Editor's note: The "Coding for virtual visits" box in this article was corrected April 3, 2024, to reflect updated Medicare rules.

The electronic health record (EHR) has changed the way clinicians practice — how they provide care and how they manage patient messages. The EHR patient portal has allowed patients unrestricted, secure communication with the primary care team. Over the last decade, the use of patient portals has rapidly expanded, thereby increasing the volume and breadth of patient inquiries directed at the clinician.¹ These messages can range widely in complexity, from straightforward messages requiring little or no clinician input to complex messages requiring clinical action and perhaps an encounter. As message volume for physicians and other providers has increased over time, it has resulted in increased indirect clinical work that is not typically reimbursed. This work is often done during “free time” and can contribute to increased dissatisfaction and burnout, which can ultimately degrade quality of care.²

To alleviate the messaging burden on clinicians, Duke Family Medicine Center, an academic family medicine practice with more than 40 physicians and other providers, implemented two major changes: