Meet the inboxologist.

WellSpan is one of the few health systems across the country employing inboxologists, who help patients get information faster and lessen the workload for providers. Here are four things you need to know about this new type of behind-the-scenes provider.

INBOXOLOGY, EXPLAINED

An inboxologist is on the front lines of medicine, helping to support other providers by working in their electronic health record inboxes. Working remotely, they assist with tasks such as answering patient questions, ordering tests, making referrals, refilling prescriptions, and doing other important time-sensitive tasks.

At WellSpan, inboxologists are primarily advanced practice providers — nurse practitioners or physician assistants — who support other providers at primary care practices. All WellSpan inboxologists have at least five years of clinical experience working in a primary care practice environment, so they understand the daily cadence of a clinical practice.

The Why Behind Inboxology

During the COVID-19 pandemic, WellSpan, like other health systems, shifted some of its primary care providers to hospitals to care for COVID-19 patients. Some of those primary care providers discovered they enjoyed hospitalist work and decided to permanently stay in that specialty. That shift was particularly acute in Franklin County, which was hit early and hard by the pandemic.

“At that time, the workload in primary care practices increased and the virtual workload went up significantly,” says Jeni Smith, director of operations for the WellSpan Medical Group in Franklin County. “Providers’ paperwork, the signatures that were needed, the forms, responding to messages on the patient portal — all of that grew more demanding.”

Providers often do these tasks after hours, at home, in a chunk of time that has been nicknamed “pajama time.” Physicians routinely take at least one to two hours of work home each night, according to a study in the Annals of Family Medicine. It’s a factor often cited in physician burnout.

Smith did some research and found a California health system that was using remote providers to help providers with the electronic work they were doing after hours. She thought the same type of provider would be helpful at WellSpan to relieve the load for primary care physicians, and that type of work also would be an attractive choice for medical professionals seeking remote positions in the pandemic and post-pandemic world.

“I woke up one day and thought I know how I can do this,” Smith says.

In August 2021, WellSpan started a pilot program of inboxologists in Franklin and Adams counties, where there are now six inboxologists working behind the scenes. The program is expanding across WellSpan’s system, with two more inboxologists now being sought: one in York and one in Lancaster/Lebanon counties.

Smith’s work on inboxology embodies many WellSpan values and strategies. Team members are encouraged to be problem solvers and to find a better way, and to reimagine health care and deliver it in a way that makes it easier for patients.

Meet An Inboxologist

Carrie McMahon is an inboxologist who supports seven providers at WellSpan primary care offices in Greencastle and Carlisle. The physician assistant previously had worked for a dermatology and plastic surgery office but left due to the demands of her own “pajama time” and burnout, so she is glad that she can help relieve that problem for other providers in her new role.

“It’s a win-win-win,” she says. “I am helping patients get information in a timely fashion. I’m helping my colleagues sustain the vast demands of clinical practice. And the flexibility of this position allows me to maintain my own work-life balance.”

What Providers Say

Dr. Ryan Crim, at WellSpan Family Medicine – Carlisle, is one of the physicians supported by McMahon. He has been impressed by her ability to match different providers’ styles, a subtle thing that has a significant impact because it makes life smoother for patients who are used to how their provider interacts with them.

“Her timely responses give patients the answers they need quickly, and that greatly improves patient satisfaction,” Dr. Crim adds. “I like having happy patients because it makes office visits so much smoother. Her work also allows me to enjoy my time away from work, especially when I am on vacation. I don’t have to worry about checking my inbox because Carrie has it covered.”

Dr. Keith Wright, WellSpan medical director of primary care in Lancaster County, said he is eager for inboxologists to come to his region. Some doctors are getting well over 100 messages a day from patients, he says. Dr. Wright, of WellSpan Family Health – Georgetown, does his own “pajama time” early in the morning, arriving at his practice by 6 a.m. so he can spend a few hours doing inbox tasks before he starts seeing patients.

“Those are the things that an inboxologist could do to relieve the pressure,” he says.

He likens an inboxologist to DAX, another recent tool being used by WellSpan providers that offers voice-activated technology to automatically transcribe patient visits, saving providers transcription time and allowing them to focus more and connect with the patients in front of them.

“When we can put the computer in the background, when we can alleviate some of those tasks, it allows us to shift so we can focus on the patient in front of us,” he says.