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EMR Inbox: the growing burden of uncompensated electronic paperwork

Posted by Dan Mazanec, MD on Mar 24, 2016 10:53:02 AM



Reviewing test results and responding to patient phone messages has always been a part of medical practice.  However, a recent study suggests that the ease of creating notifications in the era of  Electronic Medical Records has dramatically increased the time physicians spend dealing with this "electronic paperwork." Researchers at the Houston VA hospital reviewed the electronic logs of all EMR notifications to physicians in 3 large practices over a 6 month period.  Notifications were categorized as related to test results or not.  Primary care physicians received an average of almost 77 messages in their inboxes daily, only 20% related to test results! 

Since processing each message requires about one minute, this means each physician spent more than an hour each workday sorting through and dealing with EMR inbox notifications.  While the EMR may have enhanced communication among caregivers, the ease has resulted in a blizzard of "FYI's."  The harried physician is challenged to sort out the truly critical messages from the merely informational at the end of a busy clinic day.  Amazingly, this work is entirely uncompensated.

With the goal of increasing patient "engagement" another recent addition to the caregiver workload has been the launching of the patient to physician direct portal within the EMR.  In my practice, the "message my doctor" function was turned on about 2 years ago.  This encouraged patients to send messages directly to the me through the EMR.  Whether this new direct communication channel actually improves care and patient outcomes is uncertain at this point.   However, my colleagues and I can attest it certainly increases uncompensated, electronic medical paperwork for the caregiver.  For some, yet another hour of electronic paperwork was added to the workday.   Some queries can be addressed efficiently and help avoid "phone tag" or even unnecessary clinic visits.  However, too often the initial message becomes a time-consuming conversation.  Of greater clinical concern is the risk a patient reports a serious symptom in a message which may not be reviewed for hours or days.  

I've previously commented on the epidemic of physician burnout. Stuffed inboxes and managing direct patient to physician communication clearly contribute to caregiver stress and workload.  Healthcare organizations need to focus on Electronic Medical Record design and workflows that allow front line providers to sift through electronic communications efficiently and respond appropriately.  At a more fundamental level, building a user-friendly interface that facilitates documentation while increasing time for genuine patient/caregiver interaction will reduce the number of "doctor I didn't have time to ask" messages.   Both patients and caregivers will benefit.

I welcome your comments and feedback.  

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About Dan Mazanec, MD

Prior to joining Dorsata in 2016, Dan Mazanec, MD was the Associate Director of the Center for Spine Health at the Cleveland Clinic. Board certified in internal medicine and rheumatology, he has been a leader in the development of the emerging specialty of Spine Medicine. A frequent lecturer at international and national meetings, he has authored more than 70 book chapters and papers. He is an active member of the North American Spine Society with a particular focus on the development of evidence-based clinical guidelines as a member of the Clinical Guidelines Committee and the role of non- surgical care as chairman of the Rehabilitation Interventional Medical Spine Committee. Dan led the development of the Cleveland Clinic Spine CarePath which merges evidence-informed clinical management of spine disorders with patient-entered clinical outcome data focusing on optimizing value. He was the clinical lead for technologic enablement of the CarePath in the EMR and the implementation of the Spine Carepath across the entire Cleveland Clinic Health System.

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