The Challenge Hidden in Plain Sight

Not long ago, being a doctor meant you spent most of your time seeing patients. Today, it increasingly means seeing.... messages. Lots and lots of messages.

The modern doctor’s digital inbox has quietly become one of healthcare's most significant challenges—not just for clinicians, but also for patients, health systems, and the quality of care itself. Over this 5-part series, we leverage our inbox expertise to provide insight into the inbox and tactical opportunities you can take to get your doctors out of the inbox.

How do I evaluate something I can’t measure?

For all its clinical utility, the EMR was never designed to illuminate how time is spent—or wasted. Its analytical capabilities, often built as an afterthought, rarely provide the kind of operational clarity that clinical and administrative leaders need. Even well-meaning efforts like Epic’s Signal tend to offer fragmented insights.  They undercount real workload, miss connections across datasets, and fail to answer critical questions such as, ‘how does the inbox affect clinical capacity?’

As seasoned clinical operators, we understood that solving the inbox problem required first seeing it — clearly, comprehensively, and in context. That’s why we built an advanced analytics layer for our partners. Rather than settling for fragmented usage metrics, our platform surfaces impact metrics, e.g. how inbox burden fuels burnout, delays care, and drains systems of resources and talent.

In this paper, we share lessons on inbox analytics from our work partnering with leading systems across the country.
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Why is the inbox suddenly the top complaint for docs?

Across the health systems we’ve analyzed, one trend is strikingly consistent: inbox volume has grown by an average of 9% year-over-year over the past three years. That’s not incremental. That’s a structural shift in how care is delivered—one that’s happening largely outside the visit, and often outside the view of traditional analytics.

To understand what’s driving this growth, we apply a categorization framework we’ve developed specifically for EMR data—designed to quickly surface the workflows responsible for the bulk of inbox activity.

In most analytics systems, it’s difficult to get this kind of view. That’s because EMRs typically track tasks at a granular level, rather than organizing activity around broader workflow concepts. While this level of detail is useful if you already know where to look, it often fragments the data and hides the true source of burden.

By intelligently grouping related workflows, we cut through that noise—revealing a much clearer picture of where inbox volume originates and where clinician time is  actually being spent.

With this categorization we can see that while the inbox looks relatively evenly distributed across categories, one pattern stands out: results and patient messages make up just over 45% of volume, but drive nearly 75% of the time clinicians spend in the inbox.

These message types aren’t simple clicks—they’re high-touch, clinically nuanced, and mentally taxing. They demand judgment, documentation, and often asynchronous follow-up. They're the kind of messages clinicians leave unread for days (sometimes weeks!) because they take real time and thought to respond to—yet they’re also the ones that linger in the back of their minds, prompting constant phone checks and inbox refreshes.

This isn’t just lost time—it’s lost focus. And it’s happening at scale. Every minute spent on these inbox tasks is time not spent on visits, care planning, or recovery. The result is a quiet, invisible drain on clinician wellbeing and efficiency.

One final note: while documentation has historically topped the list of clinician complaints, Inbox time related to charting is actually trending down. The reason? Widespread adoption of scribing solutions. It’s a promising sign—clear proof that with the right intervention, both the burden and the burnout can be measurably reduced.

OK, so inbox is bad, but how bad is it for the system?

The effects of inbox burden don’t stop at the clinician. They ripple through the entire system, reshaping access, experience, and the underlying economics of care.

One of the most requested analyses we run at Elaborate examines how the inbox impacts clinician access and retention. And the results are striking: when a clinician’s average daily inbox time exceeds 30 minutes—the AMA’s defined burnout threshold—we consistently see a decline in patient-facing hours in the following quarters. It’s one of the clearest indicators that inbox burden isn’t just a nuisance—it’s a leading signal of shrinking clinical capacity.

At the same time, delayed response times push care further off track. As turnaround slows beyond industry benchmarks, patients follow up—sending additional messages, calling the office, or even escalating care unnecessarily. The result is a compounding feedback loop that stresses both the care team and the system meant to support them.

Is the inbox quietly driving clinicians out of seeing patients?

When we analyze inbox data at the clinician level, a clear pattern emerges across systems: clinicians are working hard. Many log 30 to 40 hours a month in the inbox—often after hours, well beyond scheduled clinic time.

The problem isn’t effort. It’s impact. Inbox work doesn’t drive revenue. It doesn’t build patient loyalty—wait times do that. What it does do is reduce access, delay responses, and accelerate burnout. The system bears the cost, but sees little return.

Forward-thinking health systems are starting to recognize the imbalance—and are redesigning workflows to ensure their teams’ effort actually moves the needle.

How should I start my inbox analysis?

To move from anecdote to action, health systems need a smarter way to measure inbox impact. Most EMRs provide fragmented metrics that fail to capture the operational toll or clinical significance of inbox work.

Based on our work with systems across the country, we recommend five core metrics to begin to bring clarity—and unlock better decisions.

If your resources are tight, Elaborate offers prospects a complementary analysis of their data and will provide these for you. Taken together, these five metrics give health systems a much more accurate picture of how inbox work affects care, operations, and cost—and more importantly, how to fix it.

Case Study Highlight

In partnership with a large multi-specialty health system, we applied this framework to analyze inbox activity at scale—translating raw data into targeted, high-leverage interventions. That insight directly shaped how Elaborate was deployed, driving measurable improvements in efficiency, response times, and clinical capacity.

What’s next?

Healthcare has no shortage of complex, structural challenges. But inbox burden isn’t one of them. This is a solvable problem—if you start with the right data.

Understanding where time is going, what’s driving message volume, and which clinicians are under the greatest load turns the inbox from a source of friction into a source of strategic clarity.

It doesn’t need to be a black box. With the right analysis, it becomes a map—pointing to both immediate efficiencies and long-term levers for change.

We’ve built the infrastructure to run this analysis—quickly, and at no cost—so systems can see exactly where to act.

This is where real transformation starts.

About Elaborate

Elaborate enables healthcare organizations reclaim clinician time from EHR inbox overload through analytics-driven workflow optimization. Our solutions have helped dozens of leading health systems reduce clinician burnout, improve patient response times, and realize significant financial savings. Visit www.elaborate.com to learn how we can transform inbox management at your organization.