Enhancing Secure Messaging in Electronic Health Records: Evaluating the Impact of Emoji Chat Reactions on the Volume of Interruptive Notifications

Background Electronic health record secure messaging (EHRSM) is an increasingly utilized tool for communication among clinicians. However, there is concern about the growing quantity of disruptions it presents via interruptive notification. Objectives The primary aim of this study is to assess whether introducing emoji reactions, which do not trigger push notifications in EHRSM, can alleviate the burden of interruptive notifications. The second aim is to use messaging notification metadata to identify subgroups that might benefit from targeted interventions to aid the adoption of this innovation. Methods We implemented the emoji reaction feature into EHRSM across a large academic health system. We evaluated the volume of push notifications 11 weeks before (pre-emoji period) and after (post-emoji period) introducing emoji reactions in EHRSM. Notification metadata was categorized by user type, and users were stratified based on notification volume. Results There were 1,387,506 fewer push notifications in the post-emoji period (a decrease of 4.7%). Subgroups of users with increasing mean daily push notifications in the pre-emoji period were associated with decreasing mean daily push notifications in the post-emoji period. Among the eight user subgroups, six experienced a significant reduction in interruptive notifications, with the pharmacy and “other” subgroups not observing a reduction. Users in the top quartile of notification volume saw the greatest reduction in burden across each user subgroup. Conclusion Integrating emoji reactions into EHRSM across a large academic health system significantly reduced the burden of push notifications among EHRSM users. Utilizing messaging notification metadata allowed us to identify subgroups that require additional intervention.