{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T06:43:04Z","timestamp":1773384184545,"version":"3.50.1"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2020,10,16]],"date-time":"2020-10-16T00:00:00Z","timestamp":1602806400000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Permanente Medical Group via its Delivery Science Research Program"},{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["1704889"],"award-info":[{"award-number":["1704889"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,4,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>Electronic health record systems are increasingly used to send messages to physicians, but research on physicians\u2019 inbox use patterns is limited. This study\u2019s aims were to (1) quantify the time primary care physicians (PCPs) spend managing inboxes; (2) describe daily patterns of inbox use; (3) investigate which types of messages consume the most time; and (4) identify factors associated with inbox work duration.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We analyzed 1 month of electronic inbox data for 1275 PCPs in a large medical group and linked these data with physicians\u2019 demographic data.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>PCPs spent an average of 52 minutes on inbox management on workdays, including 19 minutes (37%) outside work hours. Temporal patterns of electronic inbox use differed from other EHR functions such as charting. Patient-initiated messages (28%) and results (29%) accounted for the most inbox work time. PCPs with higher inbox work duration were more likely to be female (P &amp;lt; .001), have more patient encounters (P &amp;lt; .001), have older patients (P &amp;lt; .001), spend proportionally more time on patient messages (P &amp;lt; .001), and spend more time per message (P &amp;lt; .001). Compared with PCPs with the lowest duration of time on inbox work, PCPs with the highest duration had more message views per workday (200 vs 109; P &amp;lt; .001) and spent more time on the inbox outside work hours (30 minutes vs 9.7 minutes; P &amp;lt; .001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Electronic inbox work by PCPs requires roughly an hour per workday, much of which occurs outside scheduled work hours. Interventions to assist PCPs in handling patient-initiated messages and results may help alleviate inbox workload.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocaa229","type":"journal-article","created":{"date-parts":[[2020,9,4]],"date-time":"2020-09-04T03:34:18Z","timestamp":1599190458000},"page":"923-930","source":"Crossref","is-referenced-by-count":61,"title":["Physicians\u2019 electronic inbox work patterns and factors associated with high inbox work duration"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5638-6836","authenticated-orcid":false,"given":"Fatema","family":"Akbar","sequence":"first","affiliation":[{"name":"Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, California, USA"}]},{"given":"Gloria","family":"Mark","sequence":"additional","affiliation":[{"name":"Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, California, USA"}]},{"given":"E. Margaret","family":"Warton","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, California, USA"}]},{"given":"Mary E","family":"Reed","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, California, USA"}]},{"given":"Stephanie","family":"Prausnitz","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, California, USA"}]},{"given":"Jeffrey A","family":"East","sequence":"additional","affiliation":[{"name":"The Permanente Medical Group, Oakland, California, USA"},{"name":"Department of Adult and Family Medicine, Kaiser Permanente Richmond, Richmond, California, USA"}]},{"given":"Mark F","family":"Moeller","sequence":"additional","affiliation":[{"name":"The Permanente Medical Group, Oakland, California, USA"},{"name":"Department of Adult and Family Medicine, Kaiser Permanente Napa, Napa, California, USA"}]},{"given":"Tracy A","family":"Lieu","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland, California, USA"},{"name":"The Permanente Medical Group, Oakland, California, USA"}]}],"member":"286","published-online":{"date-parts":[[2020,10,15]]},"reference":[{"issue":"9","key":"2021101500055576300_ocaa229-B1","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1001\/jamapediatrics.2019.2309","article-title":"Unbounded\u2013parent-physician communication in the era of portal messaging","volume":"173","author":"Lieu","year":"2019","journal-title":"JAMA Pediatr"},{"issue":"1","key":"2021101500055576300_ocaa229-B2","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1001\/jamainternmed.2017.6325","article-title":"Communicating through a patient portal to engage family care partners","volume":"178","author":"Reed","year":"2018","journal-title":"JAMA Intern Med"},{"issue":"10","key":"2021101500055576300_ocaa229-B3","doi-asserted-by":"crossref","first-page":"809","DOI":"10.1097\/MLR.0000000000001178","article-title":"Portal use among patients with chronic conditions: patient-reported care experiences","volume":"57","author":"Reed","year":"2019","journal-title":"Med Care"},{"issue":"2","key":"2021101500055576300_ocaa229-B4","doi-asserted-by":"crossref","first-page":"e9","DOI":"10.2196\/jmir.5.2.e9","article-title":"Doctors who are using e-mail with their patients: a qualitative exploration","volume":"5","author":"Patt","year":"2003","journal-title":"J Med Internet Res"},{"issue":"7463","key":"2021101500055576300_ocaa229-B5","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1136\/bmj.329.7463.435","article-title":"Email consultations in health care: 1\u2014scope and effectiveness","volume":"329","author":"Car","year":"2004","journal-title":"BMJ"},{"issue":"12","key":"2021101500055576300_ocaa229-B6","first-page":"1513","article-title":"We got mail\u201d: electronic communication between physicians and patients","volume":"5","author":"Moyer","year":"1999","journal-title":"Am J Manag Care"},{"issue":"12","key":"2021101500055576300_ocaa229-B7","first-page":"e632","article-title":"Patient-initiated e-mails to providers: associations with out-of-pocket visit costs, and impact on care-seeking and health","volume":"21","author":"Reed","year":"2015","journal-title":"Am J Manag Care"},{"issue":"12","key":"2021101500055576300_ocaa229-B8","doi-asserted-by":"crossref","first-page":"e1918287","DOI":"10.1001\/jamanetworkopen.2019.18287","article-title":"Primary care physicians\u2019 experiences with and strategies for managing electronic messages","volume":"2","author":"Lieu","year":"2019","journal-title":"JAMA Netw Open"},{"issue":"6","key":"2021101500055576300_ocaa229-B9","doi-asserted-by":"crossref","first-page":"1142","DOI":"10.1093\/jamia\/ocx080","article-title":"Electronic health record adoption in US hospitals: the emergence of a digital \u201cadvanced use\u201d divide","volume":"24","author":"Adler-Milstein","year":"2017","journal-title":"J Am Med Inform Assoc"},{"issue":"10","key":"2021101500055576300_ocaa229-B10","doi-asserted-by":"crossref","first-page":"1817","DOI":"10.1377\/hlthaff.2013.1145","article-title":"Patient-to-physician messaging: volume nearly tripled as more patients joined system, but per capita rate plateaued","volume":"33","author":"Crotty","year":"2014","journal-title":"Health Aff (Millwood)"},{"issue":"4","key":"2021101500055576300_ocaa229-B11","doi-asserted-by":"crossref","first-page":"1432","DOI":"10.1007\/s00464-015-4347-y","article-title":"Rapid growth in surgeons\u2019 use of secure messaging in a patient portal","volume":"30","author":"Shenson","year":"2016","journal-title":"Surg Endosc"},{"issue":"3","key":"2021101500055576300_ocaa229-B12","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1207\/s15327590ijhc2103_3","article-title":"You\u2019ve got e-mail!\u201d\u2026 shall I deal with it now? 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