Center for Innovations in Quality, Effectiveness and Safety (IQuESt) (152), Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC), 2002 Holcombe Boulevard, Houston, TX, 77030, USA.
Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
J Gen Intern Med. 2019 Sep;34(9):1825-1832. doi: 10.1007/s11606-019-05112-5. Epub 2019 Jul 10.
Workload from electronic health record (EHR) inbox notifications leads to information overload and contributes to job dissatisfaction and physician burnout. Better understanding of physicians' inbox requirements and workflows could optimize inbox designs, enhance efficiency, and reduce safety risks from information overload.
We conducted a mixed-methods study to identify strategies to enhance EHR inbox design and workflow. First, we performed a secondary analysis of national survey data of all Department of Veterans Affairs (VA) primary care practitioners (PCP) to identify major themes in responses to a free-text question soliciting suggestions to improve EHR inbox design and workflows. We then conducted expert interviews of clinicians at five health care systems (1 VA and 4 non-VA settings using 4 different EHRs) to understand existing optimal strategies to improve efficiency and situational awareness related to EHR inbox use. Themes from survey data were cross-validated with interview findings.
We analyzed responses from 2104 PCPs who completed the free-text inbox question (of 5001 PCPs who responded to survey) and used an inductive approach to identify five themes: (1) Inbox notification content should be actionable for patient care and relevant to recipient clinician, (2) Inboxes should reduce risk of losing messages, (3) Inbox functionality should be optimized to improve efficiency of processing notifications, (4) Team support should be leveraged to help with EHR inbox notification burden, (5) Sufficient time should be provided to all clinicians to process EHR inbox notifications. We subsequently interviewed 15 VA and non-VA clinicians and identified 11 unique strategies, each corresponding directly with one of these five themes.
Feedback from practicing end-user clinicians provides robust evidence to improve content and design of the EHR inbox and related clinical workflows and organizational policies. Several strategies we identified could improve clinicians' EHR efficiency and satisfaction as well as empower them to work with their local administrators, health IT personnel, and EHR developers to improve these systems.
电子健康记录 (EHR) 收件箱通知的工作量导致信息过载，导致工作不满和医生倦怠。更好地了解医生的收件箱需求和工作流程可以优化收件箱设计，提高效率，并减少信息过载带来的安全风险。
我们进行了一项混合方法研究，以确定增强 EHR 收件箱设计和工作流程的策略。首先，我们对所有退伍军人事务部 (VA) 初级保健医生 (PCP) 的全国调查数据进行了二次分析，以确定对征求改善 EHR 收件箱设计和工作流程建议的自由文本问题的回应中的主要主题。然后，我们对五个医疗保健系统（1 个 VA 和 4 个非 VA 设置，使用 4 种不同的 EHR）的临床医生进行了专家访谈，以了解与 EHR 收件箱使用相关的提高效率和情境意识的现有最佳策略。调查数据中的主题与访谈结果相交叉验证。
我们分析了 2104 名完成自由文本收件箱问题的 PCP 的回复（在回应调查的 5001 名 PCP 中），并采用归纳法确定了五个主题：(1) 收件箱通知内容应为患者护理提供可操作的信息，并且与收件临床医生相关，(2) 收件箱应降低丢失消息的风险，(3) 收件箱功能应优化以提高处理通知的效率，(4) 应利用团队支持帮助减轻 EHR 收件箱通知负担，(5) 应向所有临床医生提供足够的时间来处理 EHR 收件箱通知。随后，我们采访了 15 名 VA 和非 VA 临床医生，确定了 11 种独特的策略，每种策略都直接对应于这五个主题之一。
来自实践最终用户临床医生的反馈为改善 EHR 收件箱和相关临床工作流程以及组织政策的内容和设计提供了有力的证据。我们确定的一些策略可以提高临床医生的 EHR 效率和满意度，并使他们能够与当地管理员、健康 IT 人员和 EHR 开发人员合作，改进这些系统。
