Managing the electronic medical record (EMR) inbox can feel overwhelming—especially in family medicine, where we're constantly juggling multiple responsibilities. You might clear your inbox one moment, only to find 20 new messages waiting after seeing a single patient. Inbox management is a significant part of medical practice, whether you're a nurse practitioner, physician, or physician assistant. Yet, it’s an area that receives little attention in NP education, despite being such a major component of our daily work. Inefficient inbox management can contribute to stress and burnout, often causing us to spend twice as much time on administrative tasks as necessary. My goal is to share 7 practical tips to help navigate the inbox chaos we all face, in the hopes of improving efficiency and workflow in your daily practice.

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1. How to Prioritize Tasks

When we see an inbox list of 50 items at the start of our shift, it can feel overwhelming, but we need to learn to prioritize items and hammer through tasks in between patient appointments. Here are some practical tips:

Perform a quick scan of inbox items before your shift starts and ask yourself: what needs to get done TODAY? Depending on how your EMR works, you can flag the item as more urgent. Prioritize these.
Identify items that will take time to action (e.g. an abnormal result that will require research or a consult). If non-urgent, you can forward these items to yourself when you have more administrative time (there is a function for this in many EMRs).
Identify easy items that will take seconds to a few minutes to complete - these can be tackled right before your shift starts, or even in between patient appointments if time allows. Even actioning 1 item between patient visits can save you time at the end of your shift.
Advocate for administrative time! If you are a new grad or a new employee, you will need time to adjust to the work flow and inbox management, which is totally normal.
Try not to toggle between tasks - if you open an inbox item, plan to action it while you are in the chart. We are naturally bad at multi-tasking, so focus your attention on one task at a time.

2. Use the EMR to the Fullest

Understanding how your EMR works is essential—and if you need formal training to use it effectively, it’s absolutely worth the investment. It’s equally important to understand how your specific organization integrates the EMR into its workflow, as processes can vary widely between workplaces.

If you notice inefficiencies in the workflow, bring them up with your team—small changes can lead to big improvements. At my current workplace, we've recently made several workflow adjustments that have saved us significant time.

Handling test reminders in the chart: For example, you receive an inbox alert that a patient is due for routine diabetes blood work. A quick chart review shows their last diabetes visit was three months ago, and their most recent A1C was elevated (8.0%). You generate a lab requisition in the chart, selecting the appropriate tests, and send a message to an administrator to notify the patient that labs are due—and to book a follow-up diabetes visit at the same time.
Reviewing normal results that don’t require action: For instance, you review a normal TSH result for a patient with hypothyroidism who is stable on levothyroxine. This was part of their routine annual bloodwork and no changes are needed. Many EMRs allow you to annotate the result with a note like, “TSH is normal, can advise patient, repeat in 1 year.” This ensures that if the patient calls, the administrative team can relay the appropriate information without needing to re-route the message to you.

Use EMR tools to manage cancer screening and preventive care reminders: Most EMRs can generate lists of patients due for routine cancer screenings—such as colorectal, breast, or cervical cancer—by pulling data from your roster. Many clinics also have protocols in place to regularly flag patients who are overdue. Consider whether a medical office assistant (MOA) can send reminders to these patients on your behalf, helping reduce the burden of follow-up. What systems are in place at your workplace? Are they working efficiently?
Set post-dated reminders for follow-up tests: When a diagnostic test needs to be repeated—for example, a CBC for anemia—many EMRs allow you to set a future reminder in the patient’s chart. If I start a patient on iron and want to recheck their CBC in three months, I enter the lab requisition right away (since most are valid for six months) and send a post-dated task to the MOA to contact the patient when the labs are due. This ensures follow-up happens on time—without the reminder coming back to my inbox. Let’s look at a mock patient chart:

3. Delegate Tasks

In the beginning, you may feel inclined to handle everything yourself, and it can be challenging to ask for help. However, I’ve learned the importance of delegating tasks to avoid burnout, especially when you’re part of a team. Delegation is a skill that takes practice, but it’s essential for maintaining balance.

For example, I frequently delegate tasks to our RN or RPN, such as following up with patients about test results. Understanding the scope of practice for each team member and knowing what they’re comfortable handling is integral to effective delegation. For non-urgent test results, e.g. low vitamin B12 levels, I often forward the task of following up with a patient to our team nurses (via an EMR message), including clear instructions and supplementation guidance.

Leaving detailed notes/instructions not only streamlines the process for the nurses (or other team members) but also minimizes back-and-forth communication, making the workflow smoother for everyone involved. Delegating appropriately helps distribute the workload while ensuring patients receive timely care.

Ask yourself: what team member can I delegate this task to? Examples in my workplace:

Test results: nursing can communicate certain results and follow up recommendations
Mental health follow up: our social workers often do this
Medication queries: our pharmacist does this
Emergency department follow ups: nursing can do this

4. Communicate with Patient’s Efficiently and Effectively

Emailing Test Results and Follow-Up Plans: Our EMR includes the functionality to email patients securely—a true game-changer for streamlining communication. We obtain and document email consent from all patients, typically for the purpose of sharing test results, sending forms, or providing other relevant clinical information. This consent is clearly flagged in the chart for all clinicians to reference.
During each clinical encounter, I routinely confirm whether the patient consents to receiving test results or other updates via email—particularly for routine matters that don’t require a follow-up visit, such as normal bloodwork. This approach has saved hundreds of phone calls and significantly improved our clinic’s workflow. In my experience, patients greatly appreciate this option as it eliminates the need to call the office for updates.
Emailing Lab and Imaging Requisitions: Many patients also consent to receive lab and diagnostic imaging requisitions by email. If I anticipate ordering any tests during a visit, I make a point of confirming and documenting their consent at that time.
Delegating Communication: Email communication can be delegated to nursing staff or medical office assistants (MOAs), especially for routine tasks such as sharing test results, requisitions, or follow-up instructions.
Setting Expectations for Follow-Up: If I order a test, I always inform the patient to contact the clinic if they haven’t heard back about the result within a set timeframe. Similarly, if I refer them to a specialist, I provide an estimated wait time and advise them to follow up with the clinic if they haven’t received an appointment notice.
Using Custom EMR Questionnaires: Our EMR also allows us to create and send custom questionnaires, which has been a major time-saver. We’ve developed pre-visit forms for common issues such as low back pain, headaches, and urinary symptoms. These are emailed by an MOA ahead of the appointment and are automatically integrated into the patient’s chart.
For example, if a patient calls to book a visit for painful urination, the MOA sends them a UTI questionnaire in advance. This allows the clinician to review relevant history ahead of time and use the visit more efficiently.

5. Make Notes about Results (it can be time saving!)

We’re often inundated with what feels like hundreds of test results daily, making it easy to miss something or fail to follow up appropriately. To streamline my approach, I create a note in the chart as soon as I review results that require actioning. In this note, I include the date of the lab results, any normal or abnormal findings, whether the results align clinically with the reason for the test, and a follow-up plan (e.g., additional testing, patient follow-up, forwarding results to a specialist, etc.).

This method has multiple benefits:

If I have a follow-up appointment with the patient, I can copy the note into my documentation.
Nurses or other staff handling follow-up communication with patients can read through my reasoning and plan.
It prompts me to reflect on and fully process the results.

Here’s an example in a mock chart for an asymptomatic ALT elevation result:

6. Review Charts (especially for complex patients)

In my experience temporarily covering for multiple patient rosters, I’ve developed a habit of conducting efficient chart reviews—especially for complex patients. This helps me quickly understand their medical history, prior investigations, and specialist consultations. Why is this useful?

When you're evaluating a patient with complex medical needs for the first time, it can be difficult to know where to start. Is the issue new or chronic? What investigations have already been done? What treatments have been tried? A thorough chart review helps guide your assessment and inform an appropriate treatment plan.

Chart reviews are particularly helpful when:

You will be following the patient longitudinally (for at least 6 months or more)
The patient has had multiple investigations or specialist consultations
You need to prepare efficiently for a first visit with a complex patient

Many EMRs allow you to create a “special note” or summary that is easily accessible to you and other providers. This can serve as a living document that tracks investigations, referrals, and key findings. Once you’ve started a summary, you can continue to update it as new labs or consultation reports come in.

This shared note is also incredibly helpful for continuity of care—if another provider is seeing the patient, they have a quick reference to review prior workups and consults without combing through the entire chart. Here is an example in a mock patient chart:

7. Prescription Renewal Tips

We receive never-ending prescription renewals in family medicine. We want to ensure that we are renewing them safely AND efficiently. To do this, I ask myself 4 questions:

Is it a NEW medication or an OLD medication?
Is it for an ACUTE condition or a CHRONIC condition?
Is any routine bloodwork required for monitoring while on this medication? (e.g. kidney function and electrolytes while taking indapamide).
Does the patient need a follow up appointment? (E.g. lisdexamphetamine recently initiated for ADHD).

Asking yourself these questions helps determine whether any action is needed before renewing a prescription, and what refill interval is appropriate. For example, is it safe and clinically appropriate to provide a year’s supply of a chronic disease medication like metformin for a patient with diabetes?

Inbox management can feel overwhelming, but with good habits and a continuous effort to optimize team workflows, it can become much more manageable—and help prevent burnout.

Inbox Management Tips in a Busy Primary Care Practice