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

Lieu, Tracy A.; Altschuler, Andrea; Weiner, Jonathan Z; East, Jeffrey A; Moeller, Mark F; Prausnitz, Stephanie; Reed, Mary; Warton, E. Margaret; Goler, Nancy; Awsare, Sameer

doi:10.1001/jamanetworkopen.2019.18287

Cited by 39 publications

(35 citation statements)

References 13 publications

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“…Several studies captured the apprehensions of providers due to secure messaging [ 122 , 124 ]. In these studies, health care providers articulated the lack of clarity around appropriate ways to communicate via a portal as patients had expectations to receive immediate responses to their inquires [ 124 ].…”

Section: Resultsmentioning

confidence: 99%

“…In these studies, health care providers articulated the lack of clarity around appropriate ways to communicate via a portal as patients had expectations to receive immediate responses to their inquires [ 124 ]. Lieu et al [ 122 ] reported provider anxiety because of the lack of volume restrictions on electronic messages and their coping strategies to timing their responses to patient messages. Another study found that messaging increased work outside normal work hours [ 114 ].…”

Section: Resultsmentioning

confidence: 99%

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Capturing the Impact of Patient Portals Based on the Quadruple Aim and Benefits Evaluation Frameworks: Scoping Review

2020

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Background Despite extensive and continuing research in the area of patient portals, measuring the impact of patient portals remains a convoluted process. Objective This study aims to explore what is known about patient portal evaluations and to provide recommendations for future endeavors. The focus is on mapping the measures used to assess the impact of patient portals on the dimensions of the Quadruple Aim (QA) framework and the Canada Health Infoway’s Benefits Evaluation (BE) framework. Methods A scoping review was conducted using the methodological framework of Arksey and O’Malley. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) extension for scoping reviews. A systematic and comprehensive search was conducted using the Ovid platform, and the following databases were searched: Ovid MEDLINE (R) ALL (including epub ahead of print, in-process, and other nonindexed citations), EMBASE, and PsycINFO. CINAHL on the EBSCO platform and Web of Science were searched for studies published between March 2015 and June 2020. A systematic gray literature search was conducted using the Google search engine. Extracted data were tabulated based on a coding template developed to categorize the literature into themes and areas of interest. Results A total of 96 studies were included for data extraction. The studies were categorized based on the QA dimensions, with strict adherence to the definitions for each dimension. From the patients’ perspective, it was determined that most evaluations focused on benefits and barriers to access, access to test results, medication adherence, condition management, medical notes, and secure messaging. From the population perspective, the evaluations focused on the increase in population outreach, decrease in disparities related to access to care services, and improvement in quality of care. From the health care workforce perspective, the evaluations focused on the impact of patients accessing medical records, impact on workflow, impact of bidirectional secure messaging, and virtual care. From the health system perspective, the evaluations focused on decreases in no-show appointments, impact on office visits and telephone calls, impact on admission and readmission rates and emergency department visits, and impact on health care use. Overall, 77 peer-reviewed studies were mapped on the expanded version of the BE framework. The mapping was performed using subdimensions to create a more precise representation of the areas that are currently explored when studying patient portals. Most of the studies evaluated more than one subdimension. Conclusions The QA and BE frameworks provide guidance in identifying gaps in the current literature by providing a way to show how an impact was assessed. This study highlights the need to appropriately plan how the impact will be assessed and how the findings will be translated into effective adaptations.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Capturing the Impact of Patient Portals Based on the Quadruple Aim and Benefits Evaluation Frameworks: Scoping Review

2020

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“…This result is consistent with a prior qualitative study that found that some departments in this setting had approaches to aid PCPs with inbox management, such as teams to help with messages or scheduled time for inbox management. 2 …”

Section: Discussionmentioning

confidence: 99%

“…Primary care physicians (PCPs) have identified the inbox within the electronic health record (EHR) as a source of work-related stress. 1 , 2 , 3 , 4 One possible reason is that it adds to the multiple demands that compete for PCPs’ attention during the workday. Given that PCPs spend large portions of their time using EHRs, 5 , 6 , 7 , 8 electronic inbox work could be associated with many switches in attention when processing messages amid patient visits and other clinical responsibilities.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Attention Switching and Duration of Electronic Inbox Work Among Primary Care Physicians

et al. 2021

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IMPORTANCE Primary care physicians (PCPs) report multitasking during workdays while processing electronic inbox messages, but scant systematic information exists on attention switching and its correlates in the health care setting. OBJECTIVES To describe PCPs' frequency of attention switching associated with electronic inbox work, identify potentially modifiable factors associated with attention switching and inbox work duration, and compare the relative association of attention switching and other factors with inbox work duration. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of the work of 1275 PCPs in an integrated group serving 4.5 million patients used electronic health record (EHR) access logs from March 1 to 31, 2018, to evaluate PCPs' frequency of attention switching. Statistical analysis was performed from October 15, 2018, to August 28, 2020. MAIN OUTCOMES AND MEASURES Attention switching was defined as switching between the electronic inbox, other EHR work, and non-EHR periods. Inbox work duration included minutes spent on electronic inbox message views and related EHR tasks. Multivariable models controlled for the exposures. RESULTS The 1275 PCPs studied (721 women [56.5%]; mean [SD] age, 45.9 [8.5] years) had a mean (SD) of 9.0 (7.6) years of experience with the medical group and received a mean (SD) of 332.6 (148.3) (interquartile range, 252-418) new inbox messages weekly. On workdays, PCPs made a mean (SD) of 79.4 (21.8) attention switches associated with inbox work and did a mean (SD) 64.2 (18.7) minutes of inbox work over the course of 24 hours on workdays. In the model for attention switching, each additional patient secure message beyond the reference value was associated with 0.289 (95% CI, 0.217-0.362) additional switches, each additional results message was associated with 0.203 (95% CI, 0.127-0.278) additional switches, each additional request message was associated with 0.190 (95% CI, 0.124-0.257) additional switches, and each additional administrative message was associated with 0.262 (95% CI, 0.166-0.358) additional switches. Having a panel (a list of patients assigned to a primary care team) with more elderly patients (0.144 switches per percentage increase [95% CI, 0.009-0.278]) and higher inbox work duration (0.468 switches per additional minute of inbox work [95% CI, 0.411-0.524]) were also associated with higher attention switching involving the inbox. In the model for inbox work duration, each additional patient secure message beyond the reference value was associated with 0.151 (95% CI, 0.085-0.217) additional minutes, each additional results message was associated with 0.338 (95% CI, 0.272-0.404) additional minutes, each additional request message was associated with 0.101 (95% CI, 0.041-0.161) additional minutes, and each additional administrative message was associated with 0.179 (95% CI, 0.093-0.265) additional minutes. A higher percentage of the panel's patients initiating messages (0.386 minutes per (continued) Key Points Question Among primary care physicians...

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“…In total, 18 studies [40][41][42]50,51,54,55,57,64,66,82,87,[120][121][122][123][124][125] and 3 reports [114,126,127] addressed the health care workforce perspective through various methods (mixed methods, n=7; prospective observational, n=2; qualitative, n=6; and surveys, n=6), with a focus on conducting formative and process evaluations. A total of 11 studies were conducted in the United States, 5 in Sweden, 4 in Canada, and 1 in China.…”

Section: Health Care Workforcementioning

confidence: 99%

Capturing the Impact of Patient Portals Based on the Quadruple Aim and Benefits Evaluation Frameworks: Scoping Review (Preprint)

Avdagovska¹,

Menon²,

Stafinski³

2020

Preprint

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BACKGROUND Electronic patient portals are secure websites tied to an institutional electronic health record system from which patients can view their medical information. These types of records are populated with a person’s lifetime health history. Despite the continuing extensive research in this area, measuring patient portal impact continues to be a convoluted process. OBJECTIVE To explore what is known about patient portal evaluations and provide recommendations for future endeavours. The focus was on mapping what measures are used to assess the impact of patient portals on the four specific dimensions (patient, population, healthcare workforce, and health system perspectives) of the Quadruple Aim Framework, and what components from the Benefits Evaluation Framework were most commonly evaluated to measure impact. METHODS A scoping review was conducted using the methodological framework of Arksey and O’Malley. Reporting was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A systematic and comprehensive search using the OVID platform, the following databases were searched: Ovid MEDLINE® ALL, including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Embase, and PsycINFO. CINAHL on the Ebsco platform and Web of Science were also searched for studies published between 2015 and June 2020. A systematic grey literature search was conducted using the Google search engine in Edmonton, Alberta, Canada between February 13 and February 25, 2020. A data extraction form was developed and reviewed to categorize the literature into themes and areas of interest, which varied by study type. Two frameworks for analysis were incorporated, the Quadruple Aim and the Canada Health Infoway’s Benefits Evaluation Frameworks. Extracted data were tabulated based on a coding template developed to categorize the literature into themes and areas of interest, which varied by study type and QA perspective. Furthermore, the evaluated patient portal functions were mapped onto the Benefits Evaluation Framework. A descriptive, analytical approach was used to summarize the outcomes of the studies. In addition, a list of the various terms/outcomes/variables that were used to describe ‘impact’ was compiled. RESULTS In total, 96 studies were included for data extraction. The studies were categorized based on the Quadruple Aim dimensions, with strict adherence to the definitions for each dimension(1,2). From the patient perspective, we identified that most evaluations focused on benefits and barriers to access, access to test results, medication adherence, condition management, medical notes, and secure messaging. From the population perspective, the evaluations focused on increase in population outreach, decrease in disparities related to access of care services, and improvement in quality of care. From the healthcare workforce perspective, the evaluations focused on impact of patients accessing medical records, impact on workflow, impact of bi-directional secure messaging, and virtual care. From the health system perspective, the evaluations focused on decrease in no-show appointments, impact on office visits and telephone calls, impact on admission and readmission rates and emergency department visits, and impact on healthcare utilization. Altogether, 77 peer-reviewed studies were mapped on the expanded version of the BE Framework. The mapping was done by sub-dimension to create a more precise representation about the areas that are currently explored when studying patient portals. Most of the studies evaluated more than one sub-dimension. CONCLUSIONS Despite the extensive and existing research in the area of patient portals, the evidence from this scoping review suggests that impact research is available, but it lacks multidimensionality. The Quadruple Aim and the Benefits Evaluation Frameworks provided guidance in identifying the gaps in the current literature by providing a way to show how impact was assessed. This review highlights the need to appropriately plan how impact will be assessed and how the findings will be translated into effective adaptations. If the how and what are not properly planned, the generalizability of patient portals studies will continue to elude researchers and implementation teams.

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

Cited by 39 publications

References 13 publications

Capturing the Impact of Patient Portals Based on the Quadruple Aim and Benefits Evaluation Frameworks: Scoping Review

Capturing the Impact of Patient Portals Based on the Quadruple Aim and Benefits Evaluation Frameworks: Scoping Review

Evaluation of Attention Switching and Duration of Electronic Inbox Work Among Primary Care Physicians

Capturing the Impact of Patient Portals Based on the Quadruple Aim and Benefits Evaluation Frameworks: Scoping Review (Preprint)

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