By Annette M. Boyle
WASHINGTON—Concerned about how much time clinicians spend reading and responding to emails, the VA is changing its messaging system so that more of their focus can be on patient care.
The new approach to the inbox notifications system, developed in response to concerns expressed by providers, was announced late last year.
“The number of computerized notifications currently delivered to clinicians is excessive compared to industry standard and is a major complaint from providers,” explained Sheila A. Ochylski, DNP, RN, chief nursing informatics officer for the VA and the executive sponsor of the effort.
While the messaging system initially was designed to share clinical information, such as test results or referrals, facilitate communication between providers and transmit refill requests, other kinds of less-useful messages have made finding crucial emails more difficult and time-consuming.
“The public never sees the excessive amount of emails and alerts that take up a doctor’s time,” pointed out VA Secretary David J. Shulkin, MD. “Some of it is necessary, but other emails do nothing to advance patient care and can, in fact, pose a major safety hazard because of lesser important emails. We want our doctors to have the right information they need to provide quality health care to veterans, and this is a step in the right direction.”
A survey of 2,590 primary care providers in the VA found that nearly 70% said they received “more alerts than they could effectively manage,” and almost 30% reported that they had “personally missed results that led to care delays.”1
Researchers at the Michael E. DeBakey Veterans VAMC in Houston calculated that clinicians take about 52 seconds to process each electronic health record (EHR) notification, according to a research letter published in JAMA Internal Medicine in 2016. Using that figure, the research team estimated that those notifications alone consume more than an hour a day for primary care providers. Specialists receive less than half the number of messages, they noted.2
For primary care providers, the high number of notifications makes “it harder to discern important vs. irrelevant information and [increases] their risk of overlooking abnormal test results,” the Houston team noted in their study. To ensure that important messages receive appropriate attention, the researchers recommended adopting “strategies to help filter messages relevant to high-quality care, EHR designs that support team-based care, and staffing models that assist physician in managing this influx of information.”
The VA project appears to be taking that suggestion to heart. The changes to the messaging system implemented so far, plus an educational component that trains clinicians to optimize their inbox, have reduced the time clinicians spend on these communications by an hour and a half a week, according to the VA.