University of Pennsylvania Health System – Gold Winner of the Excellence Award for Healthcare Workers’ Wellbeing

The University of Pennsylvania Health System  recognized as Gold winner for the American Hospital Association Excellence Award for Healthcare Workers’ Wellbeing at the 2024 IHF Awards

Balancing patient empowerment and portal messaging demands within the electronic health record to mitigate staff burnout

In an effort to continuously improve services, healthcare institutions have opened communication lines with patients beyond in person encounters. Following the enactment of the 21st Century Cures Act in the US, new interoperability requirements for the EHR provide patients immediate access to their test results and medical records under certain circumstances even before their providers have had an opportunity to review them. Information Officer, operational leaders, innovations team, and provider informaticists. This allows for a more inclusive view in addressing the issues affecting the healthcare team across Penn Medicine’s six hospitals and 450 primary care and specialty practices in Pennsylvania and New Jersey. Notably, they have retracted more than 330 million outdated messages with feedback on improved system performance and have established parameters to automatically allow messages to expire after specified intervals to consistently declutter. As a result, this enables end users to focus on the most time-sensitive and clinically relevant messages. Finally, despite a sustained 21% annual increase in portal enrollment, they have only seen a 0.2% increase in prescription authorization requests because of their efforts.
Health Care Institutions have good intentions for opening such channels for addressing patients’ needs. However, it has also prompted more messages about details and interpretations for the healthcare team. It has given rise to “desktop medicine” – where clinicians communicate with patients through portals, address and follow-up on diagnostic results, fulfill documentation requirements, and coordinate care across the healthcare team. This rising volume of patient messaging is becoming an increasing risk factor for burnout for healthcare team members. The University of Pennsylvania Health System (Penn Medicine) found this alarming, as some providers now regularly spend a substantial amount of time addressing such patient concerns. Since 2020, Penn Medicine has observed an over 250% increase in patient messaging. This does not even account for the rise in other message types that further contribute to care team frustration, dissatisfaction, and cognitive burden.

In response, Penn Medicine launched an In Basket Optimization workgroup that has already implemented over 30 enhancements to improve the inbox experience and reduce clinician burden. Its goals were to optimize the EHR process, improve end-user wellbeing, and encourage a team-based approach in care delivery. The workgroup consists of over 75 members that meet monthly, led by the EHR Transformation Team. Members come from different backgrounds within the hospital including providers, nurses, clinical support staff, Information Services analysts and directors, members of the Chief Medical Information Officer, operational leaders, innovations team, and provider informaticists.
This allows for a more inclusive view in addressing the issues affecting the healthcare team across Penn Medicine’s six hospitals and 450 primary care and specialty practices in
Pennsylvania and New Jersey.

Actively supporting staff wellbeing

Over the past two years, Penn Medicine has maintained the goals initially established and continues to support clinicians’ responsibility to complete In Basket tasks and communicate with patients in a reliable and efficient manner. The team leverages EHR vendor usage data in order to inform and prioritize their initiatives for optimizing message content and management. Efforts requiring more thorough member deliberation led to the formation of smaller, dedicated subgroups to address topics like message routing configuration; system-level, standardized communication responses for certain message types; and workflows for medication refill requests. Their journey continues, and their institution has already benefited from many positive outcomes. Notably, they have retracted more than 330 million outdated messages with feedback on improved system performance and have established parameters to automatically allow messages to expire after specified intervals to consistently declutter. As a result, this enables end users to focus on the most time-sensitive and clinically relevant messages. Finally, despite a sustained 21% annual increase in portal enrollment, they have only seen a 0.2% increase in prescription authorization requests because of their efforts.

Feedback from the clinicians and operational partners at Penn Medicine has been tremendously positive. A survey of the In Basket Optimization Workgroup rated the effectiveness of the work with 5 out of 5 stars and reported the most impactful changes as having more tools available in the In Basket and increased awareness of In Basket functionality. Over 1,300 end users have received direct In Basket Education and even more have been made aware of the time-saving features and functionality. They created an In Basket Website and Digital
Resource Guide containing educational tip sheets, e-learnings, and best practice guidelines.