The number of patients, the average income of patients, and hours worked by primary care physicians result in an increase of EHR inbox messages.
Primary care physicians who manage a larger patient panel, work more days per week in primary care, and care for wealthier patients, experience greater EHR inbox message volumes, according to a study published in the Journal of the American Board of Family Medicine (JABFM).
Beginning with the spread of EHR adoption, managing an EHR inbox has become a regular part of clinician workflow, oftentimes resulting in clinician burden.
According to the study, primary care physicians experience an alarming number of EHR inbox messages that oftentimes result in more than an hour of added work per day.
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While numerous studies have been completed on the volume of inbox messages and burnout, researchers wanted to know the correlation between the volume of inbox messages and whether it is impacted on patient panel size, hours worked by the primary care physician, and socioeconomic status of the physician’s patients.
Between 2015 and 2017, researchers analyzed the EHR inboxes of family medicine physicians, internal medicine physicians, medicine-pediatric physicians, and pediatricians, at an academic health system in Northeast Ohio. Researchers then utilized the American Community Survey to estimate the median income for each physician’s patient panel.
Researchers used a sample of 86 primary care physicians and 19 health facilities.
Using this data, researchers analyzed the association between EHR inbox volume and the patient panel size, the physician’s full-time equivalent (FTE) value, and estimated median income of the patients.
When dealing with the mean panel size of over 1,000 total patients, primary care physicians devoted an average of 0.69 clinical FTE to their own primary care time, and the average total inbox messages received over a three-week time period was 802 messages. Next, the median average annual income for the patient panel was just over $40,000.
When weighted to 1.0 FTE per physician, it averaged out to 1,255 messages per three-week period, resulting in an average of 84 messages per workday.
When analyzing the messages, the most common message types were test results, refill requests, other patient calls, carbon-copy charts, covered work (when a clinician is on vacation), patient portal advice, and chart co-sign requests.
Researchers found a greater patient panel size increased the volume of the total number of messages received. They also found a greater estimated income also results in a higher volume of messages received. Those two variables resulted in the greatest difference in EHR inbox message volume.
Patient portal advice requests also saw a positive correlation between average median income and patient panel size.
Overall, the study found a correlation between EHR inbox messages and panel size, hours worked by the primary care physician, and socioeconomic status of patients. Those with a higher socioeconomic status sent a higher number of messages to the clinician’s inbox than those with a lower socioeconomic status.
“As primary care transitions from volume- to value-based reimbursement, we need to ensure enough time for health care teams to work together to address patient care issues that occur outside of the face-to-face visit—including inbox management,” concluded the authors. “The workload of primary care is transforming, whether or not our teams and schedules keep up with the change.”
According to a separate study published in JAMA Network Open, there is a direct correlation between EHR inbox usability and workflow, and physician burnout, safety, and efficiency.
Researchers found that physicians would like EHR developers and healthcare organizations to reduce message processing complexity, simplify the inbox interface, provide features to reduce the physician cognitive load, facilitate care team communication, and streamline inbox message content.
In this study, physicians identified 50 barriers and 32 facilitators associated with EHR inbox designs and workflows. They also pointed out 28 other suggestions to improve the system.
Physicians felt that EHR inbox features and workflows featured too many unnecessary steps and follow-up actions. Physicians preferred methods that could streamline message processing, which would require fewer clicks.
Source: EHR Intelligence