Inbox Management

Steps for Creating an Optimal Inbox

From AMA: https://edhub.ama-assn.org/steps-forward/module/2702694#resource

1. Talk with IT about restructuring your inbox 

2. Identify the types of messages that could be routed to other team members

   • Three categories of messages:

     • Require direct physician management 

     • Can be directed to other team members 

     • Not relevant to patient care or clinic business, should be filtered or deleted 

   • Examples of messages to shift to MAs, RNs, LPNs: 

     • Refill requests 

     • Referral requests 

     • General patient questions 

   • Examples of messages physicians don’t need to flow into physician inbox: 

     • Daily progress notes for hospitalized patients 

     • Nurse visit notes for preventive care  

     • Routine physical therapy notes 

   • Alternative option – route all messages to RNs and clinical support staff 

     • Staff takes care of messages that do not require physician management 

     • For messages that require physician input: 

       • Nurse researches question 

       • Nurse and physician verbally discuss question and response 

       • Nurse responds to message 

     • This approach could save a physician an hour or more each day 

3. Work with IT to restructure your EHR  

   • Re-route messages to appropriate staff as described above 

   • Consolidate folders to decrease the number of different items flowing to your in-basket. 

   • Have IT use filters to prevent items from going into your inbox that you are not directly responsible for handling, or that have no direct bearing on patient care 

   • Develop smart phrases for: 

     • Responding to common items in the inbox, such as normal test results 

     • Promoting standardization for prescriptions and other items 

   • Incorporate flags or check boxes to help prioritize or route messages that need a particular team member’s prompt attention 

4. Create a team pool and team pool in-basket to help redistribute and streamline work 

   • Each physician/advanced practitioner has a core team of MAs/LPNs/RNs  

   • These core team members always work with the same practitioner and are only able to sign-in to their team in-basket 

   • One in-basket holds all requests for one physician 

   • Sub-folders are created for messages to be organized 

     • Examples: 

       • Refills 

       • CC’d charts 

       • Patient calls 

       • Results notes 

       • Staff messages 

   • Team handles items to the top of their licensure 

   • High priority messages are re-routed to physician inbox or team verbally notifies physician 

   • Team pool in-basket assignment template available in Toolkit and on AMA website 

5. Empower staff to contribute by utilizing principles of team-based care 

6. Develop workflows for common in-basket tasks, such as:  

   • Standardizing prior authorizations 

   • Eliminating or automating repeated tasks 

   • Delegating screening of portal requests 

   • Anticipating needs of complex patients