Opened my inbox Friday to 43 messages. Portal messages about CGM lows, refill requests that need prior auth, lab results ranging from totally benign to genuinely urgent. They all lookedidentical in the queue… no acuity signal.
A patient wrote "I'm nauseous and can't keep food down, sugars are dropping." That sat between a medication refill and a scheduling question. I found it 40 minutes in.
There was a JAMA Network Open study that looked at NLP triage across three million messages. Systems that actually classified by acuity got high priority messages read 17 hours faster than manual review. I totally believe it. My inbox has no triage architecture at all. Everything just lands in chronological order and I AM the sorting algorithm.
Notes are bounded. Inbox is not. That is the actual pajama time driver.