed for at the time of service, they may involve an equivalent amount of clinical decision-making and liability,” noted the investigators.

Study limitations include the retrospective design and the absence of data on additional telephone encounters related to the patient portal messages.

“Because of the COVID-19 pandemic, the Centers for Medicare & Medicaid Services began to pay physician telehealth services the same rate as in-office visits on an interim basis,” noted the researchers. “This study and other previous studies provide support for expansion of current telehealth reimbursement, including for the ability to bill for patient portal messages.”


Prestwood CA, Goff H, Srivastava D, Nijhawan RI. A retrospective review of unreimbursed medical care provided through electronic patient portals in dermatologic surgery. J Am Acad Dermatol. Published online December 4, 2021. doi:10.1016/j.jaad.2021.11.053