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How one medical practice used medical assistants to handle patient portal messages


Innovative workflow at Penn Family Care reduces physician burnout and enhances efficiency

Medical assistants can handle portal messages: ©JackF -

Medical assistants can handle portal messages: ©JackF -

Penn Family Care, a large urban academic practice, successfully implemented a new workflow to manage the increasing volume of Patient Medical Advice Requests (PMARs), which have surged over the past decade and intensified during the COVID-19 pandemic, according to a report published in the Annals of Family Medicine. Traditionally, primary care physicians, directly received these messages, contributing to clinician burnout. Penn Family Care instituted an approach utilizing certified medical assistants that has demonstrated significant improvements in both efficiency and clinician workload, according to the report.

The new workflow at Penn Family Care reassigns the management of PMARs from primary care physcicians to medical assistants, capitalizing on existing telephone call routing guidelines. This change aims to alleviate the burden on the physicians, who were previously managing an average of 20 messages per week, with some handling up to 112 messages. The practice, which includes more than 60 clinicians, has divided its operations into four suites and nine pods to foster continuity and efficient care delivery.

According to the report, instead of messages going directly to the primary care physicians, they now flow into CMA pools according to the suite and pod structure. CMAs distribute these messages to the appropriate team members based on established protocols. This restructuring required collaboration with information services analysts and thorough training and socialization for both the medical assistants and physicians.

The number of messages routed directly to physicians decreased by about 40%, and medical assistants now manage over 92% of messages within two business days, compared to an 85% response rate by the primary care doctors. This efficiency allows physicians to maintain direct communication with patients when necessary, without the initial overload of messages, according to the report.

Surveys done at Penn Family Care indicate that the medical assistants enjoy this work, and patients have largely accepted the team-based care model. This approach has also helped reduce the gender gap in message volumes between male and female physicians, from 17% to just 2% after adjusting for clinical full-time equivalents. Female primary care physicians now receive only two more messages per month than their male counterparts, a significant improvement toward equity.

The report notes that the success of this model at Penn Family Care suggests a promising alternative for practices struggling with RN staffing shortages. Future steps include refining protocols to further empower medical assistants in managing more messages directly, which could further reduce the message load on PCPs and streamline patient care processes.

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Jennifer N. Lee, MD, FAAFP
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health
© National Institute for Occupational Safety and Health