Understanding Primary Care Inbox Management: A Qualitative Study of Patient Message Prioritization and Inbox Workflow

<h3>Context</h3> Patient messaging to providers has dramatically increased since the pandemic, leading to informatics efforts to categorize messages to facilitate more efficient review. The increased inbox burden has particularly impacted primary care physicians. <h3>Objective</h3> Our goal was to examine how message prioritization (as distinct from categorization) occurs in primary care, and to understand the approaches primary care clinicians deployed for managing their inbox workflows. <h3>Study Design</h3> Semi-structured interviews and inbox work observations at MedStar Health. <h3>Setting</h3> Video call and screen share via Teams. <h3>Population Studied</h3> 10 female primary care providers and 1 male providers. <h3>Intervention</h3> n/a <h3>Outcome Measures</h3> We analyzed interview and observation transcripts and identified top themes and subthemes related to inbox message prioritization and inbox management workflows. <h3>Results</h3> Clinicians widely reported that they did not prioritize messages within their inboxes, primarily due to time constraints in the clinical environment and the necessity of attending to all messages, which made any prioritization or organization exercises purely additive to overall inbox time. Beyond our findings related to prioritization, we identified six themes and 14 subthemes related to clinicians’ approaches to managing their inbox workloads. The top three themes were 1) establishing workflow norms with different teams, in particular with medical assistants; 2) boundary-setting with patients, other clinicians, and with themselves; and 3) message classification heuristics that allowed clinicians to mentally categorize messages that required follow-up, messages that could be quickly deleted or acknowledged, and purely informational messages that ranged in clinical utility from tedious to valuable for care coordination. <h3>Conclusion</h3> Clinicians generally lack the time to prioritize patient messages. Future research should explore the efficacy of collaborative inbox workflows for time-savings and efficient management of patient messages as well as how to best implement these workflows with diverse teams.