While electronic health records (EHRs) were originally touted as an efficiency tool to help ease practice for physicians, recent studies have linked the additional clerical work of EHRs with greater rates of physician burnout and dissatisfaction.^1–4 With the rise of EHRs, many physicians have found that they spend more time charting and managing their personal in-basket than providing direct patient care. One study examining physician work activities during office hours found that physicians spend 27% of their time on direct clinical face time with patients and 49% of their time on EHR and desk work.⁵

To address this problem, many organizations have implemented team-based care models. However, for these models to succeed, they must include optimization of the EHR — specifically, to address physician in-basket volume. This article describes how our group converted from individual to team in-basket pools and achieved a significant reduction in physician in-basket work.

HISTORY OF THE MODEL

Presbyterian Medical Group implemented the patient-centered medical home model (PCMH) in 2009 and, a year later, adopted the EHR, which had many positive outcomes but also shifted nonclinician work to clinicians. Prior to the EHR, the clinical, clerical, and clinician teams were able to carry out much of their work independent of one another. The EHR created interdependent workflows across the health care team that contributed to many inefficiencies. For example, the nursing team members depended on the physician to finalize orders in the system and route messages before they could complete their work. The physician’s response was also a rate-limiting step for the clerical team’s work related to referrals, follow-up messages, patient scheduling inquiries, etc. Many workflows depended on the physician to set the pace for the team and proved to be inefficient. When coupled with a busy practice, workflow dependency often resulted in batching of work, a backlog of messages, loss of productivity, and an inefficient practice style resulting in dissatisfaction for the physician, patient, and team. The increased volume of work in clinicians’ personal in-baskets also limited their time available for direct patient care.