When you send a message to your doctor through an online patient portal, you may be wondering where that message goes and how your care team will address your concerns. Or maybe you'll get the answer you're looking for and your questions will be answered. A portal is definitely more convenient than being transferred through a phone line and having to wait a long time on hold. Your messages also become part of your electronic medical record and can be referenced if you need to follow up.
For primary care offices, patient portals also offer clear advantages: Written portal messages aren't too quiet to hear or drowned out by background noise, but are efficiently stored in a relay station called an inbox or basket, where they can be quickly viewed and acted upon by any member of the patient's care team. In fact, they're so advantageous for patients and medical offices that their use has grown exponentially since their introduction in the late 1990s.
They may not have imagined that messages would flood physicians’ inboxes, exceeding many practices’ ability to respond in a timely manner. Practices have tried various approaches to limit portal messages, such as informing them that a response may take up to 48 hours or outlining specific matters that are best suited for this type of outreach.
The reality is that modern life has become and will continue to become increasingly dependent on technology-driven, asynchronous communication. These tasks must be built into already busy office schedules, and despite team-based workflows designed to ease the burden, inbox overload is a major contributor to clinician frustration and burnout.
Enter Inboxology, a newest medical “specialty” created to combat inbox task overload. Inboxologists are clinicians (physicians or advanced practice physicians) who focus primarily on inbox tasks such as responding to their own and their colleagues' patient portal messages, renewing prescriptions, evaluating abnormal lab results, etc. This novel idea is already being put into practice in many health systems across the country.
Inboxology is not a specialty that requires special training or board certification, like cardiology, neurology, etc. Rather, it is a new role where multitasking clinicians have designated time between patient visits or during their personal time outside of work hours to perform standard, routine inbox-related tasks.
You may be thinking, wait a minute, shouldn't my doctor respond to my message? In some cases, they may do so if continuity of care for a complex issue takes priority. However, in many cases, it may be better to receive a response from a doctor who doesn't have competing responsibilities and can focus more on your portal questions. This process allows the office-based doctor to give their best attention to you, the patient, in the office with them.
Expanding Inboxology presents some unique challenges, including raising awareness of clinicians' roles and getting clinician and patient buy-in. Then there's the issue of reimbursement: Clinics and health systems don't typically charge patients for responding to messages, but some are now starting to charge patients and/or insurance companies. Revenues earned through value-based payer incentives could also be used to fund Inboxology services.
Primary care is changing and evolving to better meet patient needs while also finding ways to ease the burden on overworked clinicians and staff. Like scribes to help enhance consultation notes, telehealth, and out-of-hours care, inboxology is a creative innovation. Only time will tell if it will be the Blackberry or the iPhone.
Jeffrey Milstein is an internist and regional medical director for Pennsylvania Primary Care.
