Experts call on health systems, policymakers to ‘prioritize’ easing physician inbox burden
Key takeaways:
- Patient medical advice request messages and phone calls increased from before to after the COVID-19 pandemic.
- Mean weekly active EHR working time increased across all specialties after the onset of the pandemic.
Patient medical advice request inbox work and electronic health record time spent has remained elevated since the onset of the COVID-19 pandemic, according to study results.
The findings indicate that the increased volume of patient inbox messages and time spent on EHRs are ongoing sources of physician workload, researchers concluded.
Time spent
“Physician work is increasingly centered around the EHR, which consumes nearly 50% of scheduled clinic time. Time spent in the EHR and inbox has been associated with burnout,” Lisa Rotenstein, MD, MBA, MSc, assistant professor and medical director of ambulatory quality and safety at University of California at San Francisco, and director of the Center for Physician Experience and Practice Excellence, and colleagues wrote.
“Patient-initiated medical advice request messages increased substantially at the onset of the COVID-19 pandemic as other forms of care access were limited,” they wrote. “However, it is unclear how durable the post–COVID-19 increase in patient medical advice request volume has been, whether the rise in messages represents a substitution from other communication modalities, the distribution of this increase across specialties and the resulting impact on total EHR time.”
For this reason, researchers sought to assess the durability of the post-pandemic increase in patient medical advice request volume, whether the increase in patient inbox messages represents a change from other means of communication, whether the increase is specific to certain medical specialties and the impact on EHR time spent.
They pooled data from national EHR metadata to examine changes in patient medical advice request inbox work and EHR time between 2019 and 2022. Investigators used descriptive statistics to measure mean patient medical advice request volume and patient telephone call volume stratified by medical specialty. They additionally performed sensitivity tests that only included physicians with greater than 40 visits/week to assess trends in substantial clinical volume.
Observed increase
Results showed an overall increase in patient medical advice request messages and patient phone calls between the pre-COVID-19 era (June 2019 to February 2020) and the post-COVID-19 era (March 2020 to April 2022).
Data showed that primary care physicians received the most patient medical advice request messages and patient phone calls, with a mean of 24 patient calls and 16 patient medical advice request messages per week, according to study results. Researchers observed similar trends between the overall cohort and the subset of physicians with at least 40 patient weekly visits.
Researchers also observed an increase in mean weekly active working time in the EHR across all specialties after the onset of the pandemic. Specifically, EHR time among medical subspecialists increased by 9.9%, followed by an increase of 6.5% among primary care physicians and 5.2% among surgeons.
Among the subset of physicians with more than 40 patient visits/week, primary care physicians experienced the highest increase (7.8%) in EHR time during both the pre-COVID-19 era (14.1 hours/week) and post-COVID-19 era (15.2 hours/week).
Researchers reported limitations of the study, including the inability to evaluate message content or burnout, and the fact that the data were from one EHR vendor.
‘Prioritize strategies’
“Patient medical advice request messages meaningfully increased, and we found no evidence that patients were substituting other communication, such as telephone calls, which stabilized at pre-pandemic levels,” Rotenstein and colleagues wrote.
“These results suggest that the increase in message volume is likely a sustained, ongoing source of physician work,” they wrote. “Health systems and policymakers should prioritize strategies to reduce inbox burden for physicians, especially primary care physicians, while maintaining patient access to care.”
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