4 tips to mange the EHR inbox for nurse practitioners

Nurse practitioners understand how difficult it is to manage the EHR inbox.

Oftentimes, APRNs spend more time completing their task list than they do actually with patients. Nurse practitioners have a lot of responsibilities to do on a typical work day. Not only do nurse practitioners have to assess, diagnose, and treat patients, but they also have to document the findings and plan of care. 

Then add on the “other tasks” nurse practitioners are responsible for during the workday. Nurse practitioners have to review past medical documentation. They analyze diagnostic results and notify the patient.

APRNs take care of routine medication refills. When addressing refills, NPs may have to verify the correct medication and dose. Nurse practitioners have to ensure the patient has followed up on a regular basis and if not the NPs needs to contact the patient to make sure they come in for an appointment.

Then add on the never ending patient messages. The messaging the nurse practitioner is a convenient way to ask questions. But it seems like patients are asking for prescriptions without being seen in the clinic. (*** Read this article on 6 tips to manage patient messages!)

There are so many tasks a nurse practitioner does throughout the day, no wonder it is difficult to manage the EHR inbox!

Challenges with the electronic health record (EHR) inbox

Many of the electronic medical records have a taskbar showing what “tasks” (analyzing diagnostic data, reviewing medical documentation, addressing medication refills, answering patient messages) need completed. For example, there may be a 15 next to the medical refills item meaning the nurse practitioner has 15 medical refills to address.

If you are like me, the more items that need to be addressed brings more anxiety and feeling like I’m constantly running behind. It can be difficult to manage the EHR inbox! If the tasks are not completed during the work day APRNs likely have to stay late at the office or bring the charts home.

Or nurse practitioners spend too much of their workday completing these tasks and not signing the charts. Which is also a reason nurse practitioners bring charts home. Both of these examples create a lack of work-life balance and increased risk of nurse practitioner burnout.

A lot of nurse practitioners end up working more than 40 hours a week (which is unpaid time!). When NPs are unable to rest and recharge after a work day, their mental, emotional, and physical health is negatively impacted. 

Tips to manage the EHR inbox

While nurse practitioners cannot eliminate any of these tasks, there are a few things nurse practitioners can implement to assist to manage the EHR inbox in a timely manner. 

Triage tasks as a nurse practitioner.

Some tasks a nurse practitioner needs to complete have a higher value than others. Nurse practitioners will assess, diagnose, and treat patients. They then document the findings and plan in the chart note. The note is assigned an evaluation and management level which is then billed to the patient’s insurance. This is how healthcare businesses generate income (and all businesses need revenue in order to continue to provide services).

Nurse practitioners generate income by seeing and documenting patient encounters. The other tasks (med refills, analyzing diagnostic data, reviewing medical documentation, and patient messages) do not directly bring in revenue. Nurse practitioners should prioritize seeing patients first. Remembering this concept makes it easier to triage what is most important first, and then nurse practitioners can manage the EHR inbox.  

Delegate tasks to support staff.

Any healthcare provider should be working to their highest level of license. For example, there are certain tasks that a medical assistant can do. There are certain things registered nurses and LPN can do. And there are certain things nurse practitioners do. When healthcare providers work to their highest level of degree, it helps to create an efficient and productive healthcare facility. 

I know it can be hard to delegate tasks (I struggle with asking other people for help too). But if you are spending over 40 hours (unpaid time) trying to keep up with charting, then it’s time to ask support staff for help. Delegate tasks that are easy for the nurse/ medical assistant to do. This with help nurse practitioners manage the EHR inbox!

I once chatted with a nurse practitioner who was spending a lot of time walking patients out after the visit. The NP was even scheduling their follow-up appointment. It was preventing the nurse practitioner from charting right after the patient encounter.

Delegating these small tasks are really not asking much from support staff as we should all work to our highest level of license. 

Ask for what you need. 

I can already hear the comebacks about lack of staffing. Keeping enough support staff, such as front office help, nurses, medical assistants, has become challenging in the past few years. Let alone, hard working, productive, support staff. I have talked to so many nurse practitioners who have started to consume a lot of these tasks that could be delegated to support staff.

So many nurse practitioners are managing all of the patient messages, medication, refills, setting up, referrals, completing prior auths. Nurse practitioners are even checking in their own patients. Getting the vital signs, intaking information, administering medications, drawing labs. All of these tasks that could be delegated to support staff takes time away from the nurse practitioners seeing patients.

Well, some of these staffing struggles are out of the control of the nurse practitioner, there are a few things I do recommend.

• Talk with your clinic manager and explain how much extra time you are spending on doing these tasks. Make sure they realize the amount of revenue that is lost.
• If taking on the extra tasks is more than you can handle, always ask for a lighter load on the patient schedule.
• Ask for more admin time so you can complete the tasks.
• Whatever you need to do to make it work!

Remember how important it is to manage the EHR inbox, create a better work-life balance, and ultimately overcome nurse practitioner burnout. 

Create a routine.

One of the tips I share to manage the EHR inbox is creating a routine for the day. This may seem crazy as a nurse practitioner. If there is one thing certain in healthcare, it is that nothing goes as planned.

Nurse practitioners know when they look at their schedule for the day and think “I only have 8 patients to round on in the hospital” or “Oh, this doesn’t look too bad, I should be able to leave work by 5:00pm” that is not at all what will happen.

But, one of the keys of time management is to focus on the task at hand. 

It can be difficult to know where to place the focus. Nurse practitioners waste a lot of time pretending to be productive. They might lose focus on what needs to be done and end up checking social media for 20 minutes that could have been utilized to manage the EHR.

When nurse practitioners create a routine throughout the day, they can easily focus on the task at hand and not have to think about what comes next. 

An example schedule might include:

7:45-8:15am- Manage the EHR inbox (review medical records, diagnostic data, and address medication refills)

8:15-11:00am- See patients and work on charting after patient encounter

11:00-11:10am- Address patient messages

11:10-12:15pm- See patients and document

12:15-12:45pm- Lunch break, be sure to step away from your work space, go on a walk, take a moment to relax

12:45-1:15pm- Manage the EHR inbox (review medical records, diagnostic data, medication refills)

1:15-4:00pm- See patients and document

4:00-4:15pm- Address patient messages

4:15-5:00pm- See patients and document

Adjust the schedule accordingly!

This is an example of creating a routine. It will not go perfectly to plan. But it does help nurse practitioners to focus on the task at hand and better manage the EHR inbox. 

Additional time management and charting tips.

Nurse practitioners can utilize these tips to manage the EHR inbox. If they are struggling with the charting itself, The Nurse Practitioner Charting School offers a variety of services. 

When it comes to charting, The Nurse Practitioner Charting School is the one stop for all documentation resources created specifically for NPs! 

• Check out The Nurse Practitioner Charting School’s blog page for helpful charting tips!

Also checkout the paid courses: 

• Time Management and Charting Tips Course: Learn the tips and tools to chart accurately and efficiently so you can run on time during your workday, eliminate the overwhelm, leave work on time, and STOP charting at home!
• ​  Billing and Coding Course: Outpatient Visits: Feel confident choosing the correct Evaluation and Management CPT® code for an outpatient patient visit, so you can avoid over coding (and under coding!) ensuring you receive proper insurance reimbursement!
• ​ Legal Issues with Charting Course: Learn how to prevent a malpractice suit and put your mind at ease regarding legal issues of charting.
• Charting as a Nurse Practitioner Student Course: Going through nurse practitioner school is incredibly overwhelming. Don’t stress about the charting.

Utilize The NP Charting School’s Comprehensive List of Smart Phrases: Get access to over 100 smart/dot phrases to save time so you can STOP charting at home!

So if you are ready to manage the EHR inbox and improve your charting, check out The Nurse Practitioner Charting School!