Physicians have longed for electronic health-record systems that could share information across networks. But as their dreams are fulfilled, a new problem has emerged—inbox overload. And that burden is causing physician burnout, patient-safety issues and the need for new innovations to help triage the most-urgent messages.
Researchers in Texas recently gauged the current gush of EHR e-mails, and counted more than 276,200 message notifications that flooded the EHRs of 92 physicians in three group practices over 125 workdays. Their results were recently published in a JAMA research letter.
“There's a lot more variety of messages in the EHRs than we expected,” said Dr. Daniel Murphy, an assistant professor of medicine at the Baylor College of Medicine and an investigator at the Center for Innovations in Quality, Effectiveness and Safety, a joint effort of Baylor and the Veterans Health Administration. “We don't really know if they impact care in a meaningful way or just take up providers' time.”
Primary-care physicians, who comprise half of the group studied, received, on average, 77 notifications a day, the researchers reported. About 1 in 5 notifications (20.2%) were related to test results, including lab, imaging, pathology, pulmonary function, electrocardiogram, stress and other tests.
Specialists had fewer than half that number of e-mails, 29 notifications a day, but a higher percentage (35.7%) were for test results. Some of those, such as the results of metabolic test panels, contained seven to 14 lab values, which impose a greater cognitive burden on physicians than other types of messages, the researchers noted.
Based on earlier studies, the Texas researchers extrapolated that the primary-care physicians in the study spent about an hour and seven minutes a day processing their messages.
They concluded that a multipronged approach is needed to handle the information deluge, including “strategies to help filter messages relevant to high-quality care, EHR designs that support team-based care, and staffing models that assist physicians in managing this influx of information.
"With some messages, such as those imparting lab test results, their clinical impact is obvious, but others are “less proven,” Murphy said. Some e-mails come from specialists merely confirming a scheduled referral, or pharmacists communicating a prescription-refill request.
Some EHRs can pluck out and add electronic decision support to discrete data elements in incoming messages. But, by and large, IT-system users still must rely on human judgment in triaging the majority of messages, said Vic Arnold, managing director at consulting firm Huron Healthcare. “Where we see people doing the smart thing, you have a clinical administrative assistant who will follow up and say, 'We want to respond to your issue,' ” Arnold said.