epocrates

Can an eProvider model help with EHR message overload?

April 18, 2024

In response to clinician frustration over the growing volume of complex and often unbillable work associated with patient portal messages, the Duke Family Medicine Center developed an innovative eProvider (eP) model to manage patient communication and care. Brian Halstater, MD, current N. Thomas Connelly professor and vice chair of Clinical Affairs, Department of Family Medicine, University of Virginia School of Medicine and former medical director of the Duke Family Medicine Center, and his colleagues studied the outcome of eP model and published their findings in this month’s Family Practice Management. The researchers found that the eP model was positively received and resulted in reduced clinician time spent on messages, lessened job frustration, and fewer symptoms of mental overload.

What does the eProvider team look like?

The eP team is comprised of a clinician whose time is dedicated to virtual visits during the session; a nurse trained in communication triage; a nurse lead who coordinates with schedulers and the patient; and an office scheduler. The roles are rotating, particularly for the physician, who serves as the “provider of the day” and can work remotely. Clinicians who choose to function as an eP do so in lieu of an existing clinical session (eg, a half day of eP responsibilities is equivalent to a half day of in-person clinical work).

How does the model work?

When patients contact clinicians through the portal, a nurse triages the message to the appropriate member of the care team. If a clinical encounter is deemed necessary – if, for instance, a patient has pain complaints, a referral, or medication concerns – the nurse notifies the patient via the portal and routes the request to the office scheduler. This innovation, explain the authors, allows the team to capture and bill for the magnitude of indirect clinical work associated with messages.

What does the evidence show?

Since implementing the eP model in June 2022, the Duke clinic completed 3,419 eP visits and feedback from clinical staff was overwhelmingly positive. The authors queried staff at regular intervals for symptoms of burnout and perception of effort spent on in-basket management. Data revealed that staff felt less frustrated by their jobs and reported a decline in burnout symptoms. The time spent managing patient messages decreased for clinicians, from 1.9 to 1.5 hours per day, translating to a gain of 24 minutes per day. The time that clinicians anticipated they would have to spend on work associated with patient messages also decreased from 2.7 hours to 2.1 hours per day (a gain of 36 minutes per day). Triaging of messages appears to have contributed to these time savings, with clinicians reporting that the types of messages in their in-basket were more appropriate under the eP model.

The authors did identify several challenges with the eP model. First, messages were triaged inconsistently because several people were trained for the work but handled it differently. Another issue was lack of patient awareness of the scheduled eP encounter. The interval from receiving a message to scheduling a patient encounter was kept purposely short to honor a near-same day approach. Patients, however, might not check the portal for several days and as a result, may miss their virtual appointment. Despite these obstacles, the researchers concluded that the value of the care provided improved while also reducing symptoms of burnout and job frustration among physicians.

Source:

Mandall M., et al. (2024, March). Fam Pract Manag. The eProvider Model: A Novel Approach to the Modern Problem of Portal Message Overload. https://pubmed.ncbi.nlm.nih.gov/38470846/