Rates of physician and nurse burnout have risen dramatically during the COVID-19 pandemic. There are multiple causes including chaotic and emotionally draining work environments and high work loads exacerbated by staffing shortages. But another contributing factor predates the pandemic, excessive documentation burden.
Excessive documentation is a byproduct of electronic health record (EHR) systems. And it may be particularly burdensome in the US healthcare system. A 2018 article by Downing, et al in the Annals of Internal Medicine noted:
“The highly trained U.S. physician…has become a data-entry clerk, required to document not only diagnoses, physician orders, and patient visit notes but also an increasing amount of low-value administrative data. To justify billing to such payers as the Centers for Medicare & Medicaid Services, physicians must specify diagnoses from long and confusing arrays of choices relating to each test or procedure and document a clinically irrelevant number of elements for the history of present illness, review of systems, and physical examination.“1
Along with complex documentation requirements, high email message volume and poor usability of EHRs are other factors in clinician frustration with the systems.2
This past year the American Medical Informatics Association (AMIA) launched an initiative with Columbia and Vanderbilt Universities funded by the National Library of Medicine to reduce clinician documentation burdens by 75% in five years. A virtual symposium of experts was held in January and February of 2021 and this spring they released their 25x5 Symposium Summary Report. The report identified over 80 action items to streamline workflows and eliminate or automate wherever possible billing, legal issues, and regulatory requirements. “The Symposium activities were informed by one key theme: clinician documentation is for patient care delivery and clinician-patient communication.”3 Confirming the 2018 Annals paper, the symposium found that US clinicians spend 75% more time with EHR documentation than clinicians in other economically developed nations.
The report includes calls to action for providers/health systems, policy/advocacy groups, and vendors. Each will play a role in finding solutions. For example, providers and health systems are tasked with providing better training and supporting real-time information retrieval, while vendors are asked to promote an ecosystem of interoperable systems. The action items will be divided into short, intermediate, and long-term goals that will be implemented by a network of allies and working groups. You can follow developments in the 25x5 effort on the AMIA web page.
- Downing, N. L., Bates, D. W., & Longhurst, C. A. (2018). Physician burnout in the electronic health record era: are we ignoring the real cause?. Annals of Internal Medicine, 169(1), 50-51. https://doi.org/10.7326/M18-0139
- Poon, E. G., Trent Rosenbloom, S., & Zheng, K. (2021). Health information technology and clinician burnout: Current understanding, emerging solutions, and future directions. Journal of the American Medical Informatics Association, 28(5), 895-898.https://doi.org/10.1093/jamia/ocab058
- Rossetti, S. C., Rosenbloom, F. S. T., Detmer, D., Kevin Johnson, M. D., Cato, K., Cohen, D., ... & Sachson, C. Report from the 25 By 5: Symposium Series to Reduce Documentation Burden on US Clinicians by 75% by 2025. https://www.dbmi.columbia.edu/wp-content/uploads/2021/07/DRAFT_25x5_Executive_Summary.pdf
