Message Burden 2025
Striking a Balance Between Physician Accessibility & Message Burden
According to KLAS data, 59%† of patients are using technology to communicate with their provider’s office before or after visits, and 93%‡ of those patients plan to continue using technology for provider communication. However, this increased access to healthcare providers doesn’t necessarily equate to increased access to care, and ambulatory physicians in particular feel overwhelmed by the sheer volume of messages—projected to grow as patients’ use of messaging tools expands. This KLAS Arch Collaborative report—the first to focus on message burden—looks specifically at how ambulatory physicians within health systems are balancing message volume with patient expectations.
† Out of 5,913 interviewed patients
‡ Out of 3,474 interviewed patients
Access the feedback of
500,000+ clinicians worldwide
Access the feedback of
500,000+ clinicians worldwide
Here is my information:
Data Methodology
This report uses data from the Arch Collaborative EHR Experience Survey, which consists of two parts: (1) the standardized questions (including ones about message burden) that all participating organizations ask their end users and (2) an optional set of additional questions that allow organizations to collect deeper insights into key topics—in this case, message burden. KLAS added the set of additional message burden questions in April 2024 and has surveyed six organizations so far; thus, insights are still early (and are marked as such throughout the report). KLAS will continue to collect data specific to message burden and share insights via future reports.
Do Acute Care Physicians Also Experience Message Burden?
While message burden is primarily a problem among ambulatory care physicians, one-fourth of acute care physicians also feel overburdened by messages—most of their messages either are from other clinicians within their organization or require no action.
Message Volume & Backlog Exacerbate Ambulatory Care Physician Burnout
High message volume combined with pressure to promptly respond to messages is a recipe for physician burnout. Ambulatory care physicians report inconsistent or ambiguous response-time expectations across their organizations; thus, they are setting their own expectations, often holding themselves to a higher standard for response times than what their organization deems necessary. These self-imposed expectations worsen the feeling of falling behind on message management and lead to physician burnout being most severe. In contrast, ambulatory care physicians who feel they are effectively managing their messages and can respond in a timely manner are less likely to report burnout.
Message Burden Negatively Affects Ambulatory Care Physicians’ Perception of EHR Enabling Patient Care
It is natural to assume that patients’ increased access to care teams would result in improved patient outcomes. However, ambulatory care physicians experiencing message burden are less likely to agree that their EHR enables patient-centered care. Although the cause of their disagreement could appear to be the patients depending too much on messages instead of scheduled appointments, the disagreement stems from physicians feeling too overwhelmed and burdened to provide adequate care. As messaging use increases, it will be critical to balance its convenience with the facilitation of high-quality care. When effective message management is in place, more physicians agree that their EHR enables patient-centered care.
To Reduce Message Burden, Organizations Should Work to Filter Inappropriate Content & Focus on Certain Specialties
Challenges with Message Content
60%
of messages that ambulatory care physicians receive are from patients
(n=642; early insight)
Receive messages at least weekly from patients demanding care deemed inappropriate or that requires additional clinical assessments
Receive messages at least weekly from patients frustrated with system-related issues, which are out of ambulatory care physicians’ direct control
Specialties Encountering Message Burden
Ambulatory Care Physicians Want to Better Support Patients via Messaging but Need Help from Staff, Technology & Patients to Do So
Hundreds of ambulatory care physicians were asked how they would like to see their EHR message burden be reduced. The following section outlines their suggestions.
Note: KLAS began asking this message burden question in April 2024; thus, insights are still early.
Look to Staffing Solutions
Triage
Have staff triage and handle messages. Get messages to the right people the first time. Improve the triage system so that only clinical decision-making messages reach the providers.
Train staff to handle messages
Increase the number of staff (e.g., RNs, MAs, NPs) helping with messages. Ensure they have sufficient access/permissions and are well trained so they can work at the top of their license and handle patient messages without having to unnecessarily loop physicians back in.
Provide protected time
Carve out standard administrative time for clinicians so they can catch up on charting and messages.
“I have enjoyed having a trusted RN handle my messages and escalate anything appropriate to me—this approach would be a benefit to many physicians.” —Ambulatory care OB/GYN physician (large health system)
Ambulatory care physicians have confidence in their team members’ ability to respond to messages, yet nurses feel ill-equipped to address certain content. By upskilling nurses (and other staff) and providing opportunities for them to become more familiar with message content, organizations can not only improve the overall nurse experience but also help both physicians and nurses feel more satisfied with their handling of patient messages.
Improve Message Management
Limit message length and frequency
Restrict message length and the number of messages a patient can send within a certain time frame.
Prioritize current patients and encourage regular patient visits
Restrict the ability to send messages if the patient hasn’t had an appointment in over a year.
Remove clutter
Reduce duplicate messages. Automatically delete old messages after a certain amount of time.
“Send fewer copies of the same note. Stop sending drafts, pending information, duplicate notes, or cover letters and notes.” —Ambulatory care pediatrics physician (children’s hospital)
Improve Technology
Simplify message workflows
Streamline the process of handling messages and reduce the number of steps required to complete a message.
Improve message system integration
Improve the integration between messaging systems and other workflows. Use a single platform for all types of messages. Improve remote access to the chart (e.g., use a mobile app).
Make the message center easier to navigate
Make the secure chat searchable with filters.
“Streamline the number of inboxes in our message center. For example, I have 33 inboxes; it is ridiculous to expect me to check 33 inboxes throughout the day.” —Ambulatory care physician (academic health system)
Leverage AI Solutions
Filter
Use AI to filter out unimportant or duplicate messages.
Triage
Implement an AI solution to route patient requests to the correct person.
Automate responses
Use AI-generated responses for FAQs or basic patient questions.
Indicate message receipt
Use automated messages to indicate message receipt and expected response times.
Use AI to notify patients of when they should make an appointment
Have AI identify key words in messages that will alert patients to the need for an in-person visit rather than a messaging interaction.
“AI should send new problem questions directly to an appointment line.” —Ambulatory care internal medicine physician (large health system)
Provide Patient Education
Share guidelines for appropriate messaging
Inform patients about what types of questions are appropriate to include in messages. Explain that physicians will never use messages to diagnose or treat conditions without an office visit.
Communicate response times
Set clear expectations with patients for how long it will take to receive a response from their provider.
Notify patients of potential charges
Inform patients that there may be a charge for responses if their message meets certain criteria.
“I see a trend where patients are not coming to appointments and are instead messaging the provider. This does not allow for optimal care. Patient education may help address this challenge.” —Ambulatory care internal medicine physician (large health system)
Organizations That Are Successfully Reducing Message Burden
Keys to Success:
Children’s Nebraska has message reduction strategies that focus on using the four rights of decision support (i.e., information, person, time, method), being intentional about routing and recipients, using the appropriate alerting method, anticipating needs, automating responses, and engaging providers.
The strategies include using nurse inbox pools for shared access and efficient message screening, implementing evidence-based treatment protocols and orders that can be initiated without immediate provider involvement, using message documentation templates to gather necessary information up front, and suppressing courtesy message alerts to reduce unnecessary notifications. These approaches aim to streamline communication, improve efficiency, and ensure that providers receive only essential messages.
For more details, watch this webinar.
Keys to Success:
Confluence Health did several things to improve messaging at their organization. They made process improvements by using tools to analyze and improve message handling, empower staff, and embed helpful links in messages. The tools also helped reorder messages based on priority, close out message threads after 14 days, and filter out “thank you” messages. Additionally, the organization increased patient engagement and portal usage, and they batched patient test results and limited premature access to reduce patient confusion regarding results. They also offered on-demand virtual visits and explored using AI to draft messages. The organization regularly reviews these data and process improvements to measure effectiveness.
Confluence Health also wanted to shift patients’ expectations toward team-based care. For example, the organization changed their messaging option from “Message your doctor” to “Message your provider’s office,” implying that messaging is not intended for emergencies. Confluence Health also encouraged patients to review past appointment notes before messaging.
Confluence Health supported their providers and staff by regularly communicating updates and providing training around messages. They also helped foster good message etiquette by forming a superuser community that shared best practices with providers.
For more details, watch this webinar.
Partner with KLAS: Share Your Organization’s Experience with Message Burden
KLAS is looking to partner with 10-15 more healthcare organizations to further understand the impact that messages are having on clinicians’ overall EHR experience. Comparative results of these questions will be released to each organization that participates once the threshold of 15 participating organizations is met. If you are interested in participating, please contact your KLAS Provider Success Manager or visit the KLAS website.
Get Involved with the KLAS Patient Voice Collaborative
The KLAS Patient Voice Collaborative is a growing group of healthcare organizations and healthcare IT vendors committed to using patient perspectives to improve the overall patient experience with technology. For more information, see this webinar. Reach out to KLAS to get involved and learn more: patientvoice@klasresearch.com.
What Is the KLAS Arch Collaborative?
The Arch Collaborative is a group of healthcare organizations committed to improving the EHR experience through standardized surveys and benchmarking. To date, over 300 healthcare organizations have surveyed their end users and over 500,000 clinicians have responded. Reports such as this one seek to synthesize the feedback from these clinicians into actionable insights that organizations can use to revolutionize patient care by unlocking the potential of the EHR.
This report acknowledges an organization that has won KLAS Arch Collaborative Awards. The Arch Collaborative EHR Experience Pinnacle Award honors members of the Arch Collaborative who have demonstrated that success is possible with the EHR. Qualifying organizations must have a NEES of at least 75.0 for nurses or a NEES of at least 60.0 for physicians. To put this in context, the average nurse NEES is 47.3 (n=113,045), and the average physician NEES is 23.4 (n=53,037).
The Arch Collaborative EHR Experience Breakthrough Recognition honors any participating organization whose NEES has increased by at least 15 points between measurements. This can be earned for physician or nurse scores.
Report Non-Public HTML Body
Report Public HTML Body
Topics
Report Topics
Clinician Relationships and Communication, Clinician Wellness and Reducing BurnoutThis material is copyrighted. Any organization gaining unauthorized access to this report will be liable to compensate KLAS for the full retail price. Please see the KLAS DATA USE POLICY for information regarding use of this report. © 2019 KLAS Research, LLC. All Rights Reserved. NOTE: Performance scores may change significantly when including newly interviewed provider organizations, especially when added to a smaller sample size like in emerging markets with a small number of live clients. The findings presented are not meant to be conclusive data for an entire client base.