A Jay Holmgren, PhD and Julia Adler-Milstein, PhD Awarded American Medical Association Grant to Study Clinician Approaches to Patient Inbox Management


Congratulations to A Jay Holmgren, PhD, an Assistant Professor at CLIIR, and Julia Adler-Milstein, PhD, Professor and Director of CLIIR, for receiving an AMA grant for a project entitled: "Measuring What Matters: Characterizing Practice Strategies for Inbox Management and Assessing Associated EHR Audit Log Measures."

During the COVID-19 pandemic, digital technologies that enable patient-physician communication rapidly transitioned from a convenient option to an essential component of ambulatory care. Given the potential benefits of this communication modality – including improved patient experience and better access to care – it is likely that increased use will continue post-pandemic. However, these benefits have come at a cost to frontline physicians. Early evidence suggests that these asynchronous patient messages have generated a significant amount of new work for physicians – message volume is up over 150% compared to pre-pandemic levels, and each patient message received increases physician daily EHR work time by several minutes. Work schedules have not adapted accordingly, such that physicians do this new work after hours, increasing risk of burnout. Understanding how health care delivery organizations can develop technical and managerial strategies to handle this increased messaging volume is critical to turning digital tools from a burden into an opportunity to improve the quality and experience of care.

This project will generate evidence of strategies that allow patients to continue to benefit from asynchronous messaging while adapting the organization of physician work to accommodate increased message volume. We will systematically characterize current models as well as their strengths and limitations to help ambulatory practices gain a better understanding of options for how to approach inbox management. Once this characterization is complete, we will then use detailed EHR audit log metadata for ambulatory physicians at UCSF Health in the post-COVID period from August 2020 – February 2022 to evaluate the extent to which differences in organizational strategy across clinics at UCSF can be captured quantitatively. Results from this project will have important implications for managing clinician burnout while retaining the clear benefits of patient-clinician messaging.