Does your EHR inbox need a spring cleaning? Scrub it!

Georgia Garvey , Contributing News Writer

To help geriatricians who were overwhelmed and experiencing burnout, leaders at a New York health system undertook an in-basket “scrubbing”—reorganizing the way messages are distributed—and learned practical ways to improve physician well-being.

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At the pandemic’s peak, geriatricians were struggling because while their older adult patients were isolating at home, they needed to quickly adopt telehealth with little to no experience. Meanwhile, older adults struggled to use new technology and practices received many phone calls from patients and family members with questions about staying safe. 

“Well-being-wise, in a 2019 survey, 50% of us had burnout,” Veronica Rivera, MD, said during a session at the most recent American Conference on Physician Health.

Additionally, 79% reported frustration with the EHR and more than 50% reported spending 60 minutes on the EHR outside of a typical workday—days that sometimes ended as late as 2 a.m. About 30% of physicians reported spending more than 60 minutes a day on clerical work, said Dr. Rivera, a geriatrician who is medical director of an ambulatory geriatric practice at Mount Sinai.

Nationally, physicians are performing more clerical work than ever, a shift driven by increasing EHR demands. An AMA-funded analysis revealed that for every eight hours of scheduled patient time, ambulatory physicians spent more than five hours on the EHR

In another survey, Dr. Rivera noted that “about 69% of our geriatricians pinpointed that the in-basket management was what made them feel most overwhelmed.”

Partially due to the age of the patient population the geriatricians were serving, there was heavy use of a patient call center that generated Epic messages on everything from urgent medical questions to needs for pre-operative order faxes. 

To tackle the problem, Mount Sinai leaders used a grant to hire two patient coordinators to review, process and reroute the in-basket messages for 17 geriatricians at three practice sites from 2021 to 2022.

The keys, Dr. Rivera said, were the patient coordinators, whose sole focus was the project. They began by assessing needs, then coordinating with physicians, other team members and call center workers to categorize messages. A lot of the messages were going directly to the physician.

A triage system was developed, reducing unnecessary communications and lessening the clerical burden on physicians. 

“Subsequently, messages were then divided up more appropriately to different team members based on their roles and their sites,” Dr. Rivera said.

The next step was training call center agents and administrative assistants to understand the new system. 

Though the effort resulted in new protocols for nonphysician team members, Christie Mulholland, MD, said the goal was to create a process that worked for everyone.  “We were definitely concerned that work would be shifted onto other team members,” said Dr. Mulholland, well-being champion for the Department of Geriatrics and Palliative Medicine at Mount Sinai. “We wanted to make sure that everybody might actually feel an improvement from just overall greater efficiency.”

The in-basket scrubbing paid dividends. Geriatricians, Dr. Mulholland said, saw a 23% decrease in the number of call center messages, and even though MyChart messages increased due to more adoption of the system, “it did not overcome the decrease in call center messages.”

Meanwhile, the experience for patients appeared to have been unchanged. There was no increase in patients hanging up in the call center, she said, and there was no increase in call-answer wait times. 

As for staff, “92% noticed a decrease in messages,” Dr. Mulholland said. “And 10 out of 13 of our staff—that included physician and nonphysician staff—felt a positive impact on their well-being from our work.”

Drs. Mulholland and Rivera said AI may further help with categorizing and triaging messages, reducing workload even further. Ultimately, though, they said, it’s about investing in practical ways to reduce the clerical burden on physicians, a clear driver of burnout.

“Institutional funding, we know that that is hard to come by, it's not available everywhere, but at our institution it really allowed us to have two highly motivated administrative coordinators who were only focused on this effort for the entire year,” Dr. Mulholland said. “And relationship-building—we thought that was really key to the success of this project.”

Get more great advice to tackle this problem with the AMA STEPS Forward® “Taming the EHR Playbook.”