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It seems like every few days we get a message in the in-basket of our electronic health record (EHR) about a new type of message that we will be receiving in our in-basket.

They call these messages "System Notices."

Okay, maybe that's an exaggeration, maybe not every few days, but the different types of in-baskets and all the information we are bombarded with is getting out of control. As users of electronic health records know, the in-basket has become both a lifesaver and the bane of our existence, where the continuous influx of work to do piles up and up throughout the day, a tide which we continuously swim against and never seem to get ahead of.

Sometimes the messages are critically important; sometimes they are just more stuff.

Looking at my in-basket now I see the multitude of message types -- folders piled full of information for me to look at.

CC'ed charts, appointment notifications, co-sign clinic orders, open charts, outside messages, overdue results, clinical letters, patient calls, patient advice requests, patient reports, patient prescription requests, patient unread message alerts, referral requests, results, prescription requests, staff messages, system notices.

I'm out of breath just reading through all of those, let alone doing the work that lies within.

The information presented to us through the electronic health record does serve an important purpose, helping us improve the quality of the care our patients receive, improving their access to their providers, improving communication between providers, and helping improve transitions from one setting to another for our patients. All noble goals, and essential pillars of the patient-centered medical home.

The newest of these to come out was recently announced via a "System Notice" message. The new message type was "Outside Messages."

Apparently we now get one of these when any outside system sends a report to our EHR about a patient whom we've even remotely been involved in the care of.

The first one of these I got was a hospital discharge file on a patient I didn't recognize. It included multiple categories of data: patient demographics, a description of the hospital course, the patient's vital signs throughout their stay, medications on admission and discharge, problem list, diagnoses, allergies, results, procedures, and more.

I am sure this was not a patient I knew, and at first I could not figure out why I was receiving this message.

Turns out I had been a supervising physician on an encounter the patient had at our practice several weeks earlier, and when they initially set up this system they decided to alert all the members of the "care team" about this information -- including anyone who had touched the chart in the past 6 months.

It turns out this message could not be forwarded from within the EHR, so I contacted the programmers who help us maintain our EHR and told them that I shouldn't have been receiving this message, and that I wanted to make sure that the right person got it.

Luckily, within a few weeks, an option to forward these messages appeared.

Success.

Interestingly, we also receive this information as a hospital discharge summary when our patient goes home, so it felt sort of redundant, like we were getting this information as a second huge packet, but ultimately it seems like the logic of passing this information on in this format made some sense.

This morning I got an outside message from a pharmacy sending me an update that my patient received an immunization at their facility the day before.

Wonderful, now I know my patient had his flu shot, and I have actual documentation that it has been given.

Unfortunately, this information did not flow into his immunization record in the EHR, so I have to now manually transcribe it there.

Time for another message to the programmers.

All of these message types, all of these folders in our in-basket, are ultimately part of helping us take better care of our patients, to see what our fellow providers and consultants are doing, to see all the lab work as it happens, to allow our patients to access us and to communicate with us.

We do need to help continually refine the system, to prevent redundancy, to improve the signal-to-noise ratio, so that messages go to the right people at the right time, so that information flows to the right places, so today's work gets done today.

Front-line clinicians need to be able to tell the keepers of the code what really makes sense in an EHR, what gets in the way of care and what enhances it. We as caregivers need to know that the EHR cannot do everything we want it to, and the programmers need to know what does not work out in the "real world."

Just got messages from the system about an updated billing summary within the EHR and one on Ebola preparedness.

Ooh, the excitement never ends.

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