Abstract
OBJECTIVES: Patient messaging to clinicians has dramatically increased since the pandemic, leading to informatics efforts to categorize incoming messages. We examined how message prioritization (as distinct from categorization) occurs in primary care, and how primary care clinicians managed their inbox workflows. MATERIALS AND METHODS: Semi-structured interviews and inbox work observations with 11 primary care clinicians at MedStar Health. We analyzed interview and observation transcripts and identified themes and subthemes related to prioritization and inbox workflows. RESULTS: Clinicians widely reported that they did not prioritize messages due to time constraints and the necessity of attending to all messages, which made any prioritization purely additive to overall inbox time. We identified 6 themes and 14 subthemes related to managing inbox workloads. The top themes were (1) establishing workflow norms with different teams, primarily medical assistants (MAs); (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. DISCUSSION: Time constraints in primary care prevent clinicians from prioritizing their inbox messages for increased efficiency. Involvement of MAs and co-located staff was successful; however, standardization was needed for messaging workflows that involved centralized resources like call centers. Organizations should consider ways in which they can support the establishment and maintenance of boundaries, to avoid this responsibility falling entirely on clinicians. CONCLUSION: Clinicians generally lack the time to prioritize patient messages. Future research should explore the efficacy of collaborative inbox workflows for time-savings and management of patient messages.