Combating a top burnout driver: Team streamlines patient portal communication

Electronic health record patient portal messaging has ushered in a new era of convenience and accessibility in health care, which was inflated during the COVID-19 pandemic.

Nevertheless, this dependency on technology comes with unintended consequences: high volumes of non-urgent messages, requests for flexible care, and a rise in aggressive and negative behavior in the patient portal.

Deeba Minhas, M.D., a rheumatologist, IHPI member and faculty associate with the Michigan Medicine Wellness Office, has taken up the mantle to address this issue affecting the well-being of physicians and staff throughout the organization.

Focused on the surge in patient portal volumes, Minhas collaborates with the In-Basket 360 (IB360) team to reduce this clinical burden.

Inspiration from other health care leaders

“I happened to be seen as a patient at Scripps Health, and was struck by the presence of informative wall signs conveying messages such as 'please be respectful of your care team,' fostering a culture of mutual respect within their environment,” Minhas said.

This ignited her curiosity about how this communication approach reflected within their portal.

“I was impressed by the clarity and conciseness of their portal layout, which offered clear guidance for portal usage and was easily navigable,” said Minhas.

Inspired by positive practices observed in San Diego and lessons from the pandemic, Minhas embarked on a mission to instill similar principles within the framework of Michigan Medicine.

“The kindest way to address these issues is to set clear expectations for patients on what can and cannot be addressed over the portal,” said Minhas. “Simple questions, or those related to a recent visit, medication or lab may be easier to address on the portal.”

Minhas outlined how non-urgent messages often contain new and complex complaints, requiring providers to spend considerable extra time reviewing records and attempting to decipher concerns from undirected messages.

“The absence of diagnostic details usually obtained from visits, often makes offering recommendations challenging, leading to frustration for both patients and providers,” said Minhas. “This leads to messages which may only require a quick response to be hidden in the overload of messages, adding to patient frustration due to delays in receiving responses.”

Portal updates

Minhas’ advocacy efforts led to the following portal improvements updates:

• Clear expectations for portal use
• Appropriate reasons to contact the clinic
• Respectful communication standards
• Guidance for minimizing lengthy/frequent messages
• Continued emphasis on response time expectations

(See screenshots at the bottom of the story for examples.)

A trauma-informed approach

Identifying a lack of guidance for patients regarding appropriate portal use, Minhas has worked to manage these expectations through clear and concise communication, applying the knowledge gained through her research agenda in chronic pain.

“A strong patient-provider relationship is key to good patient outcomes, to which trust is fundamental,” Minhas said.

Minhas emphasized that consistency, well-defined expectations and boundaries provide the safety needed to build this trust, especially with patients who come in for help in vulnerable states, with diverse backgrounds and life experiences. Data shows that aggressive and negative behavior in the portal has disproportionately affected women, minorities and early faculty.

When patients have feelings triggered by abandonment, rejection, frustration and fear, they may react in ways they usually would not and send aggressive or negative portal messages. By providing patients with clear requirements, the hope is there will be a reduction in the overall number and improvement in the content of messages.

“This trauma-informed approach enables us to deliver compassionate care while protecting the mental health of our providers and clinical staff,” Minhas said.

When asked about advice for those identifying areas of concern within the portal or patient communication, Minhas said: "Note issues and challenges you observe, talk with your colleagues about them and talk with your leaders about them. This continuous effort is essential for spreading awareness and advocacy for problems that affect our work experience.”

With the support of the Wellness Office, Minhas collaborated with The Patient Language and Expectation Setting subgroup of the Portal Oversight Committee including: Susan Anderson, Shannon Bellers, Greta Branford, M.D., Vicky Bristley, Joann Brooks, M.S.N., R.N., Chad Ellimoottil M.D., M.S., Haley Haddad, Kyle Heckaman, Jennifer Esch, Darnysus Jackson II, Kathleen Lindsey, Kera Luckritz, D.O., M.P.H, Ryan Massay MBBS, Rebecca Miller, Kathleen Ryan, Carrie Stewart, Christy Vassel and Amy Zhang, M.D. to redesign the U-M portal layout and make the changes live in late 2023.

This improvement is one of several brought forward by In Basket 360 (IB360), a cross-functional team, which includes members from Clinical Informatics, HITS, the Wellness Office, the Center for Healthcare Engineering and Patient Safety (CHEPS), ambulatory care and the U-M Health Enterprise Triad, which looks at the issue of in-basket burnout from every angle.

After gathering feedback, the team compiled a list of 87 changes within 11 categories to consider.

Following an impact analysis, they choose to focus on five key initiatives, while continuing with some pilots and easy wins already in process.