EMR Inbox Overload: How to Take Back Control of Your Workday

When I turn on the computer in the morning, I open the EMR inbox. There they are - 150 results to review. That is the average number of results I get every day. Throughout the day, I get more results and more messages.

The EMR inbox is always going to be filled with something. The day that nothing is added into the inbox (except for the weekends), you know there is something wrong – most likely a computer glitch.

Physician friends, accept that your EMR inbox will always be filled, as long as you are still working. To have transient empty boxes, it is essential to be systematic in managing those tasks. It takes more than you to minimize the inbox burden.

Less input equals less inbox items. The main sources of inbox tasks are test results, in-office messages, interoffice messages, patient messages and correspondence notes from other clinicians.

Only order the tests you need. The more labs you order, the more results you enter your inbox. Minimize lab orders which will not change your management. You have some control over how many test results are going into the inbox.

What about messages? There are messages about medication refills. There are questions regarding patients either from the staff or from the patients or their families. Set clear protocols on the distribution of messages. The front desk staff members need to know which messages to send to the nurses first and which ones to you. Delegation is the key. Designate a triage nurse, for example, to screen the messages.

Prioritize. Most EMR systems allow the sender to designate the level of importance of a message. Address the messages with high importance first. That being said, it is important for the staff to understand what kind of messages are considered “high importance”.

Be mindful of the “reply all” button. Let your staff know to use it appropriately. If every message is sent to everyone, you will have many more messages which are not necessary for you to open – but you do not know that until you open and read the messages.

Automate whenever it is possible. Make bundled tasks for frequently encountered issues. For example, if you see many patients with iron deficiency anemia, the management is to start iron supplements, and to possibly refer the patient to a gastroenterologist. You can set up a chained sequence of events so that the patient is notified and referred to GI with a few clicks, depending on the EMR program.

Set your boundaries. Many EMRs have a chat ability. Some patients may use it as a real-time texting tool – if you allow them to. Make sure your staff and your patients know that you do not always check those dialogs in real-time. For urgent matters, call the office. While you are seeing patients, it is best to set your status to be “unavailable” or silence any notifications of messages. Every notification from a message is a source of distraction. You will be tempted to check it. Your mind will wonder what it is about. Those are precious seconds and brain power wasted.

When is it a good time to tackle the inbox? There is no set answer. Be curious and experiment. In general, it is best if you can batch tasks. Set time blocks in the day to look at your inbox. When I am seeing patients in the office, I usually check the inbox twice in the morning, in between patients. This way, I get to delegate in a timely fashion and there are less messages to review compared to if I wait until the end of the day to open the inbox. The key is not to open each message as it arrives. That is a source of distraction which adds at least seconds to your work day.

The inbox is always going to be filled with something. You get to have some control over how many items will be there. Minimize the order of unnecessary tests and have standardized protocols for the staff regarding sending messages. Delegate messages and maximize the role of each staff member. Optimize automation. Set clear boundaries to protect your well-being, so that you are always at your best to take care of your patients. Set time blocks in the day to tackle the inbox. You will empty the inbox regularly and efficiently using these strategies.