The Inbox That’s Never Empty: Making Peace With Portal Messages
If your EMR message basket seems fuller than it used to be, you're not imagining it. A study just published in JAMA analyzed national data from thousands of hospitals and found that patient-authored portal messages have climbed dramatically since 2020, with messaging intensity among frequent senders more than doubling. Office visits and phone calls have stayed roughly flat. In other words, messaging isn't replacing our other work. It's stacking on top of it.
That's not a productivity problem we can solve by simply "getting better" at typing fast. It's a systems problem, and there are some ways to protect your time and your sanity while still showing up well for your patients and their families.
Time block it. Treat your message basket like a clinical commitment, not something you squeeze in between everything else. Two or three protected 20-minute blocks a day beats an inbox you're grazing on all day and never actually finishing. Devoting time solely to your message basket also reduces task-switching, which can help prevent mental fatigue.
Gamify it. This sounds silly until you try it. Set a timer, challenge yourself to clear a set number of messages before it goes off, or race yourself against yesterday's count. A little friendly competition with your own inbox can make the task feel less like drudgery and more like a game you're allowed to win.
Let done be better than perfect. Most portal replies don't need to be a masterpiece of clinical prose. A clear, warm, three-sentence answer that closes the loop is more useful to a patient’s family than a beautifully crafted paragraph that took you ten extra minutes and three edits to produce.
Decide your redirects in advance. Some questions simply aren't safe or appropriate to answer asynchronously, and pretending otherwise burns time and adds risk. Before you're in the moment, decide what categories automatically get a "let's talk in person" response: new or changing symptoms, medication changes, anything requiring an exam, or anything you'd hesitate to chart without seeing the child. Having a go-to script ready means you don't have to compose it from scratch every time. Something like:
“Thanks so much for reaching out, and I can tell you're looking out for [child's name]. This is something I really want to evaluate in person, so I can give you my full attention and make sure we're not missing anything. Please call our office at [clinic’s phone number] to get scheduled, and if anything feels urgent before then, don't wait, go ahead and seek care sooner at a Vanderbilt Health Walk-In Clinic or the closest emergency room"
Train your team to carry some of the load. You don't have to be the only person who touches your inbox. Nurses, APPs, and trained staff can triage, draft, or fully answer a meaningful share of messages, especially routine ones like refills, forms, and scheduling questions, with your final sign-off built in where needed. It will take time up front to train them to answer messages the way you would like, but it will save you time in the long run.
Use Epic to your advantage. A few underused tools can save real time: pool messages to a shared team In Basket instead of routing everything to you alone; build QuickActions and dot phrases for your most common replies so you're editing, not writing, from scratch; use message routing rules to send administrative questions straight to the right staff member instead of your queue; and consider a brief, visible note on your MyChart response settings about expected turnaround time, which quietly resets patient expectations and takes pressure off you to answer instantly.
Crowdsource solutions. Take some time at your next faculty meeting to have everybody share their best strategies for managing their message baskets. Or spend some time browsing Reddit or YouTube for possibilities; there’s no need to reinvent the wheel.
Try one message basket management strategy for a week and see how your workflow changes. If it works, keep doing it and consider adding another. Suppose it doesn’t, switch it out for another. Experiment over and over again until you feel your inbox stress lifting. None of these strategies erase the underlying trend the JAMA authors describe. Messaging is here to stay, and it's growing. But we don't have to absorb that growth alone, or perfectly, or without boundaries. Small structural changes, used consistently, add up to real protected time and a little more breathing room.