Table. Inbox Message Metrics Before and During the COVID-19 Pandemica.
| Variable | Primary care | Medical specialties | Surgical specialties | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Before COVID | During COVID | Change, % | Before COVID | During COVID | Change, % | Before COVID | During COVID | Change, % | |
| Message volume by category and inbox time per physician, per day, monthly weighted mean (IQR), No. of messagesb | |||||||||
| Total messagesc | 45 (22-63.7) | 46.0 (25.1-63.0) | 2.2 | 29.3 (15.5-36.7) | 32.0 (15.4-41.7) | 9.2 | 16.6 (8.4-21.0) | 23.3 (12.2-27.6) | 39.9 |
| Patient-originated messages (all categories)c | 8.1 (3.3-11.2) | 11.4 (6.7-16.7) | 40.5 | 5.2 (1.5-8.1) | 6.6 (2.0-9.8) | 25.4 | 1.8 (0.2-2.5) | 3.8 (0.6-4.7) | 114.8 |
| Patient medical advice request messagesc | 1.8 (0.5-2.4) | 3.9 (1.2-5.1) | 104.9d | 1.0 (0.1-1.3) | 2.2 (0.3-2.8) | 107.7d | 0.4 (0.1-0.4) | 1.1 (0.3-1.3) | 206.2d |
| Patient callc | 6.5 (2.7-8.6) | 7.8 (4.7-10.0) | 21.1 | 4.2 (1.3-6.7) | 4.4 (1.4-7.1) | 4.0 | 2.2 (0.7-3.6) | 2.7 (0.9-4.4) | 19.4 |
| Prescription renewal messagesc | 8.8 (1.9-13.3) | 8.9 (2.0-13.4) | 1.3 | 4.6 (1.2-6.9) | 4.9 (0.9-8.2) | 7.1 | 0.6 (0.1-0.5) | 1.2 (0.1-1.3) | 94.5 |
| Physician user–initiated messagesc | 9.7 (4.8-13.9) | 8.8 (4.4-11.0) | −9.0 | 6.4 (2.8-8.2) | 5.9 (2.5-8.0) | −7.7 | 4.7 (2.1-6.2) | 5.9 (2.3-8.1) | 27.2 |
| System-generated messagesc | 9.3 (4.7-11.8) | 8.2 (4.4-10.9) | −11.7 | 7.2 (3.3-9.1) | 8.0 (4.2-10.5) | 11.1 | 7.2 (3.2-8.9) | 4.5 (4.2-11.6) | −37.9 |
| Team member–generated messagesc | 9.5 (5.1-12.4) | 9.1 (5.1-12.0) | −4.3 | 6.4 (2.4-9.2) | 6.9 (2.4-9.7) | 7.9 | 2.6 (0.9-3.2) | 4.5 (1.1-5.0) | 74.7 |
| Time in inbox, mine | 21.7 (11.5-30.4) | 25.1 (15.2-33.9) | 15.6 | 13.4 (5.8-18.6) | 15.6 (7.9-21.0) | 16.6 | 7.6 (3.1-10.1) | 11.1 (3.3-14.7) | 46.1 |
| Visit volume and type per physician, per month, mean (IQR), No. | |||||||||
| Total visits (encounters) | 189.9 (128.8-257.3) | 193.9 (130.7-253.6) | 2.1 | 163.6 (95.9-220.4) | 173.3 (109.3-234.5) | 6.0 | 147.7 (95.5-175.1) | 166.2 (93.1-211.7) | 12.5 |
| In-person visits | 189.9 (128.8-257.3) | 160.4 (109.0-218.8) | −15.6 | 163.6 (95.9-220.4) | 147.2 (94.8-196.4) | −10.0 | 147.7 (95.5-175.1) | 157.9 (93.1-197.4) | 6.9 |
| Telehealth visits | 0 (0-0) | 33.6 (16.2-46.0) | 0 (0-0) | 26.1 (5.5-36.2) | 0 (0-0) | 8.3 (0.4-8.6) | |||
| Count of unique patients in visits and percentage with electronic patient portal account, weighted mean (IQR), per physician, per month | |||||||||
| Unique patientsf | 181.6 (123.9-243.6) | 152.7 (109.5-207.8) | −15.9 | 157.2 (93.3-216.5) | 143.3 (94.3-193.1) | −8.8 | 132.6 (82.8-156.7) | 140.7 (82.3-186.1) | 6.0 |
| Patient MyChart utilizationg | 72.6 (68.1-81.6) | 83.2 (79.1-90.2) | 14.7 | 70.1 (63.0-77.3) | 78.0 (73.5-86.0) | 11.3 | 66.7 (56.6-76.4) | 77.6 (71.7-84.9) | 16.4 |
| Unique physician count (N = 419) | 223 (53.2) | 142 (33.9) | 54 (12.9) | ||||||
| Message volume by category, count of messages, No. (%)c | |||||||||
| Total messages (all specialty combined = 10 850 401) | 7 149 410 (65.9) | 3 016 875 (27.8) | 684 116 (6.3) | ||||||
| Patient originated | 1 489 406 (20.8) | 579 996 (19.2) | 85 972 (12.6) | ||||||
| Prescription renewal | 1 384 178 (19.4) | 461 421 (15.3) | 25 976 (3.8) | ||||||
| Physician user initiated | 1 437 779 (20.1) | 606 487 (20.1) | 182 306 (26.6) | ||||||
| System generated | 1 357 236 (19) | 712 631 (23.6) | 269 754 (39.4) | ||||||
| Team member generated | 1 480 811 (20.7) | 656 340 (21.8) | 120 108 (17.6) | ||||||
The period before the COVID-19 pandemic refers to March 3, 2018, to February 2020. The period during the pandemic refers to March 2020 to June 2021.
Refers to days in each reporting period that a clinician sees patients or logged into the electronic health record system.
See eTable 1 in the Supplement for message category details.
Findings from piecewise linear regression of patient medical advice request trend are shown in the Results section of the text.
Time in in basket per day (Signal, Epic Definition) refers to the mean amount of time spent in the in basket per physician per day. The numerator is the total number of minutes spent per physician in an in basket activity or navigator section within the reporting period. The denominator is the total number of days that the physicians logged in and worked during the reporting period.
Refers to count of unique patients among monthly patient encounters.
Refers to percentage of patients seen each month having an account in MyChart, the Epic patient health record platform.