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DISCUSS – A Secure HER-integrated Inpatient Proxy Messaging: Baseline Perceptions and Ongoing Mixed-Method Evaluation

Kai Feng YAM

Communication between inpatient teams and patients’ nominated next‑of‑kin (NOK)/proxies in community hospital wards often relies on synchronous phone calls. This workflow is vulnerable to schedule mismatch, repeated call attempts, fragmented documentation, and misaligned expectations—factors that can reduce patient/caregiver experience and increase staff workload.To illustrate DISCUSS (DynamIc Secure Credentials-verified commUnicationS Software) as a solution to current communication issues and its evaluation protocol. In addition, to report baseline perceptions of current phone‑based communication and acceptability to messaging as an alternative to selective medical updates.DISCUSS  is a national identity software‑authenticated, Electronic Health Records(EHR)‑integrated secure messaging channel with one‑admission–one‑thread architecture, role‑based routing to ward pools, structured templates, read‑status indicators, and auto‑documentation. A convergent mixed‑methods evaluation is planned: a 4‑week proof‑of‑concept (POC) in one ward followed by a 4–8‑week proof‑of‑value (POV) in matched intervention/control wards. Quantitative outcomes will be derived from EHR or DISCUSS logs (adoption rate, missed communication, estimated time saved per update, calls avoided, early discharge rates and matched average length of stay. Qualitative interviews will explore usability, workflow fit, perceived safety, and trust. Baseline perceptions were assessed using a pre‑implementation survey.A baseline survey was  conducted among 58 respondents (44 proxies, 14 patients): Satisfaction with the ease of communication and frequency of updates was modest (40% and 29% reporting satisfied/very satisfied, respectively). An update‑cadence mismatch was prominent: 69% reported currently receiving updates ≤ once weekly, whereas 90% preferred ≥ twice weekly. Office‑hours phone update timing was variably compatible with caregiver schedules (33% convenient vs 31% inconvenient). Acceptability of an asynchronous secure‑messaging alternative was high: 79% rated it useful, 81% rated it more convenient than phone calls, and 81% were willing to download/login a communication application; proxies showed lower baseline satisfaction than patients but similarly high acceptability.Baseline findings suggest that current phone‑based processes do not meet desired update cadence for many patients and proxies, while readiness for secure asynchronous messaging is high.The DISCUSS protocol provides a pragmatic blueprint for evaluating feasibility, workflow impact, and communication reliability in community hospital settings relevant to family medicine and transitional care. POC findings are expected to be available by June 2026.