Appl Clin Inform 2021; 12(04): 877-887
DOI: 10.1055/s-0041-1735257
Research Article

An Analysis of Electronic Health Record Work to Manage Asynchronous Clinical Messages among Breast Cancer Care Teams

Bryan D. Steitz
1   Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
Kim M. Unertl
1   Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
Mia A. Levy
1   Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
2   Division Hematology, Oncology and Cell Therapy, Department of Medicine, Rush University School of Medicine, Chicago, Illinois, United States
› Author Affiliations
Funding B.D.S. was supported by the 4T15LM007450 training grant from the United States National Library of Medicine.


Objective Asynchronous messaging is an integral aspect of communication in clinical settings, but imposes additional work and potentially leads to inefficiency. The goal of this study was to describe the time spent using the electronic health record (EHR) to manage asynchronous communication to support breast cancer care coordination.

Methods We analyzed 3 years of audit logs and secure messaging logs from the EHR for care team members involved in breast cancer care at Vanderbilt University Medical Center. To evaluate trends in EHR use, we combined log data into sequences of events that occurred within 15 minutes of any other event by the same employee about the same patient.

Results Our cohort of 9,761 patients were the subject of 430,857 message threads by 7,194 employees over a 3-year period. Breast cancer care team members performed messaging actions in 37.5% of all EHR sessions, averaging 29.8 (standard deviation [SD] = 23.5) messaging sessions per day. Messaging sessions lasted an average of 1.1 (95% confidence interval: 0.99–1.24) minutes longer than nonmessaging sessions. On days when the cancer providers did not otherwise have clinical responsibilities, they still performed messaging actions in an average of 15 (SD = 11.9) sessions per day.

Conclusion At our institution, clinical messaging occurred in 35% of all EHR sessions. Clinical messaging, sometimes viewed as a supporting task of clinical work, is important to delivering and coordinating care across roles. Measuring the electronic work of asynchronous communication among care team members affords the opportunity to systematically identify opportunities to improve employee workload.

Supplementary Material

The plots that display underlying distributions for all summary statistics presented in the manuscript can be accessed via the following link:

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, which was reviewed by Vanderbilt University Institutional Review Board.

Publication History

Received: 07 December 2020

Accepted: 23 July 2021

Article published online:
15 September 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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