Description

An onsite recording of this session will be included in the Symposium OnDemand offering. 

Association of Concurrent Secure Messages on Clinician Workload

Presentation Time: 08:00 AM - 08:15 AM

Abstract Keywords: Healthcare Quality, Documentation Burden, Patient Safety
Primary Track: Applications
Programmatic Theme: Clinical Informatics

Secure messaging applications are ubiquitously used in clinical settings for clinician communication. We investigated effect of concurrent secure messaging—engaging in multiple conversational threads of communication—on clinician workload. Based on a large-scale study involving more than 2,400 clinicians (physicians, APPs, and trainees) and over 280,000 secure messages, we found that having 2 or more concurrent conversations increased total EHR time spent per day. The effects were significantly higher with an increasing number of concurrent conversations.

Speaker(s):
Linlin Xia, Ph.D.
Washington University

Author(s):

Toward Relieving Clinician Burden by Automatically Generating Progress Notes using Interim Hospital Data

Presentation Time: 08:15 AM - 08:30 AM

Abstract Keywords: Natural Language Processing, Deep Learning, Clinical Decision Support
Primary Track: Applications
Programmatic Theme: Clinical Research Informatics

Regular documentation of progress notes is one of the main contributors to clinician burden. The abundance of structured chart information in medical records further exacerbates the burden, however, it also presents an opportunity to automate the generation of progress notes. In this paper, we propose a task to automate progress note generation using structured or tabular information present in electronic health records. To this end, we present a novel framework and a large dataset, ChartPNG, for the task which contains 7089 annotation instances (each having a pair of progress notes and interim structured chart data) across 1616 patients. We establish baselines on the dataset using large language models from general and biomedical domains. We perform both automated (where the best performing Biomistral model achieved a BERTScore F1 of 80.53 and MEDCON score of 19.61) and manual (where we found that the model was able to leverage relevant structured data with 76.9% accuracy) analyses to identify the challenges with the proposed task and opportunities for future research.

Speaker(s):
Sarvesh Soni, PhD
National Library of Medicine (NLM)

Author(s):
Dina Demner-Fushman, MD - National Library of Medicine;

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;

Digital Overload: A Comparison of Electronic Health Record Time and Inbox Volume among Advanced Practice Providers and Physicians

Presentation Time: 08:45 AM - 09:00 AM

Abstract Keywords: Documentation Burden, Workflow, Administrative Systems
Primary Track: Policy
Programmatic Theme: Clinical Research Informatics

This study compares electronic health record (EHR) burden among advanced practice providers (APPs) and physicians in ambulatory care settings from a large academic medical center. Using EHR audit log data, our findings suggest that APPs spend more time in the EHR and are responsible for more EHR messages than physicians. Time in the EHR has been highly associated with burnout, and therefore, organizations should address strategies to mitigate burnout among these essential providers.

Speaker(s):
Magdalene Kuznia, BSN, MS-HCI, RN
University of California San Francisco

Author(s):
Magdalene Kuznia, BSN, MS-HCI, RN - University of California San Francisco; A J Holmgren, PhD - University of California, San Francisco; Ulrike Muench, RN, PhD, FAAN - University of California San Francisco;

Triaging Inbox Work: An Interview Study with Primary Care Physicians

Presentation Time: 09:00 AM - 09:15 AM

Abstract Keywords: Documentation Burden, Human-computer Interaction, Qualitative Methods, Workflow
Primary Track: Applications
Programmatic Theme: Clinical Informatics

Through semi-structured interviews with nine physicians we identify four themes in how primary care teams triage inbox work: 1) EHR inboxes require constant triage, 2) team support for triaging and performing inbox work can vary due to having new or distributed team members, 3) the initial triage and later involvement of team members affects how PCPs triage inbox work, and 4) expectations for rapid responses to patient messages contribute to EHR use outside clinic hours.

Speaker(s):
Adam Rule, PhD
University of Wisconsin - Madison

Author(s):
Adam Rule, PhD - University of Wisconsin - Madison; Rutvi Shah, MD - University of Wisconsin-Madison; Christina Dudley, MD - University of Wisconsin-Madison; Mark Micek, MD - University of Wisconsin-Madison; Brian Arndt, MD - University of Wisconsin-Madison;