Inbox message prioritization and management approaches in primary care

dc.contributor.authorApathy, Nate C.
dc.contributor.authorHicks, Katelyn
dc.contributor.authorBocknek, Lucy
dc.contributor.authorZabala, Garrett
dc.contributor.authorAdams, Katharine
dc.contributor.authorGomes, Kylie M.
dc.contributor.authorSaggar, Tara
dc.contributor.departmentMedicine, School of Medicine
dc.date.accessioned2024-12-10T13:31:07Z
dc.date.available2024-12-10T13:31:07Z
dc.date.issued2024-11-11
dc.description.abstractObjectives: Patient messaging to clinicians has dramatically increased since the pandemic, leading to informatics efforts to categorize incoming messages. We examined how message prioritization (as distinct from categorization) occurs in primary care, and how primary care clinicians managed their inbox workflows. Materials and methods: Semi-structured interviews and inbox work observations with 11 primary care clinicians at MedStar Health. We analyzed interview and observation transcripts and identified themes and subthemes related to prioritization and inbox workflows. Results: Clinicians widely reported that they did not prioritize messages due to time constraints and the necessity of attending to all messages, which made any prioritization purely additive to overall inbox time. We identified 6 themes and 14 subthemes related to managing inbox workloads. The top themes were (1) establishing workflow norms with different teams, primarily medical assistants (MAs); (2) boundary-setting with patients, other clinicians, and with themselves; and (3) message classification heuristics that allowed clinicians to mentally categorize messages that required follow-up, messages that could be quickly deleted or acknowledged, and purely informational messages that ranged in clinical utility from tedious to valuable for care coordination. Discussion: Time constraints in primary care prevent clinicians from prioritizing their inbox messages for increased efficiency. Involvement of MAs and co-located staff was successful; however, standardization was needed for messaging workflows that involved centralized resources like call centers. Organizations should consider ways in which they can support the establishment and maintenance of boundaries, to avoid this responsibility falling entirely on clinicians. Conclusion: Clinicians generally lack the time to prioritize patient messages. Future research should explore the efficacy of collaborative inbox workflows for time-savings and management of patient messages.
dc.eprint.versionFinal published version
dc.identifier.citationApathy NC, Hicks K, Bocknek L, et al. Inbox message prioritization and management approaches in primary care. JAMIA Open. 2024;7(4):ooae135. Published 2024 Nov 11. doi:10.1093/jamiaopen/ooae135
dc.identifier.urihttps://hdl.handle.net/1805/44908
dc.language.isoen_US
dc.publisherOxford University Press
dc.relation.isversionof10.1093/jamiaopen/ooae135
dc.relation.journalJAMIA Open
dc.rightsAttribution 4.0 Internationalen
dc.rights.urihttps://creativecommons.org/licenses/by/4.0
dc.sourcePMC
dc.subjectPatient messaging
dc.subjectPhysician inbox
dc.subjectPhysician burnout
dc.subjectQualitative research
dc.titleInbox message prioritization and management approaches in primary care
dc.typeArticle
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