9 ways systems can reduce EHR clutter

Administrative burden and inbox clutter are known factors contributing to burnout, and systems across the country are finding ways to reduce volume and streamline the process, according to an Aug. 1 article on the American Medical Association website.

Newton, Mass.-based Atrius Health, for example, reduced its in-basket volume by 25 percent between 2016 and 2022.

"We used a strategy of elimination, automation, delegation and collaboration to find a multitude of tactics to reduce the total volume [of messages]," Jane Fogg, MD, former executive chair of internal medicine and family medicine at Atrius Health, said in the article. "We really understood that there was no one single fantastic solution that would solve it all and that we had to tackle this piece by piece to get the results we wanted." 

Here are nine strategies systems use to reduce inbox messages:

1. Measure the current situation: Measure the type and volume of inbox messages to identify areas for greatest improvement.
   
   
2. Reengineer the inbox: Develop a governance structure, strategic framework and target for inbox reduction. Preliminary optimization could take up to a year, but do not rush the process, the article said.
   
   
3. Cut low-value and duplicate messages: Discontinue carbon copies, eliminate unnecessary messages at the system level and route important messages to a folder for physicians to view.
   
   
4. Implement pre-visit lab and prescription protocols: Have lab results at the visit to allow for questions in person and start an annual renewal protocol to reduce refill requests and unnecessary gaps in patient access to medications.
   
   
5. Establish a single recipient for test results: Avoid safety hazards by having results given to a single individual — "you order it, you own it."
   
   
6. Redirect normal test results: Send normal results directly to patient portals and bypass physicians' inboxes.
   
   
7. Automate routing of prescription renewals: Empower a care team member or technology to handle prescription renewal requests, the article said.
   
   
8. Delegate remaining inbox triage: Empower team members to manage the inbox and flag important messages for physicians.
   
   
9. Collaborate during absences: Create a system for inbox coverage when a physician is out of office, such as a physician who can cross over or an on-call nurse who can handle the inbox.