For primary care physicians swimming in a sea of EHR inbox messages, it might seem like a dream to have 25% of them disappear. But Jane Fogg, MD, MPH, says it’s an achievable goal.
“We all work in a time of constrained resources, of staffing shortages. We do not all have ample IT support for all of our clinics and all of our projects, but we all can do something,” said Dr. Fogg, a senior physician adviser to the AMA on professional satisfaction and practice sustainability. “Some priorities are less resource-heavy and you can build trust amongst your clinicians that you're actually doing something.”
During a plenary session at the 2023 American Conference on Physician Health, Dr. Fogg discussed four ways health systems can redesign the EHR to improve physician well-being and reduce administrative burdens.
Eliminate the waste
The elimination strategy was simple: Remove from the EHR in-basket all “low-value information,” Dr. Fogg said, noting elimination is an early priority to demonstrate that progress can be made without physicians having to learn a new workflow.
For example, Atrius Health in Massachusetts—where Dr. Fogg was previously chair of internal medicine and family medicine—targeted chief complaint charts from specialists, which made up 13% of a primary care physician’s in-basket. This information was already available in the patient’s chart and was of variable usefulness.
“High-value information—a new cancer diagnosis, a change in prognosis, choosing hospice—was absolutely buried in a sea of ‘normal annual dermatology check,’” she said.
To help, automatically routing all specialist chief complaint charts to the primary care physicians were stopped. Instead, specialists sent only the important messages—for example, about major changes in prognosis, action needed by the primary care physician or a new diagnosis.
There was a 40% reduction in the number of chief complaint charts in the primary care physicians’ inboxes, Dr. Fogg said. “But importantly, it also helped reduce the noise of low-value information that can obscure the high value.”
For more information about how to reduce the EHR inbox’s burden on physicians, explore the AMA STEPS Forward® “Taming the EHR Playbook.”
Automate what can be
Dr. Fogg acknowledged that automation can sometimes require more investment, but says the payoff can be worth it for physicians, care team members and patients.
At Atrius, for example, primary care physicians received about 16 prescription-renewal requests per day. Typically, the physician would do a quick review of the patient’s chart, and this added work that could have been delegated to team members using refill protocols. To address this, Atrius used a vendor to automate prescription renewals wherever possible.
“It turned into a yearlong pilot because once you actually put it into practice, we found further areas where the automation workflow was not aligned with the operational or clinical one,” Dr. Fogg said. “And we really wanted it to work perfectly, and it did.”
Delegate early in the process
Delegation, Dr. Fogg said, is an essential part of a physician’s work life. Within the framework of the EHR, that meant “enforcing the delegation” by “directing the task straight to the team member who can best resolve it or triage it to the right team member.”
“When you think about it, it's like phone triage. What practice would say to the doctor, ‘Go out and answer the phone and figure out if a secretary or a nurse needs it,’” she said. “So why didn't we do it with email?”
Collaborate to prevent burnout
The collaborative process in EHR strategy, Dr. Fogg said, means sharing in-basket responsibility. That’s empowering for team members like medical assistants, she said, and speeds care for patients.
She said Atrius also brought in senior, essentially retired physicians to help manage inbox messages for physicians on extended leave or new physicians struggling with burnout.
“We know that we retained a couple of young doctors by supporting them while they developed their work habits and skills,” Dr. Fogg said.
Manage expectations
Health system leaders with slimmer budgets can still overhaul their EHR inboxes, said Dr. Fogg, noting there’s a solid financial case that these efforts help retain physicians as well as their patients, reduce errors and save money.
“As leaders, your guiding light is to do the right thing for patients, your care teams and your organization,” she said. “You can make decisions and don't be afraid to do it.”
Learn more with the AMA STEPS Forward EHR inbox-reduction checklist (PDF) and nine-step process (PDF) for more tips on a system-level approaches.
