Electronic health records (EHRs) have contributed to physicians’ increased reports of burnout and reduction in autonomy. Most studies examining the effects of these systems have focused on the introduction of EHRs to physician practices as a whole, but a recent study in JAMA Open Network Health Informatics focused on an often-overlooked aspect of EHR systems: the messaging inbox.
The researchers compiled a list of 28 recommendations for healthcare organizations, EHR vendors, and researchers to reduce the growing onslaught of EHR messages for physicians.
Below are the recommendations which are organized into five categories: messaging complexities, inbox interface, cognitive load, team communication, and message content.
Reduce message processing complexity
- Ensure EHR-based workflows and clinical workflows match
- Reduce the number of clicks required to accomplish an action
- Provide contextual information (eg trends) within inbox for easier accessibility
- Present related results together in a manner familiar to physicians
- Ensure full message contents are contained within the subject line
Improve inbox interface design
- Highlight abnormalities or other deviations from normal
- Quickly trend test results over time
- Hide irrelevant, distracting, or duplicate interface elements
- Allow periodical display customization
- Ensure interface elements are simplified, free of technical jargon
- Allow message prioritization
- Deliver messages to a single inbox or ensure clear and practical rules for delivery to multiple inboxes
Provide functions to reduce cognitive load
- Allow customizable reminders / to-do lists
- Provide ability to prioritize messages and sort accordingly
- Allow comments and tags on messages
- Allow flagging, sorting, and filtering of messages to enable prioritization and triaging
- Further distinguish new messages from previously read messages
Facilitate team communication
- Require explicit action to remove messages
- Allow read-receipts for closed-loop communication
- Provide out-of-office functionality
- Allow manual forwarding of inbox messages
- Automatically send message copies to physicians whose patients are under the care of another physician or specialist
- Incorporate staff into the message triaging process
- Allow tasks to be distributed among clinical team members
Curate message content
- Reduce transmissions of messages that do not affect care
- Instruct staff to only transmit messages to appropriate clinicians when the message includes care that the clinician provides
- Prevent duplicate messages
