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. 2014 Mar 6;16(3):e75. doi: 10.2196/jmir.2976

Table 4.

Exemplar quotes of barriers to using Secure Messaging.

Theme Exemplar quotes
Initiation and knowledge barriers The authentication process to use [Secure Messaging] is too cumbersome. I feel like if I can come in and see a doctor without having to do all this and the doctor knows it’s me. I mean, this seems like it ought to be something that could be done in your doctor’s office and not some other way. There has to be an easier way to do it.

I would say [Secure Messaging] is a good idea. I’m not 100% sure what you’re supposed to use it for. The site doesn’t tell you so I’m never sure if I’m supposed to ask medical questions or just, hey, can I make an appointment, or hey, can I get a refill. I don’t know how in-depth you’re supposed to get with your provider.
Privacy and security issues (personal health information) I think Secure Messaging has great potential but it just has to be explained…they have to stop letting you think you’re talking to your doctor somehow, it has to be a little clearer…it’s misleading to say you’re sending a message directly to your primary care provider.

I would say it’s an indirect way of getting in touch with your doctor, and it’s open to who knows how many people in the system. I get responses from a lot of people, sometimes the call center even. It’s disconcerting…when I first started using Secure Messaging, it would go directly to [my primary physician] although everybody in the clinic gets them for some reason.
Prohibited personal expression I’ve just made my messages more brief. Instead of sending a clinical message and then tagging on a personal message, I don’t tag on a personal message anymore.
Clinician resistance There’s another specialty clinic I went to not long ago and the [specialist] told me at this point in your treatment I want you to call me and tell me this. He said, ‘I probably won’t answer the phone, so leave a message.’ I said, ‘Can I just use Secure Messaging?’ And he said, ‘No, no, I don’t use that, I don’t want to have an inbox with a thousand messages’.