Primary care physicians' experiences with inbox triage

Many primary care physicians (PCPs) feel overwhelmed by the number of electronic health record inbox messages they receive. The objective of this study was to characterize PCPs' experiences with inbox triage-the process of reviewing inbox messages and deciding when and how to address them.

We conducted 3 focus groups and 1 individual interview with 9 PCPs at an academic medical center and coded the transcripts for themes related to inbox triage.

We identified 5 themes in PCPs' experiences with inbox triage: (1) inbox triage is a continuous process; (2) inbox triage involves different team members performing multiple activities, including identifying messages better addressed through synchronous care, preparing messages to be reviewed by PCPs, and prioritizing messages; (3) PCPs prioritize messages based on multiple factors including clinical urgency, time constraints, and team member involvement; (4) team support for inbox triage varies by clinical experience, team stability, and co-location; and (5) patient expectations and clinic practices help make inbox triage a continuous process, requiring PCPs to establish personal policies to constrain inbox work.

Designers of clinic workflows, healthcare policy, and health information technology should aim to support the diverse activities involved in inbox triage, message prioritization based on multiple factors, and the collaborative process of establishing and communicating messaging norms.

Inbox triage is a collaborative and continuous process requiring PCPs to evaluate multiple aspects of each message, find time to address those messages during busy clinic days, and negotiate different expectations for messaging behavior.