‘Inboxologists’, chatbots among tools medical practices use to manage patient messages

Physicians and medical offices are often overwhelmed with administrative tasks like responding to dozens of patient portal messages. To help lighten the load, some health systems are using creative human and machine-powered solutions. For example, last year, Corewell Health West in Grand Rapids, Mich., started an "inboxologist" pilot program at two of its large primary care practice sites.

Through this workflow, a registered nurse completes an initial triage of so-called "in-basket messages" arriving through the patient portal, while an advanced practice provider like a physician assistant or nurse practitioner serves as a second-line "inboxologist" to further manage patient requests.

Highlighting practices' attempts to manage patient requests while also reducing burnout among their providers is an interesting trend for journalists to cover. Reporting on these innovative solutions may encourage other medical offices or health systems to develop their own innovative management tools.

Easing the burden

Administrators at Corewell found that since 2019, primary care physicians experienced a 330% increase in their in-basket messages from patient portal messaging, e-visits and consults from other clinicians and departments.

"This issue was discussed as a top barrier to achieving work-life balance and job satisfaction, and was thought to be unsustainable," the authors wrote in an article about the program in NEJM Catalyst.

Through their pilot, patient messages related to non-urgent medical questions, visit follow-up questions and questions related to medication or test results are automatically routed to the registered nurse. The RN, using clinical guidelines, responds to simple questions about medical conditions or symptoms, and provides education on topics like preventive care and vaccines. The RN also can schedule in-person visits using the electronic health record.

The RN routes messages requiring advanced clinical decision-making such as medication side effects or dose changes, complex problems with new symptoms, and messages that require the creation of orders, to the advanced practice provider inboxologist. That person can address questions, create referrals, authorize prescription refills and provide an e-visit if warranted. With this system, far fewer messages are triaged up to the primary care providers.

Over several months of the pilot:

• Primary care providers handled 41% fewer in-basked messages.
• They spent an average of 47% less time on messages they received.
• Time to resolution of patient messages decreased by 93%.

Corewell plans to expand the program to all of its primary care sites and selected specialty practices.

A similar approach was adopted by Cooper Care Alliance, a community-based physician group in Camden, N.J., which built its own inboxologist program, Becker's Health IT reported. The group hired a registered nurse with 20 years of experience as their first inboxologist to scan the phone and online portal messages to generate appropriate appointments. The RN can triage emails to the right practitioner, prescribe medications, give advice following an office visit, order and interpret lab work, and more. Physicians working with her reported 25% fewer messages at the end of the day.

"I believe this will be the norm five years from now," Greg Taylor, D.O., the practice's medical director, told SJ Mag Media. "And both patients and providers will benefit from this new approach."

AI tools are also in play for patient responses

Some health systems are embracing tools powered by artificial intelligence to keep up with patient demand for information:

• About 15,000 doctors at more than 150 health systems are using a new AI feature in the MyChart patient portal communications platform to draft replies to messages sent by patients, the New York Times reported in September. The tool, called In Basket Art, crafts responses using a version of GPT-4, the same technology underlying ChatGPT. It pulls in context from patients' prior messages and information such as medication lists from their electronic health records to create a draft message that providers can approve or change, according to the Times.

• Johns Hopkins Medicine launched a new chatbot feature on many clinical department webpages to provide patients with online access to appointment information. The tool allows patients to review, cancel or reschedule appointments. Departments using the tool include dermatology, urology, neurology/neurosurgery, psychiatry, the cancer center and more.

• Community Health Systems in Franklin, Tenn., deployed a conversational AI tool within its patient access center, which serves nearly 1,000 primary care providers and handles more than 25,000 calls a day, Becker's Health IT reported. In its initial phase, the AI bot is being used to authenticate the identity of callers, understand the reason for their calls and capture additional information before transferring callers to a human agent for further assistance. The health system announced this initiative already has resulted in a notable reduction in total call time, creating "immediate efficiencies" and freeing agents to handle more complex patient needs.

Interestingly, one recent study found that nurses at UC Health in Colorado, more than their physician or medical assistant colleagues, liked using AI-generated MyChart messages. Nurses most liked the tool's efficiency, empathy and tone and were most likely to say the AI helped them stay within their scope of practice and reduced the need to forward messages, Becker's Health IT reported.

However, physicians and advanced practice providers may get more complex messages that are harder for AI programs to interpret, so the platforms may need to be refined to filter who receives which messages, the story said.

Story ideas

Reporters could follow several story angles in this type of reporting.

• How are your local health systems handling patient messages? Are they doing anything creative?
• How are patients and staff responding to these programs?
• What is the market for innovative tech tools to handle patient in-box messages and other queries?

Resources

• The "Inboxologist" - A Novel Approach to In-Basket Management in Primary Care - NEJM Catalyst
• Cooper: The Inboxologist - SJ Mag media
• That Message From Your Doctor? It May Have Been Drafted by A.I. - New York Times
• CHS deploys 'conversational AI' bot systemwide: 5 thing to know - Becker's Health IT