Evaluating the Impact of Billing Patient Messages as E-Visits on Clinician EHR Inbox Burden

Presentation Time: 08:30 AM - 08:45 AM

Abstract Keywords: Workflow, Telemedicine, Documentation Burden, Healthcare Economics/Cost of Care
Primary Track: Policy
Programmatic Theme: Clinical Informatics

Following the onset of the COVID-19 pandemic, patient-initiated secure messages to clinicians increased dramatically and has remained at an elevated level. Many health systems have sought solutions to address the resulting clinician EHR inbox burden, including billing for a sub-set of these messages as "e-visits." Using EHR metadata from all clinicians delivering outpatient care at UCSF Health, a large academic medical center that implemented e-visit billing in November 2021, from November 2020 to November 2022, we describe clinician adoption of e-visits and use a difference-in-differences framework to identify the impact of e-visit billing on clinician EHR inbox time.

We found that physicians, and clinicians practicing in family medicine, dermatology, or internal medicine, billed the most e-visits. Importantly, we found that clinicians in the top quartile of e-visit billing reduced their monthly inbox time by 19.6 minutes, a roughly 5% reduction in overall EHR inbox time, compared to clinicians in the lowest quartile of e-visit billing. These results suggest that clinicians who adopt e-visits more intensively may realize durable reductions in EHR inbox burden, while those who bill fewer e-visits are unlikely to see the same reductions.

Speaker(s):
A J Holmgren, PhD
University of California, San Francisco

Author(s):
Julia Adler-Milstein, PhD - UCSF School of Medicine;