Dead Weight
A lot of my time, these days, is spent helping medical systems redesign their workflows. One of the first steps in that work is identifying the pain points in the existing system--the components of the system that cause the most waste, inefficiency, frustration and rancor--and there’s one that consistently rises near the top: the electronic inbox.
I’m not sure anyone would have predicted this, back when we were all eagerly anticipating the Electronic Health Record revolution. Who knew that his handy little device to gather up all of our various tasks in one place would become the bane of our existence. And yet, here we are.
Here are the top five reasons all providers hate electronic inboxes:
They are always full. The inflow of tasks is constant, and seemingly endless. You can clear it out one day, and find it full to the brim by noon the next day. And woe to anyone who dares to go on vacation.
They contain hidden dangers. Not only are they full, but in that tsunami of random tasks, there are always a few that can’t or shouldn’t wait. You just don’t know which ones they are. Among your fifty abnormal lab results, is there a Hct of 18 hiding? In all those refill requests, has someone run out of their rescue inhaler, and they’re curled up on their sofa gasping for breath? It’s like a haunted house, with real almost-corpses.
They are full of things you shouldn’t have to do. Routine refills, normal labs, forms that need signing, records to review. The vast majority of tasks either could or should be done by someone else, or shouldn’t have been generated in the first place.
They require a continuously broken stream of thought. Open the chart, review the patient, complete and document the chart, sign and close the chart. Repeat. Repeat. Repeat. Each task requires a completely different context and focus. It’s like being on an assembly line where every item that you have to work on is a different part of a different vehicle of a different brand.
They keep you from doing more important things. Every mind-numbing hour spent on the inbox is another hour not connecting with patients, not expanding your knowledge, and not having dinner with your family.
Because providers hate the inbox, they often end up ignoring it. Tasks pile up, creating a burden and sense of dread for the provider. Problems go undiscovered or unaddressed. Patients get frustrated and keep calling in, creating more tasks. It takes a lot of thought and planning, not to mention additional resources, to deal with the inbox more effectively, and that’s why so few systems have taken it on. But over time, the collective weight of the inboxes becomes an anchor that drags behind the entire system, slowing it to a crawl.
