Exploring the Impact of In Basket Metrics on the Adoption of a New Electronic Health Record System Among Specialists in a Tertiary Hospital in Alberta: Descriptive Study (Preprint)
Authors: Avdagovska Melita , Kuziemsky Craig , Koosha Helia , Hadizadeh Maliheh , Pauly Robert P , Graham Timothy , Stafinski Tania , Bigam David , Kassam Narmin , Menon Devidas 
Published: October 2023

BACKGROUND

Health care organizations implement electronic health record (EHR) systems with the expectation of improved patient care and enhanced provider performance. However, while these technologies hold the potential to create improved care and system efficiencies, they can also lead to unintended negative consequences, such as patient safety issues, communication problems, and provider burnout.

OBJECTIVE

This study aims to document metrics related to the In Basket communication hub (<i>time in In Basket per day, time in In Basket per appointment, In Basket messages received per day,</i> and <i>turnaround time</i>) of the EHR system implemented by Alberta Health Services, the province-wide health delivery system called Connect Care (Epic Systems). The objective was to identify how a newly implemented EHR system was used, the timing of its use, and the duration of use specifically related to In Basket activities.

METHODS

A descriptive study was conducted. Due to the diversity of specialties, the providers were grouped into <i>medical</i> and <i>surgical</i> based on previous similar studies. The participants were further subgrouped based on their self-reported clinical full-time equivalent (FTE ) measure. This resulted in 3 subgroups for analysis: <i>medical FTE &lt;0.5</i>, <i>medical FTE &gt;0.5</i>, and <i>surgical</i> (all of whom reported <i>FTE &gt;0.5</i>). The analysis was limited to outpatient clinical interactions and explicitly excluded inpatient activities.

RESULTS

A total of 72 participants from 19 different specialties enrolled in this study. The providers had, on average, 8.31 appointments per day during the reporting periods. The providers received, on average, 21.93 messages per day, and they spent 7.61 minutes on average in the <i>time in In Basket per day</i> metric and 1.84 minutes on average in the <i>time in In Basket per appointment</i> metric. The time for the providers to mark messages as <i>done</i> (<i>turnaround time</i>) was on average 11.45 days during the reporting period. Although the surgical group had, on average, approximately twice as many appointments per scheduled day, they spent considerably less <i>connected time</i> (based on almost all time metrics) than the medical group. However, the surgical group took much longer than the medical group to mark messages as <i>done</i> (<i>turnaround time).</i>

CONCLUSIONS

We observed a range of patterns with no consistent direction. There does not seem to be evidence of a “learning curve,” which would have shown a consistent reduction in time spent on the system over time due to familiarity and experience. While this study does not show how the included metrics could be used as predictors of providers’ satisfaction or feelings of burnout, the use trends could be used to start discussions about future Canadian studies needed in this area.