ArticleJAMA network open2019
An Exploration of Barriers, Facilitators, and Suggestions for Improving Electronic Health Record Inbox-Related Usability: A Qualitative Analysis.
Article in JAMA network open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04166240 (Measuring and Improving the Safety of Test Result Follow-Up), which is not on this map. Cited by 28 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Measuring and Improving the Safety of Test Result Follow-Up
Who cites it
28 citing papers in PubMed, 3 syntheses or guidelines pooled it, 45 citations in OpenAlex.
- Impact of Large Language Model-Based AI Tools on Physician-Patient Communication: Systematic Review and Meta-Analysis.Journal of medical Internet research · 2026Pooled it
- Optimizing Clinical Decision Support System Functionality by Leveraging Specific Human-Computer Interaction Elements: Insights From a Systematic Review.JMIR human factors · 2025Pooled it
- The impact of eHealth use on general practice workload in the pre-COVID-19 era: a systematic review.BMC health services research · 2024Pooled it
- Optimizing Resident Experience in Continuity Clinic: Recommendations for Internal Medicine Residency Training-A Report from the Society of General Internal Medicine (SGIM) and Association of Chiefs and Leaders of General Internal Medicine (ACLGIM) Hess Initiative Work Group on Learner Experience in Primary Care.Journal of general internal medicine · 2026Article
- A scoping review of studies on secure messaging through patient portals: persistent challenges and potential solutions.npj health systems · 2026Article
- Taming the In-Basket-How Two Simple Tools Reduced Portal Message Volume in an Academic Internal Medicine Clinic.Journal of general internal medicine · 2025Article
- Utilization of Generative AI-drafted Responses for Managing Patient-Provider Communication.NPJ digital medicine · 2025Article
- Bridging Global Frameworks and Local Practice: Quantitative Evaluation of Electronic Health Record Safety in Kuwait's Public Hospitals.JMIR medical informatics · 2025Article
- Networked Behaviors Associated With a Large-Scale Secure Messaging Network: Cross-Sectional Secondary Data Analysis.JMIR medical informatics · 2025Article
- Burden of administrative responsibilities in primary care: Qualitative study.Canadian family physician Medecin de famille canadien · 2025Article
- Primary care staff members' experiences with managing electronic health record inbox messages.Journal of the American Medical Informatics Association : JAMIA · 2025Article
- Assessment of EHR Efficiency Tools and Resources Associated with Physician Time Spent on the Inbox.Journal of general internal medicine · 2024Article
- A holistic view of facilitators and barriers of electronic health records usage from different perspectives: A qualitative content analysis approach.Health information management : journal of the Health Information Management Association of Australia · 2024Article
- Medical and nursing clinician perspectives on the usability of the hospital electronic medical record: A qualitative analysis.Health information management : journal of the Health Information Management Association of Australia · 2024Article
- Electronic Health Records' Support for Primary Care Physicians' Situation Awareness: A Metanarrative Review.Human factors · 2023Review
- Moving Away from Chaos: Intentional and Adaptive Management of the Non-visit Care River.Journal of general internal medicine · 2023Article
- Electronic Co-design (ECO-design) Workshop for Increasing Clinician Participation in the Design of Health Services Interventions: Participatory Design Approach.JMIR human factors · 2022Article
- Evaluation of an Electronic Medical Record Module for Nursing Documentation in Paediatric Palliative Care: Involvement of Nurses with a Think-Aloud Approach.International journal of environmental research and public health · 2022Observational
- Using Log Data to Measure Provider EHR Activity at a Cancer Center during Rapid Telemedicine Deployment.Applied clinical informatics · 2021Article
- Building the evidence-base to reduce electronic health record-related clinician burden.Journal of the American Medical Informatics Association : JAMIA · 2021Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
Importance: Managing messages in the electronic health record (EHR) inbox consumes substantial amounts of physician time. Certain factors associated with inbox management, such as poor usability and excessive and unnecessary inbox messages, have been associated with physician burnout. Additionally, inbox design, usability, and workflows are associated with physicians' situational awareness (ie, perception, comprehension, and projection of clinical status) and efficiency of processing EHR inbox messages. Understanding factors associated with inbox usability could improve future EHR inbox designs and workflows, thus reducing risk of burnout while improving patient safety. Objective: To determine barriers, facilitators, and suggestions associated with EHR inbox-related usability. Design, Setting, and Participants: This qualitative study included cognitive walkthroughs of EHR inbox management with 25 physicians (17 primary care physicians and 8 specialists) at 6 large health care organizations using 4 different EHR systems between May 6, 2015, and September 19, 2016. While processing EHR inbox messages, participants identified facilitators and barriers associated with EHR inbox situational awareness and processing efficiency and potential interventions to address such barriers. A qualitative analysis was performed on transcribed recordings using an inductive thematic approach with an 8-dimension sociotechnical model as a theoretical lens from May 6, 2015, to August 15, 2019. Results: The cognitive walkthroughs identified 60 barriers, 32 facilitators, and 28 suggestions for improving the EHR inbox. Emergent data fit within 5 major themes: message processing complexity, inbox interface design, cognitive load, team communication, and inbox message content. Within these themes, similar barriers were identified across sites, such as poor usability due the high numbers of clicks needed to accomplish actions. In certain instances, an identified facilitator at one site provided the exact solution needed to address a barrier identified at another site. Conclusions and Relevance: This qualitative study found that usability of the EHR inbox is often suboptimal and variable across sites, suggesting lack of shared best practices related to information management. Implementation of optimized design features and workflows will require EHR developers and health care organizations to collectively share this responsibility. Development of regional or national consortia to support collaborative sharing and implementation of EHR system best practices across EHR developers and health care organizations could also improve safety and efficiency and reduce physician burnout.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.