As patients become more involved their own care, communication takes on a more important role in a patient-physician partnership. But, if not managed correctly, a practice’s inbox can add another layer of administrative burden, diverting precious time to spend with patients and become a contributing factor to physician burnout.
Basic steps can be taken to make sure the messages that come to physicians through the electronic health record (EHR) in-basket or patient portal are assets and not burdens and require the expertise of a physician, as explained in the AMA STEPS Forward™ open-access module, “EHR In-Basket Restructuring for Improved Efficiency.”
“One consequence of adopting an EHR is that the physician’s in-basket often becomes the default destination for most forms of communication in the office,” the module says. “As the physician’s workload grows, so does the volume of the in-basket, creating a burden that can be difficult to effectively manage during the day.”
The module was written by James Jerzak, MD, physician lead of team-based care at Bellin Health Ashwaubenon, and Christine Sinsky, MD, AMA vice president of professional satisfaction.
One of its key messages is that most in-basket messages do not need to be routed to the physician. The module has several other in-box management tips.
Create three overarching categories to optimize your in-basket. Work with IT experts to separate emails into these groups:
- Those that require direct physician management.
- Those that can be routed to other team members.
- Those that are not relevant to patient care or clinic business and should be filtered or deleted.
Designate which types of messages can be handled by a medical assistant, licensed nurse practitioner, registered nurse or patient services representative to help lighten physician workload.
Anticipate the needs of complex patients. A robust transitional care program that meets the needs of complex patients leaving a hospital or skilled nursing facility can reduce in-basket work and phone calls.
Co-locate team members. In-person communication is a key component of effective in-basket management. Co-location promotes team members talking to each other, resulting in less need for electronic communication that clutters the in-basket and speeding resolution of questions.
Delegate screening of portal requests. Patient portal messages should not go, by default, directly to the physician. Have these messages screened and completed by appropriate staff.
STEPS Forward is part of the AMA Ed Hub™️, an online platform that brings together all the high-quality CME, maintenance of certification, and educational content you need—in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards.
Learn about six new codes that are part of the 2020 Current Procedural Terminology (CPT®) code set will help physicians and others report a range of digital health services, including electronic visits through secure patient portal messages.
Harnessing a “fantastic tool”
In an interview with the AMA, Robert Tennant, the Medical Group Management Association’s director of health information policy, said practices must have their priorities in order on portal messages.
“You don’t want physicians wasting their time going through a hundred messages when only three are germane to their relationship to the patient,” Tennant said, adding that portals “can be a fantastic tool” for both the administrative and clinical sides of a practice.
The “remote clipboard option” has clinical and administrative value. Sending pre-visit forms that patients fill out at their convenience instead of in a waiting room means less reliance on memory when answering questions on prescriptions, allergies, chronic illness and family history. This also means fewer errors being entered in the EHR.
Disclaimers can counteract excessive messaging. Lowering expectations by using strategic disclaimers lowers the tendency of some patients to over email and helps them understand that asking questions on a portal is not a substitute for treatment.
Tennant suggested disclaimers regarding:
- Timing: “While we aim to respond to inquiries as quickly as possible, we cannot guarantee that we will do so in less than 48 hours.”
- Content: “Use the portal only for routine questions. Please call the practice for urgent or sensitive questions.”
- Test results: “Some laboratory results will not be displayed due to their sensitive nature. Patients are encouraged to call the practice.”
Send notifications and receipts. Patients appreciate “receipt” messages such as “Your secure message was received” or notifications that they have secure messages waiting for them.
Give patients access to their records. Allow patients to download their information to their own devices or to transmit to a third party.
Include a comment box and FAQs. Give patients the ability to provide feedback and suggestions.
Learn from your peers. Ask colleagues:
- What functions work or don’t work?
- What have patients told you?
- If you could start over, what would you do differently?
“Think of ways the portal can decrease administrative tasks like bill payments, appointment scheduling and prescription-refill requests,” Tennant said. “Get those automated, so your staff will have time to do tasks that are more patient facing.”
