An Exploration of Barriers, Facilitators, and Suggestions for Improving Electronic Health Record Inbox-Related Usability

Murphy, Daniel R.; Giardina, Traber Davis; Satterly, Tyler; Sittig, Dean F.; Singh, Hardeep

doi:10.1001/jamanetworkopen.2019.12638

Cited by 30 publications

(31 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Currently, scant published information exists to help operational leaders and practicing physicians understand the stressors associated with the electronic inbox and the array of possible strategies for management. [4][5][6][8][9][10] We studied physician perspectives on this topic in one of the largest medical groups in the nation. This study's aims were to describe how electronic inbox management has affected current medical practice, to identify resulting stressors, and to characterize a wide range of management strategies by individual physicians and practice groups.…”

Section: Introductionmentioning

confidence: 99%

Primary Care Physicians’ Experiences With and Strategies for Managing Electronic Messages

et al. 2019

View full text Add to dashboard Cite

IMPORTANCE The increasing use of electronic communications has enhanced access to physicians for patients and clinical staff. Primary care physicians (PCPs) have anecdotally identified electronic inbox management as a new source of work-related stress. OBJECTIVES To describe PCPs' experiences managing their electronic inboxes and to characterize the array of management strategies developed by individual physicians and practice groups. DESIGN, SETTING, AND PARTICIPANTS This qualitative study was conducted in 8 medical centers of a large group practice with more than 4 million patients in diverse settings and a mature electronic health record. The group encourages patients to use portal secure messaging to enhance access to their physicians and the care experience. Semistructured interviews were conducted with 24 internists and family medicine physicians identified via snowball sampling. Interviews were

show abstract

Section: Introductionmentioning

confidence: 99%

Primary Care Physicians’ Experiences With and Strategies for Managing Electronic Messages

et al. 2019

View full text Add to dashboard Cite

show abstract

“…53 Several recommendations for improvement exist, such as increasing message processing efficiency and decreasing clicks, redesigning the inbox interface, reducing cognitive load, and limiting duplicate or low-value messages. 53 All clinicians should be competent in optimal test result management strategies that increase efficiency and decrease errors. [54][55][56] Adequate inbox coverage should be ensured for clinicians who are out of the office or have recently left the organization.…”

Section: Failure Of a System To Track Test Resultsmentioning

confidence: 99%

Assessment of Health Information Technology–Related Outpatient Diagnostic Delays in the US Veterans Affairs Health Care System

et al. 2020

Self Cite

View full text Add to dashboard Cite

IMPORTANCE Diagnostic delay in the outpatient setting is an emerging safety priority that health information technology (HIT) should help address. However, diagnostic delays have persisted, and new safety concerns associated with the use of HIT have emerged. OBJECTIVE To analyze HIT-related outpatient diagnostic delays within a large, integrated health care system. DESIGN, SETTING, AND PARTICIPANTS This cohort study involved qualitative content analysis of safety concerns identified in aggregated root cause analysis (RCA) data related to HIT and outpatient diagnostic delays. The setting was the US Department of Veterans Affairs using all RCAs submitted to the Veterans Affairs (VA)

show abstract

“…[18][19][20][21] An inefficient EHR can consume the amount of time a clinician spends resulting in cognitive overload, decreased performance levels, clinician stress, and burnout placing patients at risk. 20,[22][23][24][25] Thus, workflow studies that include an analysis of EHR usage are necessary to identify issues and make critical changes to ensure the well-being of patients and clinicians. 26 Our examination of 24/7 EHR usage gave rise to results different from previous time motion studies.…”

Section: Discussionmentioning

confidence: 99%

Impact of Patient Census and Admission Mortality on Pediatric Intensive Care Unit Attending Electronic Health Record Activity: A Preliminary Study

et al. 2020

View full text Add to dashboard Cite

Background Physicians may spend a significant amount of time using the electronic health record (EHR), but this is understudied in the pediatric intensive care unit (PICU). The objective of this study is to quantify PICU attending physician EHR usage and determine its association with patient census and mortality scores. Methods During the year 2016, total EHR, chart review, and documentation times of 7 PICU physicians were collected retrospectively utilizing an EHR-embedded time tracking software package. We examined associations between documentation times and patient census and maximum admission mortality scores. Odds ratios (ORs) are reported per 1-unit increase in patient census and mortality scores. Results Overall, total daily EHR usage time (median time [hh:mm] [25th, 75th percentile]) was 2:10 (1:31, 3:08). For all hours (8 a.m.–8 a.m.), no strong association was noted between total EHR time, chart review, and documentation times and patient census, Pediatric Index of Mortality 2 (PIM2), or Pediatric Risk of Mortality 3 (PRISM3) scores. For regular hours (8 a.m.–7 p.m.), no strong association was noted between total EHR, chart review, and documentation times and patient census, PIM2, or PRISM3 scores. When patient census was higher, the odds of EHR after-hour usage (7 p.m.–8 a.m.) was higher (OR 1.262 [1.135, 1.403], p < 0.0001), but there were no increased odds with PIM2 (OR 1.090 [0.956, 1.242], p = 0.20) and PRISM3 (OR 1.010 [0.984, 1.036], p = 0.47) scores. A subset of physicians spent less time performing EHR-related tasks when patient census and admission mortality scores were elevated. Conclusion We performed a novel evaluation of physician EHR workflow in our PICU. Our pediatric critical care physicians spend approximately 2 hours (out of an expected 10-hour shift) each service day using the EHR, but there was no strong or consistent association between EHR usage and patient census or mortality scores. Future larger scale studies are needed to ensure validity of these results.

show abstract

An Exploration of Barriers, Facilitators, and Suggestions for Improving Electronic Health Record Inbox-Related Usability

Abstract: This qualitative analysis using interviews with physicians determines barriers and facilitators in electronic health record inbox management and suggestions for improvement.

Cited by 30 publications

References 38 publications

Primary Care Physicians’ Experiences With and Strategies for Managing Electronic Messages

Primary Care Physicians’ Experiences With and Strategies for Managing Electronic Messages

Assessment of Health Information Technology–Related Outpatient Diagnostic Delays in the US Veterans Affairs Health Care System

Impact of Patient Census and Admission Mortality on Pediatric Intensive Care Unit Attending Electronic Health Record Activity: A Preliminary Study

Contact Info

Product

Resources

About