Association of Electronic Health Record Inbasket Message Characteristics With Physician Burnout

Abstract

ImportancePhysician burnout is an ongoing epidemic; electronic health record (EHR) use has been associated with burnout, and the burden of EHR inbasket messages has grown in the context of the COVID-19 pandemic. Understanding how EHR inbasket messages are associated with physician burnout may uncover new insights for intervention strategies.ObjectiveTo evaluate associations between EHR inbasket message characteristics and physician burnout.Design, Setting, and ParticipantsCross-sectional study in a single academic medical center involving physicians from multiple specialties. Data collection took place April to September 2020, and data were analyzed September to December 2020.ExposuresPhysicians responded to a survey including the validated Mini-Z 5-point burnout scale.Main Outcomes and MeasuresPhysician burnout according to the self-reported burnout scale. A sentiment analysis model was used to calculate sentiment scores for EHR inbasket messages extracted for participating physicians. Multivariable modeling was used to model risk of physician burnout using factors such as message characteristics, physician demographics, and clinical practice characteristics.ResultsOf 609 physicians who responded to the survey, 297 (48.8%) were women, 343 (56.3%) were White, 391 (64.2%) practiced in outpatient settings, and 428 (70.28%) had been in medical practice for 15 years or less. Half (307 [50.4%]) reported burnout (score of 3 or higher). A total of 1 453 245 inbasket messages were extracted, of which 630 828 (43.4%) were patient messages. Among negative messages, common words included medical conditions, expletives and/or profanity, and words related to violence. There were no significant associations between message characteristics (including sentiment scores) and burnout. Odds of burnout were significantly higher among Hispanic/Latino physicians (odds ratio [OR], 3.44; 95% CI, 1.18-10.61; P = .03) and women (OR, 1.60; 95% CI, 1.13-2.27; P = .01), and significantly lower among physicians in clinical practice for more than 15 years (OR, 0.46; 95% CI, 0.30-0.68; P < .001).Conclusions and RelevanceIn this cross-sectional study, message characteristics were not associated with physician burnout, but the presence of expletives and violent words represents an opportunity for improving patient engagement, EHR portal design, or filters. Natural language processing represents a novel approach to understanding potential associations between EHR inbasket messages and physician burnout and may also help inform quality improvement initiatives aimed at improving patient experience.

Association Between Billing Patient Portal Messages as e-Visits and Patient Messaging Volume

“…To capture clinician adoption of e-visit billing, we measured total patient medical advice message threads (each representing a back-and-forth exchange) and the subset billed as e-visits each week, and calculated the percentage of threads billed . Our sample covered November 1, 2020, through October 22, 2022, with November 1, 2020, as the start of patient-initiated e-visits and November 14, 2021, as the switchover to clinician-initiated e-visit billing.…”

Electronic Health Record Messaging Patterns of Health Care Professionals in Inpatient Medicine

“…Although secure messaging use has surged, concerns exist regarding its contributions to HCP interruptions and burnout analogous to in-basket messaging for outpatient HCPs . We cannot yet comment on adaptive messaging behaviors but emphasize that Epic Secure Chat should not be used for urgent and emergent issues; this should ease expectations of fast responses and promote HCP concentration.…”

Clinician Burnout and Effectiveness of Guideline-Recommended Psychotherapies

“… 26 This measure is mainly associated with the emotional exhaustion domain of burnout. 27 Consistent with prior research, 7 , 28 , 29 , 30 , 31 we dichotomized burnout with scores 2 or less (no symptoms of burnout) vs 3 or more (indications of burnout).…”