New research suggests that as the pandemic tails off, the volume of patient messages to physicians may remain at a significantly higher level than they had been at in the past.
This conclusion comes as part of a study of ambulatory EHR use in the US during the COVID-19 pandemic. To conduct the study, which appeared in the Journal of the American Medical informatics Association, researchers analyzed EHR metadata from ambulatory care clinicians in 366 health systems between December 2019 and December 2020. All of the institutions studied used the Epic EHR system.
The analysis looked at active use time across clinical activities, time after hours and messages received. The authors measured EHR active use time across four different functions, including clinical review of patient history, inputting orders and In-Basket messaging.
The researchers found that clinician time spent using the EHR per day dropped at the onset of the pandemic but that by July 2020, time spent stabilized at higher levels than seen before the pandemic by July 2020. This trend also extended to time spent after hours in the EHR.
The analysis determined that In-Basket messages increased compared with pre-pandemic levels, with the biggest growth coming from messages from patients. The volume of these messages increased to 157% over the pre-pandemic average. Each additional patient message was tied to a 2.32-minute increase in EHR time per day. Providers also spent more time in clinical review of patient records.
In their discussion of the results, the researchers point out the obvious, which is that if processes are changing in the wake of COVID, it’s important that we have reimbursement models and workflows that support these changes.
What makes these results particularly interesting Is that these changes may be poised to stay in place over the longer term. The authors suggest that the increased use of messaging was caused by a growth in the use of patient portals, something they don’t see going away in the near future.
On the surface, this research seems to have drawn some negative conclusions. After all, given that the risk of burnout from EHR use is already fairly high, trends that push physicians to use EHRs more sound like a problem.
That being said, it’s possible that there could be a net benefit to this shift that we haven’t seen yet. It may be that with patients writing to their doctors more often, they’re getting used to working on their health proactively, and that could ultimately be a good thing for everyone. The key here will be to find out how to take advantage of this new way of working and make sure doctors get compensated for the extra time they’re spending messaging.
