How We’re Improving Physicians’ Messaging Experience Through Digital Tools
More patients are utilizing digital health services at NYU Langone Health than ever before. In addition to telemedicine visits, patients are taking advantage of electronic health tools and applications that allow them to engage more closely with their physicians. Patients’ increased appetite for connecting digitally with physicians speaks to the amazing work our teams have done to empower patients and put them in control of their care.
While these tools present opportunities to improve engagement, they may also tax physicians’ capacity to meet the expanded demand for it, challenging their ability to address patients’ needs promptly. Those of us at NYU Langone focused on improving the Clinician Digital Experience (CDX) across our health system are keenly aware of these ever-increasing demands, and are working closely with our physicians to meet this challenge.
Much of these digital demands arrive via the InBasket, the communication hub of our electronic health record, Epic. This is where physicians send and receive messages from patients, refill medications and review results, among many other tasks. While physicians have always dedicated time to managing their InBaskets, in the last year alone we have seen a greater than 30% increase in the number of messages our primary care physicians receive every day. Each physician now averages approximately 40 messages daily, and it isn’t uncommon for some physicians to receive more than 150 InBasket messages per day!
The rapid rise of digital health services is closely linked to ever-increasing demand for care delivered outside of the office and hospital. But because health systems were not designed to meet such demand, physicians have filled the gap by spending hours of time at work and at home sifting through messages and responding to patients’ needs. Properly meeting these new demands requires that health systems design and implement complete solutions, which NYU Langone’s IT and operational teams — including our faculty group practice — approached as a collaborative team sport.
Our goal was to improve the messaging experience and help our physicians work smarter, not harder, in their InBaskets. That would allow them to spend more time connecting with and providing care to their patients, and less time juggling messages and performing administrative tasks that others could do.
We began by conducting a current state assessment of how our physicians interact with their InBaskets, using Epic’s Signal tool, which provides analytics about usage patterns on the platform. We were able to see volume and types of messages received, along with time spent after-hours and on weekends logging into the system. This analysis not only provided an aggregate view of how much time was being spent on messaging, but also enabled us to drill-down and identify specific opportunities for change with system-wide impact.
We quickly realized that there were several types of messages flooding physicians’ inboxes that have very low — if any — clinical value. These include messages related to canceled orders or other informational notifications that physicians were already seeing elsewhere within the EHR. We evaluated the technical configuration contributing to these messages and suppressed them.
Canceled Order Messages per Physician Per Day
Suppressing clinically irrelevant messages led to a 75% drop of canceled orders messages going to physicians InBaskets.
With those messages filtered out, the next step was to determine whether certain messages could be managed by staff other than physicians. For example, messages from patients asking to reschedule appointments, or alerts that a patient hadn’t yet fulfilled an order could be passed along to administrative staff for follow up. Additionally, many clinical messages can oftentimes be addressed immediately by nursing staff. Drawing on our team sport mentality, we worked closely with our operational partners to determine how we can best redirect messages to the most appropriate staff for management.
Drop in one physician’s time spent in InBasket from 32 minutes to 15 minutes per day after re-routing relevant messages to support staff.
For those messages that still require physician review, we looked for opportunities to facilitate taking prompt action. We deployed a set of macros called quick actions to allow clinicians to quickly respond to common questions more easily. For example, one of the most common types of messages physicians receive are from patients who are concerned about their test results. Oftentimes, results may technically be out of range, but are not clinically significant. We created a quick action that allows physicians to respond to these messages and reassure patients that there is no reason for concern.
Additionally, we also made it easier for clinicians to complete refill requests by providing decision support displaying pertinent information within the appropriate refill screens. For example, when renewing certain medications, oftentimes relevant labs or blood pressures need to be reviewed first. By displaying this information in the same screens where a medication is requested, it saves time for physicians who would otherwise need to search through the record for it. Now, approximately 50% of all refill requests display relevant clinical information to our physicians.
Decision support displaying relevant information to physicians when renewing a thyroid medication.
Further building on our successes, we are beginning to explore other technologies we can leverage to help reduce the InBasket burden. These include using tools such as robotic process automation (RPA) and machine learning to safely filter, redirect and manage more types of messages, so that our physicians can spend more time caring for patients in person and within their InBaskets.
Paul Testa, MD, Chief Medical Information Officer
Adam Szerencsy, DO, Medical Director, Ambulatory Clinical Informatics
