At the onset of the pandemic, inbox messages increased by 57% and that volume has become the “new normal” for physicians. The added work not only cuts into physicians’ time—each message results in an additional 2.32 minutes of EHR active-use time—but it also contributes to physician burnout.
In one AMA survey (PDF), 75% of physicians reported that the volume of inbox work they faced when they returned from taking personal time off was a barrier to taking the days for themselves. And when physicians do take time off, 63% told researchers that they spent time responding to patient-related phone calls and inbox messages while on vacation.
Some organizations are finding solutions to ease that in-basket burden for physicians and restore joy in medicine.
During an AMA Insight Network webinar, physician leaders at Atrius Health—a practice of 700 primary care and specialty physicians in Eastern Massachusetts—discussed how rethinking the in-basket allowed them to eliminate 1,500 clicks a day per physician. That added up to 50 million fewer clicks annually for the organization’s physicians.
The AMA Insight Network helps AMA Health System Program members save time and money, gain early access to innovative ideas, get feedback from their peers, network and learn about pilot opportunities.
Overall, Atrius cut the inbox volume by 25% for its primary care physicians who had previously received about 100 messages daily.
“Atrius has historically had a team-based model. We share the work amongst a team. … But the in-basket was not a shared endeavor. You send it to the PCP [primary care physician], and they figure out what they are going to do. So, it did not reflect our team-based model,” said Jane F. Fogg, MD, chair of internal and family medicine at Atrius Health. “I heard again and again: My inbox is killing me. I can’t keep up.”
Steven Strongwater, MD, the former president and CEO of Atrius Health, joined Dr. Fogg during the webinar to discuss why their organization saw eliminating in-basket volume as a key investment for professional and organizational well-being, and how they collaborated with internal stakeholders to implement interventions that successfully reduced EHR inbox volume and improved the quality of care.
After assembling a team—which included medical chiefs, primary care physicians, EHR professionals—as well as finding a focus and finding funding, this is how Atrius pared down the in-basket.
Eliminate low value tasks
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The team looked through emails to carefully determine which were wasteful, duplicative or had little clinical value. They then worked with the EHR professionals to stop those from ever hitting the in-basket.
Together they were able to eliminate 98% of their media-manager messages. This was a folder of messages that contained everything that had a scan attached to it, such as patient-screening forms. Most could be filed in the chart silently and didn’t need a physician to accept it.
Additionally, they were able to eliminate 35% of carbon copy charts from other physicians, such as normal dermatology reports, and 100% of emergency department and hospital messages. Atrius removed automatic feeds to the inbox and routed them to a dashboard where nurses and physicians can go to pull the information needed about hospital stays.
Automate workflows
Protocols and automated pathways are now imbedded into the in-basket to resolve routine and repetitive tasks. Through this, Atrius was able to cut 50% of prescription-renewal messages and 30% of normal laboratory results.
Delegate tasks
The system now directs tasks to team members who can resolve them within their scope of practice. This is accomplished with set clinical protocols. Atrius did this for portal message triage and abnormal lab results.
Collaborate with care team
Atrius ensured there was shared accountability for tasks between two or more team members. When it came to patients seeing medical advice, Atrius was able to cut the in-basket volume 40% by using this workflow strategy.
After these changes, “the messages that wind up coming back into your inbox, those were really important. Those were safety matters,” Dr. Strongwater said. “Those were drug interaction matters. You weren’t just getting barraged and missing those things by the barrage.”
