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Research Letter |

The Burden of Inbox Notifications in Commercial Electronic Health Records

Daniel R. Murphy, MD, MBA1,2; Ashley N. D. Meyer, PhD1,2; Elise Russo, MPH1,2; Dean F. Sittig, PhD3,4; Li Wei, MS1,2; Hardeep Singh, MD, MPH1,2
[+] Author Affiliations
1Houston Veterans Affairs Center for Innovations in Quality, Effectiveness, and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas
2Department of Medicine, Baylor College of Medicine, Houston, Texas
3University of Texas Health Science Center at Houston’s School of Biomedical Informatics
4University of Texas–Memorial Hermann Center for Healthcare Quality and Safety, Houston
JAMA Intern Med. 2016;176(4):559-560. doi:10.1001/jamainternmed.2016.0209.
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This study quantifies the notifications that physicians received via inboxes of commercial electronic health records to estimate their burden.

With wider use of electronic health records (EHRs), physicians increasingly receive notifications via EHR-based inboxes (eg, Epic’s In-Basket and General Electric Centricity’s Documents). Examples of types of notifications include test results, responses to referrals, requests for medication refills, and messages from physicians and other health care professionals.1,2 Previous work within the Department of Veterans Affairs found that health care professionals receive large quantities of EHR-based notifications, making it harder to discern important vs irrelevant information and increasing their risk of overlooking abnormal test results.36 Information overload is of emerging concern because new types of notifications and “FYI” (for your information) messages can be easily created in the EHR (vs in a paper-based system). Furthermore, the additional workload to read and process these messages remains uncompensated in an environment of reduced reimbursements for office-based care.1,2,4 Conversely, EHRs make it easier to measure the amount of information received. We quantified the notifications that physicians received via inboxes of commercial EHRs to estimate their burden.

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Figure.
Quantities and Types of Notifications Received by Site and Physician Role

Primary care providers (PCPs) received an overall mean of 76.9 notifications per day (blue line). Specialists (site A only) received a mean of 29.1 notifications per day (P < .001).

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