Journal of general internal medicine · 2025
Taming the In-Basket-How Two Simple Tools Reduced Portal Message Volume in an Academic Internal Medicine Clinic.
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Hadeed Nicole, Ameling Jessica, Henderson James, Bucala Matthew, Salamey Yvette, Meddings Jennifer
Аннотация
BACKGROUND: Patient portal messaging has emerged as a critical tool in primary care, particularly during the COVID-19 pandemic, facilitating asynchronous communication between patients and providers. The surge in portal messages during the pandemic has exacerbated work overload and burnout among primary care providers.
OBJECTIVE: To enhance primary care clinic portal message workflow efficiency by identifying barriers through surveys and interviews, then implementing interventions to address challenges and streamline processes.
DESIGN: We used a pre- and post-intervention with concurrent control design to evaluate this quality improvement project. The project was conducted at an Internal Medicine ambulatory clinic site within a large academic medical center in the Midwest.
PARTICIPANTS: The quality improvement project involved primary care physicians, registered nurses, licensed practical nurses, medical assistants, and patient services associates managing patient portal messages in primary care clinics.
INTERVENTION: Interviews and surveys assessed workflow practices, perceptions, and gaps. Interventions included developing "Best Practice Standards" and "Routing Guide" documents and restructuring staffing with dedicated time for message management.
MAIN MEASURES: The co-primary outcomes were the volume of portal messages per physician clinical full-time equivalent (cFTE) and the proportion of message encounters with physician involvement. The secondary outcome was the proportion of messages sent to multiple recipients ("carbon copy" messages).
KEY RESULTS: The intervention site showed a 16% reduction in messages per physician cFTE monthly (RRR, 0.84; 95% CI, 0.75-0.94) and a 65% decrease in "carbon copy" messages (RR, 0.35; 95% CI, 0.31-0.39) compared to controls. Physician involvement in messages remained unchanged at the intervention site but increased 8% at control sites. Pre-intervention interviews identified workload, process, training, and stress barriers. Post-intervention, staff noted improvements from role clarification and dedicated message time.
CONCLUSION: Targeted interventions can reduce portal message burden and improve workflow efficiency in primary care by implementing standardized protocols and clarifying roles.
OBJECTIVE: To enhance primary care clinic portal message workflow efficiency by identifying barriers through surveys and interviews, then implementing interventions to address challenges and streamline processes.
DESIGN: We used a pre- and post-intervention with concurrent control design to evaluate this quality improvement project. The project was conducted at an Internal Medicine ambulatory clinic site within a large academic medical center in the Midwest.
PARTICIPANTS: The quality improvement project involved primary care physicians, registered nurses, licensed practical nurses, medical assistants, and patient services associates managing patient portal messages in primary care clinics.
INTERVENTION: Interviews and surveys assessed workflow practices, perceptions, and gaps. Interventions included developing "Best Practice Standards" and "Routing Guide" documents and restructuring staffing with dedicated time for message management.
MAIN MEASURES: The co-primary outcomes were the volume of portal messages per physician clinical full-time equivalent (cFTE) and the proportion of message encounters with physician involvement. The secondary outcome was the proportion of messages sent to multiple recipients ("carbon copy" messages).
KEY RESULTS: The intervention site showed a 16% reduction in messages per physician cFTE monthly (RRR, 0.84; 95% CI, 0.75-0.94) and a 65% decrease in "carbon copy" messages (RR, 0.35; 95% CI, 0.31-0.39) compared to controls. Physician involvement in messages remained unchanged at the intervention site but increased 8% at control sites. Pre-intervention interviews identified workload, process, training, and stress barriers. Post-intervention, staff noted improvements from role clarification and dedicated message time.
CONCLUSION: Targeted interventions can reduce portal message burden and improve workflow efficiency in primary care by implementing standardized protocols and clarifying roles.