Graph theoretic visualization of patient and health worker messaging in the EHR

The electronic health record (EHR) has greatly expanded healthcare communication between patients and health workers. However, the volume and complexity of EHR messages have increased health workers' cognitive load, impeding effective care delivery and contributing to burnout. To understand these potential detriments resulting from EHR communication, we analyzed EHR messages sent between patients and health workers at Emory Healthcare, a large academic healthcare system in Atlanta, Georgia. We quantified the burden of messages interacted with by each health worker type and visualized the communication patterns using graph theory. Our analysis included 76,694 conversations comprising 144,369 messages sent between 47,460 patients and 3,749 health workers across 85 healthcare specialties. On average, nurses/certified nursing assistants/medical assistants (nurses/CNA/MA) interacted with the most messages (350), followed by non-physician practitioners (NPP) (241), physicians (166), and support staff (155), with the average conversation involving 10.51 interactions before resolution. Network analysis of the communication flow revealed that each health worker was connected to approximately two other health workers (average degree = 2.10). In message sending, support staff led in closeness centrality (0.44), followed by nurses/CNA/MA (0.41), highlighting their key role in fast information spread. For message reception, nurses/CNA/MA (0.51) and support staff (0.41) also had the highest values, underscoring their vital role in the communication network on the receiving end as well. Our analysis demonstrates the feasibility of applying graph theory to understand communication dynamics between patients and health workers and highlights the burden of EHR-based messaging.