COVID-19 Exacerbated Gender Disparity in EHR Message Burden

While the COVID-19 pandemic increased patient EHR message volume across specialties, women physicians experienced a significantly greater message increase, according to a study published in JAMIA.  

Researchers analyzed EHR metadata on UCSF Health physician inbox messaging for the pre-COVID (August 27, 2018–September 30, 2019) and post-COVID onset periods (August 31, 2020–September 27, 2021).

Prior studies have found that women physicians spend more time on the EHR in total, after-hours, and on clinical documentation. Additionally, women physicians receive more messages from patients and staff members. Increased EHR work, particularly after-hours, has been linked with burnout.

Optimizing the experiences of women physicians is crucial, given a higher prevalence of burnout and a growing share of women physicians in the healthcare workforce.

The researchers noted that at the same time, it is critical to balance inbox work optimization with high quality care, as research has revealed that greater EHR inbox time is associated with better patient health outcomes for primary care physicians.

The disparity in messages sent by women physicians was driven primarily by more responses to patient-initiated messages.

“These results suggest that women physicians are responding to a higher demand for communication from patients as compared to male colleagues,” the authors wrote. “Future work should examine policies, technologies, and organizational interventions to alleviate differential messaging burden by gender while maintaining access to care for patients.”

For example, artificial intelligence (AI)-based message content has the potential to draft empathetic answers to patient questions. Future studies should examine how this content may help support patient communication methods for physicians, particularly women physicians.

“Optimization of team-based care models, in which non-physician members of the team partner with physicians to contribute to care plans and patient communication, may also help balance the workload emanating from electronic inbox messaging,” the authors suggested.

The researchers noted that the study is limited, as it includes data from a single academic institution that may not generalize to all physicians. The study also only examined patient messaging rather than all messages received.

“Further, organizations with different workflows for non-physician team members routing and answering electronic inbox messages may have different levels of gender disparities in inbox messaging,” they acknowledged.