Anecdotal evidence from discussing with Gastroenterology providers at UCSF suggests that patient-provider messaging has become a major aspect of clinical care at UCSF, taking up significant time and providing valuable service to patients. However, there is no formal requirement to provide this type of care, nor is there a mechanism to provide re-imbursement. It is clear that this type of care will continue to increase in importance and use over time. I propose a project to formally study its use, highlighting the following aspects:

1) Assess its use and changes over time. Is the amount of messaging increasing year over year, and with an estimate of the amount of time spent on patient messaging on the provider level.

2) Quantify exactly what is being done in these messages. How many  are patient generated versus physician generated? How much messaging relates to new issues that were not brought up in clinic, versus follow-up of issues addressed in clinic? Is its use replacing clinic visits or augmenting clinic visits somehow?

3) Is there a away to assess the effect of its use? Can it cut down on patient visits? Are patients more satisfied with their care that use it? Is there a correlation between its use and physician burnout? Can we estimate a cost-benefit of its use somehow? Are there improved patient outcomes with its use? Can we understand better variation between patient populations and providers and its use? Can we extrapolate how it will be used in 5 years? Can we envision a mechanism for funding its use?