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How to prevent patient portal messages from causing burnout
Allotting dedicated time for answering patient portal messages and taking a team-based care approach to inbox management can reduce provider burnout.
It's broadly understood that managing a full patient portal inbox is a key contributor to provider burnout nowadays, but it doesn't have to be that way.
In a series of studies published recently in the Journal of General Internal Medicine, researchers from the University of Michigan Medicine found that more judiciously allotting time for patient portal messaging can help reduce the overwhelm doctors feel when faced with a full inbox.
Giving primary care providers small amounts of time during the day to handle patient portal messages might be effective. Additionally, spreading patient portal messages across a multidisciplinary care team could be a good first step in managing the burnout caused by high message volumes, researchers found.
Patient portals contributing to provider burnout
There's no way around it -- the influx of patient portal messaging, spurred on in part by the pandemic's tilt toward remote care access, is putting a strain on healthcare providers.
According to one of the U-M Medicine studies, the typical healthcare provider is spending just under an hour responding to patient portal messages each day. This tracks with other assessments pegging provider burnout to high administrative burden, especially within the EHR and patient portal.
Notably, portal-driven provider burnout is not felt equally across provider demographics. Particularly, women are 60% more likely to say patient portal messaging requires more clinical assessment compared to men and 76% more likely to say messaging contributes to burnout. This comes even as female doctors are less likely to say the EHR is difficult to use.
Healthcare organizations, facing serious workforce issues, need to improve clinician engagement and job satisfaction. Identifying ways to help healthcare providers of all genders manage the patient portal index could help move the needle on burnout levels.
Dedicating time to answer patient portal messages
One of the U-M studies assessed how creating dedicated time during the provider's workday to answer patient portal messages can alter burnout.
The researchers dubbed these PACE slots, or Patient Asynchronous Care Effort slots, and they allotted providers 20 minutes for every four hours spent seeing patients to answer patient portal messages.
The study, led by Jennifer Reilly Lukela, M.D., sought to find out whether those dedicated portal messaging times could reduce "pajama time," or the time outside of a provider's workday they spend answering clinical documentation.
The PACE slots did not move the needle on pajama time, the researchers found. After assessing the organization's EHR, the researchers found no change in the amount of time providers spent responding to patient portal messages after hours.
However, the PACE slots did change the perception of patient portal messaging, particularly its impact on provider burnout.
A sizeable proportion (88%) of providers said it felt like PACE slots reduced the amount of time they spend on patient care outside of working hours. Another 93% said the PACE slots made it easier for them to respond to urgent patient portal messages, and 86% said the slots made their patient portal messaging work feel less overwhelming.
The primary driver could be a better sense of autonomy for healthcare providers, who might feel as though the PACE slots let them control how they spend their time in and out of the clinic.
"As we think about physician wellbeing and the sustainability of careers in primary care, one of the most critical things is agency over your day and control over your schedule," Lukela said in a press release.
Using team-based care to tackle patient portal inboxes
In addition to giving providers more dedicated time to respond to patient portal messages, U-M Medicine researchers also found that practicing more team-based care can make inboxes more manageable.
In a third study, a separate research team led by Nicole Hadeed, M.D., designed a standards and routing guide for various types of patient portal messages based on interviews with different types of healthcare providers. Interviewed providers included physicians, medical assistants, licensed practical nurses, registered nurses and patient services associates.
The standards and routing guides were intended to spread patient portal messages out across the medical team based on the type of message received. This strategy aimed to reduce the amount of messages each physician handled on their own and the amount of duplicative messages they received.
Overall, the standards and routing guides helped reduce the number of messages each physician received by 16% and the number of copy-cat messages by 62%. Although the number of messages physicians received directly at care sites that followed the standards and routing guides did not go down, the researchers did observe that the rate went up at care sites that maintained existing patient portal messaging protocols.
In qualitative interviews, the researchers also observed improvements in dedicated messaging time.
These improvements were possible because the standards and routing guides clarified the role each member of the care team plays. This reduced the number of patient portal messages arriving to the wrong care team member, promoting more efficiency.
"Focusing on getting the right message to the right place the first time was a simple and powerful intervention to reduce intra-clinic message traffic that is budget-neutral and completely within the clinic site's control," Hadeed stated publicly.
Sara Heath has reported news related to patient engagement and health equity since 2015.
