It’s a common story at private practices. The electronic health record (EHR) that was promised to bring efficiency becomes a daily disrupter of care, bombarding physicians with a stream of messages. Find out how to restore the human factor needed to make the technology work as it was intended.

AMA STEPS Forward™ can help

Access more than 40 online modules, plus resources, case studies and other content around: patient care, workflow, leading change, professional well-being, technology and finance.

“The inbox is one of the major sources of pain for physicians,” said internist Christine A. Sinsky, MD, who recently retired from private practice and is the AMA’s vice president for professional satisfaction.

Physicians can find a prescription for relief in a module on restructuring the EHR in-basket that is part of the AMA STEPS Forward™ collection of open-access modules, offering innovative strategies that allow physicians and their staff to thrive in the new health care environment. These modules can help prevent physician burnout, create the organizational foundation for joy in medicine and improve practice efficiency.

STEPS Forward is part of the AMA Ed Hub, an online platform that brings together all the high-quality CME, maintenance of certification, and educational content you need—in one place—with activities relevant to you, automated credit tracking and reporting for some states and specialty boards. 

Before EHRs, a nurse or medical assistant was the first stop for all incoming message traffic, would bring order to it, and in one quick session receive directives from the physician, said Dr. Sinsky, co-author of the module.

A poorly structured EHR implementation instead requires that the physician triage the messages. Dr. Sinsky said that’s a backward system that needs to be flipped, so that at the start “the majority of messages go to the staff rather than to the physician.”

She recently co-wrote the article “Advanced team-based care: How we made it work,” published in the Journal of Family Practice. The article details the experiences of the Bellin Health system in Northeast Wisconsin, where in-basket redesign was among highlighted success stories.

“One of the key principles of redesigning the in-basket is to diffuse work out to the staff, who can handle it at the highest level of their skillset,” said Bellin family physician James T. Jerzak, MD, who also co-wrote the article and the module.

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Taming your unruly in-basket is possible with a little teamwork

The concept is simple, but the execution takes planning, technology skills and a commitment to team-based care.

From the beginning, engage with the practice EHR’s information technology experts. “Let your IT team know that you’ll need their help to restructure your EHR with the goal of optimizing your in-basket,” advises the module. “You may find that they have suggestions or advice to overcome challenges and make the transition easier on everyone.”

As the process moves ahead, the module points out, it will be the IT professionals who will do the under-the-hood work to “configure the filtering capabilities of your EHR to decrease the number of items you are not actively managing.”

Identify the types of messages and how they should be routed. There are three essential categories.

There are messages that:

  • Require direct physician management.
  • Can be routed to other team members, such as a medical assistant, licensed nurse practitioner, registered nurse or patient services representative.
  • Are not relevant to patient care or clinic business and should be filtered or deleted.

Decide who has access to the inbox. “Some practices, particularly those with one or more RNs on the core team, have routed all in-basket messages to the clinical support staff,” notes the module. Messages requiring physician input are researched by a nurse, reviewed verbally with the physician and routed for action—saving an hour or more of physician time per day.

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How true teamwork can tame the physician's in-basket

A variation is the team pool in-basket approach. Each physician or advanced practice provider works with a pool, for example, of a permanently assigned medical assistant, licensed nurse practitioner and registered nurse. Only they can access the team pool in-basket. The module points out, “It is advantageous to form this cohesive unit because everyone is familiar with the physician’s patients and their care plans.”

All the elements of inbox redesign reflect the powerful potential of team-based care, detailed in STEPS Forward modules. Those elements include co-location of team members—having them work in close proximity to promote verbal communication—and instituting a physician-staff daily huddle to reduce unneeded electronic communication.

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