National trends in oncology specialists' EHR inbox work, 2019-2022

Electronic health record (EHR) burden is an important driver of the ongoing physician burnout crisis. In particular, EHR-based messaging (also known as "inbox")-including messages from patients-is associated with burnout and decreased well-being. Little is known about EHR messaging burden for oncologists. To address this gap, we assessed trends in oncologist EHR messaging volume and EHR time from 2019 to 2022 across oncology subspecialties.

This study used EHR metadata for all US oncology physicians (including medical oncologist/hematologists, radiation oncologists, pediatric oncologists, gynecologic oncologists, and surgical oncologists) providing ambulatory care using an Epic EHR system to measure inbox volume and EHR time from July 2019 through April 2022. Descriptive statistics and multivariable regression were used to evaluate differences over time and across subspecialties.

This sample of 15 653 oncology physicians across 43 228 633 ambulatory visits found that message volume for oncologists increased 19.0% from 2019 to 2022, and patient-initiated messages increased 34.0%. The EHR time increased 16.2% from 2019 to 2022, whereas EHR "work outside of work" time increased 12.1%. Medical oncologist/hematologists had the highest inbox volume, patient-message volume, and EHR time of oncology subspecialists.

Rising levels of EHR work and message volume among oncology physicians are concerning given the role of EHR burden in physician burnout. Oncologists have seen increased EHR time and message volume, especially patient-initiated messages, following the onset of the COVID-19 pandemic. Health system leaders and policymakers should invest in efforts to reduce EHR and inbox burden for all oncologists, with a focus on physicians with the greatest burden.