Health IT

Physicians starting to get overwhelmed by clinical messaging

Researchers from Baylor College of Medicine and the University of Texas Health Science Center in Houston reported their findings in JAMA Internal Medicine.


Secure clinical messaging promises to improve communications between healthcare providers and promote continuity of care, but office-based physicians are starting to get overwhelmed with e-mail, just like the rest of us. It’s a particularly serious problem for primary care physicians, according to a research letter published Monday in JAMA Internal Medicine.

Researchers from Baylor College of Medicine and the University of Texas Health Science Center in Houston examined electronic logs of messages to physicians at three large medical practices in Texas. They found that primary care doctors received a mean of 76.9 notifications per day through the electronic health record’s messaging system. About 20 percent were related to test results.

Specialists — present at only one of the three practices studied — got a mean of 29.1 notifications daily, the Baylor-UTHealth team reported.

Two of the sites had Epic Systems EHRs, while the third had GE Healthcare Centricity technology.

Based on an earlier study the same researchers conducted at the Department of Veterans Affairs in Houston, they calculated that primary care physicians spent 66.8 minutes each day reading, reacting and responding to clinical messaging. “Because a single notification often contains multiple data points (e.g., results of metabolic panels contain 7-14 laboratory values), the actual burden and required cognitive effort required of the physicians is likely greater,” they wrote.

The researchers sounded a caution to designers of EHRs and of staffing models to support team-based care.

“Information overload is of emerging concern because new types of notifications and ‘FYI’ (for your information) messages can be easily created in the EHR (vs. in a paper-based system). Furthermore, the additional workload to read and process these messages remains uncompensated in an environment of reduced reimbursements for office-based care,” the research letter said.

The experience in the Texas study may actually underestimate the problem.

“I should be so lucky as to have only 77 in-basket messages; it averages way over 100 for me, more like 110 to 140,” Dr. Richard Roberts of the University of Wisconsin told MedPage Today. “The more time I spend fussing with in-basket, the less time I spend talking to patients. It never ends; it’s a constant, and that gets discouraging for docs.”

Photo: Flickr user Kelly Schott