Report: Clinician-to-clinician messaging a burden on providers
As EHR adoption rates tick upwards, sending notes via the EHR is becoming a viable means of communicating clinician-to-clinician. Requiring electronic signatures to prove receipt of notes is becoming a viable means of ensuring communication, but large amounts of additional signature required (ASR) alerts on EHRs could be a burden for providers, according to research published February in the Archives of Internal Medicine.
To determine the value of clinician-to-clinician messaging via EHR, researchers collected 160 days' worth of ASR alerts sent to primary care providers through the EHR system used throughout the outpatient clinics of a large tertiary care Department of Veterans Affairs (VA) facility. Researchers randomly selected 1 percent of the total ASR alerts and reviewed them to determine each one’s importance, its sender’s role, its reason for giving an alert and whether its message was communicated in another manner.
According to the results of their analysis, researchers determined 39 percent of providers’ ASR alerts came from members of their primary care team, that 54 percent were of high value, 26 percent came from the telephone triage service and 99 percent of ASR alerts were for messages that were not communicated in another manner. Additionally, they determined notes contained a median of 142 words, of which 19.7 percent were relevant to the receiving provider, and 40 percent of ASR alerts were regarding medication refill requests.
“Approximately half of EHR-based alerts for clinician-to-clinician messaging were of high value, but inefficiencies in information transfer required primary care providers to read through large amounts of extraneous text to find relevant information,” wrote Daniel R. Murphy, MD, of the Michael E. DeBakey VA Medical Center in Houston, along with his colleagues. “Few alerts were deemed nonessential, but in conjunction with the low percentage of relevant text in parent notes, they likely lead to a perception of information overload from ASR alerts.”
Researchers suggested several solutions to the problems posed by ASR alerts, such as assigning follow-up duties to support staff and allowing senders to highlight relevant text.
“Because clinician-to-clinician messaging is likely to increase as systems become more integrated, our study might be useful to others as they explore interventions to improve outpatient communication,” Murphy concluded.
To determine the value of clinician-to-clinician messaging via EHR, researchers collected 160 days' worth of ASR alerts sent to primary care providers through the EHR system used throughout the outpatient clinics of a large tertiary care Department of Veterans Affairs (VA) facility. Researchers randomly selected 1 percent of the total ASR alerts and reviewed them to determine each one’s importance, its sender’s role, its reason for giving an alert and whether its message was communicated in another manner.
According to the results of their analysis, researchers determined 39 percent of providers’ ASR alerts came from members of their primary care team, that 54 percent were of high value, 26 percent came from the telephone triage service and 99 percent of ASR alerts were for messages that were not communicated in another manner. Additionally, they determined notes contained a median of 142 words, of which 19.7 percent were relevant to the receiving provider, and 40 percent of ASR alerts were regarding medication refill requests.
“Approximately half of EHR-based alerts for clinician-to-clinician messaging were of high value, but inefficiencies in information transfer required primary care providers to read through large amounts of extraneous text to find relevant information,” wrote Daniel R. Murphy, MD, of the Michael E. DeBakey VA Medical Center in Houston, along with his colleagues. “Few alerts were deemed nonessential, but in conjunction with the low percentage of relevant text in parent notes, they likely lead to a perception of information overload from ASR alerts.”
Researchers suggested several solutions to the problems posed by ASR alerts, such as assigning follow-up duties to support staff and allowing senders to highlight relevant text.
“Because clinician-to-clinician messaging is likely to increase as systems become more integrated, our study might be useful to others as they explore interventions to improve outpatient communication,” Murphy concluded.