Epic In Basket and Communication

Click here to skip down to details and resources on recent changes to In Basket (effective September 14, 2021) that deleted old messages and affected the storage times.

Epic In Basket is a secure, online system for sending and receiving messages and completing tasks related to patient care. In Basket drives efficiencies in practice communications, resource allocation and Epic usability. It is integral to several key practice workflows:

• Managing telephone calls and telephone triage
• Communicating test and lab results to staff and patients
• Responding to patient messages via Patient Gateway (PG)
• Refilling prescriptions
• Scheduling appointments
• Communicating with other clinicians

Use In Basket for routine patient-specific messaging. For urgent clinician/patient communication, use standard practice protocol (e.g., phone call, page, text message). Using In Basket for non-administrative communication is prohibited.

In Basket can be accessed on a desktop or on a mobile device with access to the internet.

Key In Basket Components

• Message types: Each message type represents a type of task to be completed and appears as a unique folder in a user’s In Basket. The characteristics of a message type, such as how it is routed and which buttons appear on the toolbar, are predetermined (e.g., prescription refill requests) and cannot be customized by departments.
  • Most tasks can be worked through In Basket.

• Folders: Predefined In Basket folders automatically appear when a message of a particular type arrives. For example, if you have Results messages, you will see a Results folder.
  • Each folder has a specific set of functionalities and toolbar related to the message type it contains (see the In Basket Folders Tip Sheet for a list).
  • Folders are role-based; each role is associated with specific folders (e.g., MA would not have Co-Sign Clinic Orders folder).
  • Patient Gateway folders in the In Basket start with Pt.

• Pools: In Basket pools (i.e., distribution lists) are defined groups of practice staff who receive and process specific messages and tasks. Required staff (typically front desk, nursing, and occasionally medical assistants) should use In Basket Pools to manage and act upon messages sent to clinicians’ offices and auto-routed messages from Patient Gateway, pharmacies, and other external sources.
  • All members of a pool are treated as a single recipient.
  • All members of a pool receive a copy of the same message that requires an action from any one person in the group.
  • Baton holding/passing indicates who is currently working on a message within a pool.
  • Ownership icons distinguish who is responsible for a given message/task.
  • Baton passing is separate from responsibility. The baton holder icon indicates whether someone is working on a message; responsibility indicates the person responsible for clinical sign-off on a message.
  • Only one member at a time can act on the message. When a pool member resolves an In Basket message, the message automatically disappears from all other pool members’ In Basket.
  • Staff members should know which pools they belong to and the names of their department pools. Pool names typically start with P and include the Epic department name.
  • Managers can edit their pools.

• Use Epic In Basket for all routine communication related to patient care. If you are not confident that the intended recipient will check In Basket, email the recipient instructing them to check In Basket (rather than emailing clinical data).

• Every practice must adopt one of the following In Basket guidelines. Any modification to these guidelines must be submitted in writing to the Practice Improvement Division for review.
  • Primary Care In Basket Messaging Guidelines
  • In Basket Efficiency Tips

• Check In Basket at least once daily, and aim to respond to messages as follows:

• In Basket Messages	Recommended Response Time
  Prescription refills	2 business days
  Results (lab, radiology, etc.)	2 business days
  Co-sign orders	1 business day
  Patient portal	2 business days

• Clinical and administrative support staff should manage the incoming Patient Gateway messages, triage to clinicians as needed, and save patient communication in Chart Review.

• Refer to In Basket workflows for best practices for staff and clinicians. Basic workflows for select In Basket tasks include:
  • Generic In Basket Workflow
  • In Basket Rx Refill Pool
  • Patient Medical Advice
  • Physician Workflow Steps Tip Sheet
    • Results are sent to the provider’s In Basket.
    • Support staff and clinicians can be attached to the provider’s In Basket to help monitor results.
    • Determine what actions licensed and non-licensed support staff will take for normal and abnormal results.
    • The clinician is responsible for selecting “Mark Reviewed” to remove the result message from their In Basket.
    • “Result notes” and “Comments” can facilitate documentation and communication.

• To save staff messages and make them visible in the chart, convert them to a Telephone Encounter.
  • Determine which telephone calls should be documented in the patient’s chart.
  • Leverage standardized SmartTexts and SmartPhrases for efficiency.

• Use Letter/Communication Activity for communicating with the patient and with non-clinical entities (e.g., work, jury duty, insurance). Do not use Letter/Communication Activity for communicating encounter notes or summaries to referring clinicians, as there is no easy way for the recipient to know if action is required.

• Create Quick Actions to complete routine follow-ups more quickly.

• Reorder important and commonly used folders so they appear at the top of the list by following the steps in the “Change the order of your In Basket folders” section of the In Basket Efficiency Tip Sheet.

• Grant colleagues access to your In Basket if you want them to read and follow up on your messages.

• Use the Baton Passing function to indicate whether someone is working on a message.

• If you often search for the same type of message, save your search for future use.

• Practice managers must ensure that In Basket Pools are properly assigned and functioning.

• Practice managers should monitor clinicians’ In Basket use and chart completion.

• Practice managers must know which reports to run for ongoing observation and early detection of In Basket challenges. In Epic Reports, use the PHS AMB In Basket Messaging by Message Type – CR. Also review the In Basket Management Dashboard (under In Basket Alerts on the MGH Ambulatory Clinic Manager Dashboard).