See what physicians suggest that EHR vendors and their health care organizations should change to cut physician burnout and improve patient safety.
It is no secret that physicians hate their electronic health records. Perhaps you have noticed the past several years how often he turns his back to you looking instead at the computer monitor. Some physicians use an iPad or Surface notebook which they can place on their lap as they face you. There some upsides to these arrangements, which can be found elsewhere.
On the other side of inputting data into the EHR, the electronic health record is morphing into practice management, messaging systems, as well as for intra-office communication.
The much-maligned physician inbox
The much-maligned physician inbox—which the average primary care physician spends 49 to 85 minutes dealing with daily—is often difficult to use and filled with excessive and unnecessary messages that decrease face-to-face time and lead to stress that has been associated with physician burnout. It has become the replacement for the 'sticky note' taped to the wall or placed on the desk.
Looking for ways to make electronic health record (EHR) inboxes more physician-friendly, researchers went directly to doctors to get their feedback on what would make the tool more efficient and relevant. The qualitative analysis included interviews with 25 physicians at six large health care organizations.
The result:
Five key takeaways and 28 specific suggestions to improve the physician inbox, with the expectation that, in turn, there will be a reduction in physician burnout and an increase in patient safety. The original investigation, “An Exploration of Barriers, Facilitators, and Suggestions for Improving Electronic Health Record Inbox-Related Usability,” was recently published in JAMA.
Engage IT to prepare for restructuring your in-basket
Identify the types of messages that could be routed to other team members
Work with IT to restructure your EHR to direct messages to the right team members and declutter your in-basket
Create a team pool and team pool in-basket to help redistribute and streamline work
Empower staff to contribute by utilizing principles of team-based care
Develop workflows for common in-basket tasks
These are the takeaways
Cut the cognitive load
A customizable reminder or to-do lists that remind physicians to take action for a particular patient at a future date.
A way to assign priority to messages and enable sorting by priority to triage work.
Messages that allow added comments or tags to facilitate a subsequent review.
Flagging, sorting and filtering options for messages to enable prioritization and triaging.
A way for new messages to be easily distinguished from previously read messages.
Enable better team communication
A system to prevent messages from disappearing until the physician explicitly indicates that is desired, such as a complete button.
Read receipts to ensure closed-loop communication.
An out-of-office message to indicate when an inbox is not being actively monitored.
A function that allows one to manually forward inbox messages to others.
A way for physicians to automatically receive or otherwise review messages sent to other physicians whose patients they may be temporarily caring for.
A system to incorporate staff into the message triaging process rather than sending all messages to physicians.
Let tasks be distributed among clinical team members.
Cut the message volume
Reduce messages that do not affect care.
Educate staff to avoid sending messages to clinicians when the message does not affect the care the clinicians provide.
Prevent duplicate messages.
EHR Usability
Physician Burnout
Referencing JAMA Network™
Practice Transformation
How to accomplish these items:
EHR In-Basket Restructuring for Improved Efficiency
Efficiently manage your in-basket to provide better, more timely patient care
There is a handy outline for accomplishing these tasks and
Physicians weigh in: 5 keys to fixing the EHR inbox | American Medical Association:
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