Inbox message prioritization and management approaches in primary care

Area of Science:

• Health Informatics
• Primary Care Medicine
• Clinical Workflow Management

Background:

• Patient messaging to clinicians has surged post-pandemic, necessitating efficient inbox management.
• Current informatics efforts focus on message categorization, but message prioritization remains a challenge in primary care.

Purpose of the Study:

• To examine how primary care clinicians prioritize patient messages.
• To understand the inbox workflow management strategies employed by primary care clinicians.

Main Methods:

• Conducted semi-structured interviews with 11 primary care clinicians.
• Performed inbox work observations to analyze real-time workflows.
• Analyzed transcripts to identify themes and subthemes related to message prioritization and inbox management.

Main Results:

• Clinicians reported not prioritizing messages due to time limitations, viewing prioritization as an added burden.
• Identified key themes: establishing team workflow norms (especially with medical assistants), setting boundaries with patients and colleagues, and using message classification heuristics.
• Message classification involved mentally categorizing messages for follow-up, deletion/acknowledgment, or informational value.

Conclusions:

• Time constraints in primary care impede effective message prioritization.
• Collaborative workflows involving medical assistants and co-located staff show promise, but standardization is needed for centralized resources.
• Healthcare organizations must support boundary-setting to alleviate clinician burden in managing patient messages.