Published August 15, 2023
Tips for EHR In-Basket Management
The in-basket can feel like a lot of work, especially when you have just started working in primary care as a nurse practitioner (NP) or physician assistant (PA) and are now solely responsible for following a panel of patients. I remember feeling overwhelmed because it was completely new to me, but I eventually became an Electronic Health Record (EHR) superuser in my outpatient clinic and so can you with a few helpful tips.
Types of In-Basket Tasks You Will Tackle as an NP or PA
Before we get into how to successfully manage your EHR in-basket, let us review the types of in-basket tasks you will face as a nurse practitioner or physician assistant.
Results
The test results you ordered for your patient may include labs, biopsy results, imaging reports, and diagnostic tests. If you have your own panel, you may receive results of testing ordered by a different provider, such as a specialist.
In addition, you may get sent results from point-of-care labs performed by office staff that need to be reviewed, such as Hemoglobin A1C, urinalyses, and rapid strep tests.
Patient Portal Messages
Patients can send messages through the EHR that may include questions about lab results, general care questions, an update on their medical condition, or something else. You can also send patients messages informing them of results and replying to their follow-up questions or comments.
Staff Messages
Messages from clinical staff, the administrative team, nursing, medical assistants, specialists, and other members within your healthcare organization may also be communicated to you via your EHR.
Requests for Medication Refills
Patients and pharmacies can send you medication refill requests through the EHR.
Tips for Staying on Top of In-Basket Management
In the video below from the Primary Care Bootcamp for NPs and PAs, an on-demand curriculum created to help early-career nurse practitioners and physician assistants hone skills and build confidence, you can view a few practical tips to go from being a hesitant EHR user to an EHR superuser.
Check Your In-Basket Frequently
To ensure you stay on top of your in-basket, check your in-basket frequently, including before a patient’s session begins, one or two times in between patients, and at the end of a session. You can also take advantage of the extra time you have if a patient does not show up for an appointment and review your in-basket then.
Use Shortcuts
Take advantage of keyboard shortcuts that may be available as part of your EHR. Shortcuts can be useful to learn, as they can help you open the search bar, log in/out of the EHR, make choices in a dropdown menu, and navigate to different note sections quickly.
Create Message Templates and/or Dictate Messages
Create message templates to quickly respond to common questions and requests, including appointment requests, common result notes, patient portal messages, and letters. You can also save time by using a dictation feature to dictate your messages quickly rather than typing them out.
Encourage Patients to Utilize Patient Portal
Encourage patients to sign up for the patient portal so that you can quickly communicate with them. This is especially helpful when test results are normal, and no follow-up is required. Make sure to remind patients that urgent issues, or concerns that require a response in less than one business day, should not be addressed via the portal.
Ask Patients for a Follow-Up Visit
If a patient sends a message through the portal that you anticipate will take additional time to answer, you can ask the patient to schedule a follow-up visit.
Ask Patients for Labs Before Appointments
Ask the patient to get certain routine labs, such as a cholesterol panel, done before the appointment so that you can review them during the visit.
Tips to Organize Your In-Basket
It may feel like there are a lot of in-basket tasks and not enough time to manage them all. The first step to getting through your in-basket is to ensure that you have a good method in place to sort out the different tasks and deal with them in a timely manner.
Deal With Anything Urgent ASAP or Delegate to a Team Member
Try to reply to anything urgent right away, ensuring patients receive the care needed quickly. Depending on the practice, you may be able to ask a team member, such as a nurse or medical assistant, to check your in-basket periodically throughout the patient’s session for any urgent messages.
Empty the Basket One Type of Task at a Time
When you have time to dedicate to in-basket management, work on emptying it one type of task at a time (e.g., review all patient portal messages, then your results and staff messages.)
Use the Postpone Feature
If your EHR has a postpone feature, postpone less urgent in-basket messages to a different date.
Tips for Maximizing Your Team to Manage Your In-Basket
You do not have to manage your in-basket alone. If you utilize your team effectively, managing your in-basket can be quick and easy.
Work as a Team
An MA (Medical Assistant) can help NPs and PAs with in-basket management by checking prescription renewals, seeing if a patient is due for a screening, and alerting you when there are urgent messages or critical lab results to be reviewed.
Work with the Same Nurses and MAs Consistently
Continuity of care allows the care team to get to know patients and anticipate their needs. It also fosters a collaborative and supportive environment among the patient and clinical team.
Share Panels with Other Clinicians
Clinicians may share panels with other clinicians to improve access for patients and save time, as both clinicians can effectively and efficiently collaborate.
Provide Staff Education
Provide staff with the necessary training to ensure they know how to handle messages and patient paperwork. Simplify forms when possible and ask designated team members to pre-fill information such as the date of the last appointment and diagnosis. This will allow you to quickly review and sign the form. If forms are complex, ask the patients to schedule an appointment.
Train staff members to screen portal messages and obtain additional information if required before forwarding them to you.
Implement Team Workflows for Medication Refills
Utilize a medication refill template, allowing team members to easily fill out a request form that includes necessary information for the request to be fulfilled.
Have a Plan for Cross-Coverage
Be sure to have a cross-coverage plan when team members are out of the office to ensure there is no interruption of patient care. If you are out of the office, make sure your patient notes are finished. Timely and accurate documentation can help cross-covering team members answer questions that may arise about your patients in your absence. In addition, make sure that your in-basket is as empty as possible.
Managing your in-basket can feel overwhelming when you have so many other duties to take care of, but following these tips will help you stay in control while getting everything else done.
For more tips on managing your in-basket and other practice management skills, check out Primary Care Bootcamp for NPs and PAs, an on-demand curriculum with over 40 courses designed to help early-career NPs and PAs hone skills, build confidence, and succeed.
Megan Brochu, PA-C has been working as a Physician Assistant for over 6 years. Her career began in urgent care and then she transitioned into family medicine at UMass Memorial Health in Worcester, Massachusetts. At this institution, she does clinical work and is also on the Epic Mastery Taskforce. This task force is working on a “Home for Dinner” initiative to help providers become more efficient with the Electronic Medical Record. Additionally, Megan is the primary care leader for the UMass Memorial Health Osteoporosis Initiative. She precepts third-year medical students and has taught lectures to family medicine residents about the business of medicine. She is enrolled in an MBA (Master of Business Administration) at Isenberg School of Management at the University of Massachusetts Amherst.