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An early adopter of billing for patient-provider electronic communication saw a decline in the number of messages received from patients after implementing a workflow change in which its clinicians determined whether a virtual exchange warranted charges, Fierce Healthcare reports. The decline in message volume at University of California San Francisco Health was accompanied by a nearly fivefold increase in weekly billed “e-visits,” though researchers noted that adoption by the clinicians classifying patient messages as billable was low, according to a research letter published in the Journal of the American Medical Association.