Reduction in EHR Inbox Notifications Not Enough to Cut Clinician Burnout

Reducing EHR inbox notifications in the primary care setting did not have a measurable effect on clinician burnout, according to a study published in AJMC.

In 2017, the Veterans Health Administration (VHA) led an initiative to reduce low-value EHR inbox notifications. Each facility formatted its EHR to include a mandatory set of notifications based on VHA and facility priorities and trained PCPs in EHR customization of optional notifications.

Researchers estimated the share of PCPs experiencing clinician burnout using VHA All Employee Survey responses before and after the initiative in 2016 and 2018. The study aggregated survey responses from 6,459 PCPs at 138 VHA facilities.

The VHA initiative resulted in increases and decreases in notification volumes for PCPs. In both instances, there was not a measurable impact on clinician burnout.

Additionally, although the initiative focused on reducing burdensome EHR messages, inbox optimization did not always result in fewer notifications. Almost 20 percent of facilities in the study experienced an increase in notification volume post initiative.

“The multisite nature of this study demonstrates the wide range in notification volumes that PCPs may experience, depending on personal and organizational preferences,” the study authors wrote.

“Also, some VHA facilities had already made substantive improvements to their inbox systems, reducing notifications prior to the initiative,” the researchers pointed out. “These facilities may have increased their notification volumes because they were required to comply with the initiative.”

The study authors noted that despite contributing to notification volume, some notifications likely contributed little to notification-related workload, whereas others contributed more.

For instance, the initiative emphasized reducing duplicative notifications and notifications that required reading time but not additional PCP actions, which may not have been time intensive.

“Notification volume alone may be a poor measure of the actual effort required for inbox management,” the researchers wrote. “Although substantial increases and decreases in notification volume may reflect improved EHR utilization, changes in notification volume may not have influenced aspects of EHR-related workload that are predictive of burnout.”

“Assessment of notification type, value, and cognitive burden may improve measures of EHR notification burden, which may then be associated with burnout,” they continued. “Further work is needed to understand how time spent on low-value notifications and sufficient work time to respond to notifications can influence PCP fatigue and burnout.”

The researchers said health systems should collaborate with providers to address clinician burden through EHR optimization.

“PCPs spend more time on inbox messaging than do clinicians in other medical or surgical specialties, and interventions reducing EHR work burden should consider PCPs’ specific needs,” the study authors wrote. “Collaboration between health system leaders and PCPs on EHR design, with a focus on staff well-being, is essential.”