Prior to widespread implementation of the electronic health record (EHR), non-face-to-face patient contact with the primary care clinician's office was traditionally limited to telephone calls during office hours or patient voicemail messages after hours. Practices used telephone triage and medical advice protocols to ensure that patient calls or messages would be managed in a standardized way by the appropriate person in the practice.

Today, EHRs offer the use of patient portals, which allow unfettered patient-initiated messaging to the clinician at all hours of the day. This marks a major step forward in patient communication with the health care team but also marks a significant increase in indirect patient care needs. In primary care, these patient queries cover the gamut of health care needs, including appointment or referral requests, referral status updates, financial or insurance questions, result clarification, clinical advice requests, and medication requests (new or refill). Additionally, traditional phone calls are converted to EHR messages, which adds to the EHR message burden. While protocols and procedures on how to best manage patient telephone calls are well established, similar systems have not been widely adopted for electronic communication from patients.

This article describes how an academic family medicine practice designed and implemented a system for optimally managing electronic patient messages. Our multiple part-time clinicians comprise approximately 8.8 clinical FTEs managing a panel of 16,000 patients. The clinical team also includes 15 registered nurses (RNs)/certified medical assistants (MAs)/licensed practical nurses (LPNs), two triage RNs, two licensed clinical social workers, and one clinical pharmacist.

A NEW WORKFLOW FOR PATIENT MESSAGES

Before this intervention, all patient messages went directly to the clinician, who then decided whether to handle a message personally or forward it to another team member. As the volume of messages increased and response times increased, this strategy of having the clinician review all messages became non-viable.

Our first step in developing a new work-flow for managing patient messages was to assemble a small multidisciplinary work team with representatives from administration, nursing, and clinicians. The over-arching goal was to develop a consistent, systems-based approach to patient messaging and to get “the right message to the right team member.”