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Research: EHR Notifications Add Burden to Docs’ Workdays

March 16, 2016
by Rajiv Leventhal
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Primary care physicians are receiving an average of 77 notifications per day from their electronic health records (EHRs), making it harder to discern important vs. irrelevant information and increasing their risk of overlooking abnormal test results, according to researchers from the Baylor College of Medicine in Houston.

With wider use of EHRs, physicians increasingly receive notifications via EHR-based inboxes (Epic’s In-Basket and General Electric Centricity’s Documents, for example). Examples of types of notifications include test results, responses to referrals, requests for medication refills, and messages from physicians and other healthcare professionals. As such, information overload is of emerging concern because new types of notifications and “FYI” (for your information) messages can be easily created in the EHR (vs. in a paper-based system), according to the researchers, whose findings were published in JAMA Internal Medicine.

Furthermore, the additional workload to read and process these messages remains uncompensated in an environment of reduced reimbursements for office-based care. Conversely, EHRs make it easier to measure the amount of information received. For the study, the researchers quantified the notifications that physicians received via inboxes of commercial EHRs to estimate their burden.

The researchers obtained electronic logs of all notifications received by all physicians during a six-month period in 2015 at three large practices in Texas (2 primary care and 1 multispecialty). They then tabulated notifications that conveyed new information to physicians for the 125 workdays during the study period. Types of notifications were categorized according to whether or not they were related to test results. To account for different times each physician spent in the outpatient clinic, the researchers normalized the number of notifications by percentage of time worked such that the number of notifications would represent the number of notifications received if the physician was full-time.

After the exclusion of certain physicians, the EHR inboxes of 92 physicians were left for analysis: 19 primary care physicians (PCPs) and 46 specialists at site A using Epic; 12 PCPs at site B using General Electric Centricity; and 15 PCPs at site C using Epic. Across the three sites, 46 PCPs received an average of 77 total notifications per day, of which an average of 15.5 notifications per day (20.2 percent) were related to test results, according to the findings.

Extrapolating this finding to commercial EHRs suggests that physicians spend an estimated 67 minutes per day processing notifications, which likely adds a substantial burden to their workday, according to the researchers. Specialists received less than half this amount of notifications, and part-time physicians appeared to receive proportionately more notifications. Strategies to help filter messages relevant to high-quality care, EHR designs that support team-based care, and staffing models that assist physicians in managing this influx of information are needed, they concluded.

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