Posted and filed under Healthcare.

We’ve spoken before about physician burnout and how to leverage technology to reduce its impact on providers and patients, and now a study by Health Affairs has been released that supports this push for innovation. The study was designed to find strategies on managing in-basket messages, and how these messages can improve frontline clinical staff job satisfaction. Through observing and analyzing clinical and administrative data, Health Affairs was able to identify a correlation between this kind of messaging and the probability of burnout. Taking into account data from a large multispecialty practice, Health Affairs determined that in-basket messages created from algorithms in electronic health records systems were responsible for nearly half of the in-basket messages received per physician. The remainder came from varying sources, from colleagues and patients.

In-basket messages are art of a secure, closed messaging system that is used for the dispatch and receipt of messages about patient care and billing needs with an EHR or health system, and thus are a necessary “evil” for many providers. Fortunately, in-basket messages aren’t all bad, especially if they can be leveraged and redesigned to add value, rather than adding responsibility. In reviewing these messages and their implications, the study found that receiving an above-average number of EHR-generated in-basket messages was associated with a 40% increase in the probability of burnout, and 38% higher chances of a provider intending to reduce their clinical work time. When considering the increase in physician burnout and its impact on patient care – these results are shocking. Electronic health records should facilitate interoperability and reduce the administrative duties left to providers. The technology is available, it’s just become a matter of harnessing it properly.

These algorithmic messages are typically generated to remind physicians to perform work that might be overlooked, but when reviewed in addition to manual messages from patients and peers – providers can easily find themselves buried in an onslaught of digital correspondence. The insurmountable volume of automated messages not only hide those sent by a human-counterpart, but providers report losing a sense of autonomy in their practice and scheduling because of these in-baskets. Those responsible for the study urge developers and health systems to reconsider their in-basket messaging practices. Front line physicians already spend a significant amount of time in an EHR; which removes them from their clinical duties. Perhaps automated messages, while well-intended, should be omitted from front line physicians’ in-basket messages.

Many physicians blame burnout on the industry’s dependence on EHR systems – but the responsibility should instead be taken on by the misuse or misunderstanding of an EHR’s capabilities. Embrace the technology, make friends with it – and instead examine other policies that are contributing to burnout. This could include revising policies on work emails, after-hours professional engagements, desktop medicine during off-hours, and other components of a healthy work-life balance. One suggestion is to only allow in-basket messages to be accessible during work hours, allowing providers time to truly recover from on-the-job stressors. Non-emergent messages should be triaged and delegate to support staff or other members of the care team. Ultimately, EHRs have become scapegoats for a problem that extends far beyond their digital reach. To combat physician burnout, the industry must be willing to observe and overhaul a myriad of practices. Sure, in-basket messaging and EHRs are a good place to start – but the work is far from over.

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