Inboxology – The Newest Medical Specialty? | Expert Opinion

When sending a message to your primary care clinician through the online patient portal, you may wonder exactly where it goes and how your care team addresses your concern. Or perhaps not, as long as you get the response you are requesting. The portal is certainly more convenient than being transferred around the phone tree followed by a sometimes lengthy hold. Messages also become part of your electronic chart where they can be referred to as needed for follow up.

On the primary care office side, patient portals also have distinct advantages. Written portal messages are never too soft to hear or obscured by ambient noise, and they can be efficiently stored in a way station called the inbox or in basket, quickly referenced and addressed by any member of the assigned care team. In fact, they are so advantageous for patients and medical offices that, since the introduction of patient portals in the late 1990s, their use has exponentially increased.

You may not have imagined that messages are now flooding clinician inboxes and outgrowing the capacity of many offices to respond to them in timely fashion. Practices have tried various approaches to limiting portal messages, such as noting that it may take up to 48 hours to reply, or outlining specific matters that are most appropriate for this type of outreach.

The reality is that contemporary life has become highly dependent on technology driven, asynchronous communication which will most likely continue to increase. These tasks need to be weaved into already busy office schedules and, despite team-based workflows designed to ease the burden, inbox overload has contributed significantly to clinician work dissatisfaction and burnout.

Enter Inboxology, the newest medical “specialty” created to help remediate inbox task overload. Inboxologists are clinicians — physicians or advanced practice providers — who focus primarily on responding to their own and colleagues’ patient portal messages along with other inbox tasks such as renewing prescriptions and evaluating abnormal test results. This novel idea is already being put into practice in many health systems nationally.

Inboxology is not a specialty that requires specific training and board certification like cardiology, neurology, and others. Rather, it is a new role with designated time to perform standard, routine inbox work, in contrast to the status quo — multi-tasking clinicians wedging them into time cracks and crevasses between patient visits, or during what should be after-hours personal time.

You may be thinking — wait, shouldn’t my own primary care clinician respond to my messages? In some cases, yes, when continuity of care around complex matters is a priority. In many cases though, you may be better off receiving a reply from a clinician who is able to focus more completely on your portal question without competing responsibilities. This process also frees office-based clinicians to be most attentive to you, the patient with them in the exam room.

There are some unique challenges to scaling inboxology, including cultivating clinician interest in the role and buy-in among clinicians and patients. Then there is the issue of reimbursement. Practices and health systems have not typically billed patients for answering messages, although some have now started to charge patients or their insurance companies. Revenue earned through value-based payer incentives may also be used to fund inboxology services.

Primary care is changing and evolving to better meet the needs of patients while also finding relief valves for overworked clinicians and staff. Like scribes to help with visit documentation, telemedicine, and enhanced after-hours care, inboxology is a creative innovation. Time will tell if it is destined to be a Blackberry or an iPhone.

Jeffrey Millstein is an internist and regional medical director for Penn Primary Care.