title: Improving efficiency and reducing administrative burden through electronic communication.
abstract: BACKGROUND
  The InBox messaging system is an internal, electronic program used at Mayo Clinic, Rochester, MN, to facilitate the sending, receiving, and answering of patient-specific messages and alerts. A standardized InBox was implemented in the Division of General Internal Medicine to decrease the time physicians, physician assistants, and nurse practitioners (clinicians) spend on administrative tasks and to increase efficiency.
  
  
  METHODS
  Clinicians completed surveys and a preintervention InBox pilot test to determine inefficiencies related to administrative burdens and defects (message entry errors). Results were analyzed using Pareto diagrams, value stream mapping, and root cause analysis to prioritize administrative-burden inefficiencies to develop a new, standardized InBox. Clinicians and allied health staff were the target of this intervention and received standardized InBox training followed by a postintervention pilot test for clinicians.
  
  
  RESULTS
  Sixteen of 28 individuals (57%) completed the preintervention survey. Twenty-eight clinicians participated in 2 separate 8-day pilot tests (before and after intervention) for the standardized InBox. The number of InBox defects was substantially reduced from 37 (Pilot 1) to 7 (Pilot 2). Frequent InBox defects decreased from 25% to 10%. More than half of clinicians believed the standardized InBox positively affected their work, and 100% of clinicians reported no negative affect on their work.
  
  
  CONCLUSIONS
  This project demonstrated the successful implementation of the standardized InBox messaging system. Initial assessments show substantial reduction of InBox entry defects and administrative tasks completed by clinicians. The findings of this project suggest increased clinician and allied health staff efficiency, satisfaction, improved clinician work-life balance, and decreased clinician burden caused by administrative tasks.
authors.affiliation: Division of General Internal Medicine at the Mayo Clinic in Rochester, MN, USA. cook.katlyn@mayo.edu
authors.forename: Katlyn E
authors.initials: KE
authors.lastname: Cook
authors.forename: Gail M
authors.initials: GM
authors.lastname: Ludens
authors.forename: Amit K
authors.initials: AK
authors.lastname: Ghosh
authors.forename: William C
authors.initials: WC
authors.lastname: Mundell
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Fleming
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Majka
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D017598:Efficiency, Organizational; D034742:Electronic Mail; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000458:organization & administration*; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D016526:Workload / Q000706:statistics & numerical data