ORLANDO, Fla. — Clinical messaging between providers could cost the U.S. health care system tens of millions of dollars annually, but probably also saves unknown millions just by streamlining coordination of care for the 16 million Americans diagnosed with diabetes, according to a study presented here Monday.

An informatics team at Vanderbilt University Medical Center (Nashville, Tenn.) based this conclusion on research they did in their own disease management program for adults with both diabetes and high cholesterol. They unveiled the findings at an international symposium on improving quality and value in health care, a prelude to the Institute for Healthcare Improvement’s 19th annual forum on health care quality.

In a study of more than 20,000 electronic messages exchanged among 578 physicians and staff during a seven-month period in 2003, Vanderbilt researchers found that each message averaged 26.5 words, took 1.39 minutes to compose and cost the institution 55 cents in labor, based on 2003 dollars. That, they surmise, is far less than the expense generated by transmitting similar information by telephone, fax, and paper, but they left quantifying that element for future study.

“How much is this black box costing us?” is the question they tried to answer since clinical messaging may become a standard of care, according to Steven Deppen, health system database analyst at Vanderbilt. “If this is going to become a method in the future, what’s your methodology for determining the cost of this?”

The research team, which includes biomedical informatics gurus Randall Miller, M.D., from Vanderbilt and Theodore Speroff from the Veterans Affairs Tennessee Valley Healthcare System, also headquartered in Nashville, compared the time it takes to create a handwritten message, and compared it to existing data — from outside of health care — on the average time it takes to write a new e-mail.

Nurses generated 50 percent of the $11,441 in labor costs for messages studied, while physicians, whose messages tended to be shorter but whose time is more expensive, accounted for 37 percent.

The poster presented here follows on work published in the December issue of the journal Medical Care, in which the same group analyzed the content of electronic messaging. In that study, the researchers categorized messages into two broad groups: coordination of care (communication, scheduling, or insurance questions) and production of care (diagnosis, documentation, medication, and treatment). About 62 percent of the messages were related to production, they found.

The research will continue, with the team next attempting to determine if the coordination and timing of messages are optimal, and also to validate the cost model in a general care setting and how cost varies by type of provider. “My guess is this will be very different,” Deppen says.

Some future research will look at how to manage clinical messages within the context of an electronic medical record. “What is the mix of resources if you want to have an electronic component?” wonders Deppen.

Vanderbilt has a well-developed EMR, and much of the school’s in-house work has been commercialized as McKesson’s Horizon Clinicals. The messaging system is self-developed.

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