Patient messages via Epic increased during COVID-19, raising burnout concerns

A research letter published this week in the Journal of the American Medical Association Network Open found that physicians saw a “small but sustained” increase in patient message volume during the first 15 months of the COVID-19 pandemic.  

By analyzing more than 10 million messages to 419 unique clinicians from 38 specialties across 141 practice sites, researchers from the Yale University School of Medicine and the Mayo Clinic found that ambulatory physicians spent more time in their inbox amidst the public health emergency.  

“Given the existing physician burnout crisis and the already known pandemic-related stressors and risks to the physician workforce, the additional inbox burden reported here warrants additional exploration to assess the nature of pandemic-related medical advice requests and the generalizability of these findings,” wrote researchers.  


The research team relied on de-identified electronic health record metadata from Epic Systems’ Signal. They examined inbox messages sent to physicians in a large ambulatory practice network in New England from March 2018 to June of this year.

Between March 2020 and this June, the average total messages per day increased from 45.0 to 46.0 for primary care physicians, from 29.3 to 32.0 messages per day for medical physicians, and from 16.6 to 23.3 messages per day for surgical physicians.  

Patient-originated messages also increased, with average numbers more than doubling for primary care physicians, medical physicians and surgical physicians.  

Unsurprisingly, time in the inbox also increased across specialties – and researchers note this is likely an underestimation based on how Signal tracks such activity.  

At the same time, the message increase did not displace patient calls.  

“Consistent with national trends, during 2020 COVID months, monthly in-person visits decreased for all specialties … whereas telehealth visits increased,” noted the researchers.    

“The number of unique patients seeking care during the pandemic decreased for primary care and medical specialties through June 2021 but increased for surgical specialties in 2021,” they added.  


Clinicians and support staff have repeatedly cited patient communications and patient-generated data as contributing to feelings of burnout. This, in turn, has led stakeholders to propose new EHR workflows and redesigns to make the process more intuitive.   

But the correlation between time spent in the EHR and job departure is perhaps more complex than originally hypothesized.  

Researchers in another study published earlier this week found that physicians who spent less time in the EHR were more likely to leave their jobs.  


“With COVID-19 potentially remaining a long-term endemic threat to public health, the priority to systematically address inbox burden before the pandemic through workflow redesign, team-based inbox management, and consideration of reimbursement for inbox-related work remains,” wrote researchers in the recent study in JAMA Network Open.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]
Healthcare IT News is a HIMSS Media publication.

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