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Difference between revisions of "Reducing Clinician Burden"

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<div style="background-color: white; border: 1px solid red; margin: 4px; padding: 2px; font-weight: bold; text-align: center;">
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Current Content related to this page can be found on Confluence [https://confluence.hl7.org/display/EHR/Reducing+Clinician+Burden Here]</div>
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The Reducing Clinician Burden (RCB) Project is an activity of the HL7 Electronic Health Record Work Group (EHR WG).
 
The Reducing Clinician Burden (RCB) Project is an activity of the HL7 Electronic Health Record Work Group (EHR WG).
  
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==HL7 RCB Project - Presentations==
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==HL7 RCB Project - Presentations and Reports==
  
*[[media:Reducing_Clinician_Burden-Overview-20210125.pdf|Reducing Clinician Burden Project Overview, updated 25 Jan 2021]]
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Additional presentations are included in the "Success Stories" section below.
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*[[media:Reducing_Clinician_Burden-Overview-20210222.pdf|Reducing Clinician Burden Project - Overview, updated 22 Feb 2021]]
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*[[media:HL7_Reducing_Clinician_Burden-Progress_Report-20210222.pdf|Reducing Clinician Burden Project - Progress Report, updated 22 Feb 2021]]
 
*[[media:Reducing_Clinician_Burden-US_Core_Data_for_Interoperability-20201026.pdf|Burden Reduction Opportunities in the World of US Core Data for Interoperability (USCDI)? Presentation for Discussion, Gary Dickinson, updated 26 Oct 2020]]
 
*[[media:Reducing_Clinician_Burden-US_Core_Data_for_Interoperability-20201026.pdf|Burden Reduction Opportunities in the World of US Core Data for Interoperability (USCDI)? Presentation for Discussion, Gary Dickinson, updated 26 Oct 2020]]
 
*[[media:Burden_Reduction_OBRHI_9-21-2020.pdf|Interoperability and Burden Reduction - Emerging Opportunities for Collaborative Care, Denise St Clair PhD, US Centers for Medicare and Medicaid Services, Office of Burden Reduction and Health Informatics, presented 21 Sep 2020]]
 
*[[media:Burden_Reduction_OBRHI_9-21-2020.pdf|Interoperability and Burden Reduction - Emerging Opportunities for Collaborative Care, Denise St Clair PhD, US Centers for Medicare and Medicaid Services, Office of Burden Reduction and Health Informatics, presented 21 Sep 2020]]
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==HL7 RCB Project - Analysis, Derivations and Worksheets==
 
==HL7 RCB Project - Analysis, Derivations and Worksheets==
*[[media:Reducing_Clinician_Burden_Analysis_Worksheet-20210125.xlsx|DRAFT Reducing Clinician Burden Analysis Worksheet, updated 25 Jan 2021]]
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*[[media:Reducing_Clinician_Burden_Analysis_Worksheet-20210222.xlsx|DRAFT Reducing Clinician Burden Analysis Worksheet, updated 22 Feb 2021]]
This version of the RCB Analysis Worksheet includes the ONC FINAL "Strategy on Reducing Burden Relating to the Use of Health IT and EHRs".  Each of the four ONC Initiatives(I), along with Strategies(S) and Recommendations(R) are inserted within the related RCB topic area and are identified as Ix.Sx.Rx.  NOTE also that all reference sources up through #122 have been reviewed and are incorporated in this version.  See "References" Tab.
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NOTE that all reference sources up through #122 have been reviewed and are incorporated in this version.  See "References" Tab.
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*[[media:Reducing_Clinician_Burden-Burden_Impact_Statement-20210222.pdf|DRAFT Burden Impact Statement, updated 22 Feb 2021]]
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Proposed HL7 Burden Impact Statement (BIS) targets HL7 Projects – to assess potential impact on clinician burden and identify possible benefits toward burden reduction.  Intended for inclusion as part of HL7 Project Scope Statements (new projects) and within HL7 Standards and Implementation Guides.  The BIS is a collaboration with the American Medical Association.
 
*[[media:Reducing_Clinician_Burden-Cause_Matrix-20210125.pdf|DRAFT Reducing Clinician Burden - Cause Matrix, updated 25 Jan 2021]]
 
*[[media:Reducing_Clinician_Burden-Cause_Matrix-20210125.pdf|DRAFT Reducing Clinician Burden - Cause Matrix, updated 25 Jan 2021]]
 
This one page DRAFT outlines key causal factors for clinician burden and is offered for review and comment.
 
This one page DRAFT outlines key causal factors for clinician burden and is offered for review and comment.
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*[[media:Re-envisioning_HL7-Gary_Dickinson-20201130.pdf|"Re-Envisioning HL7", Gary Dickinson, submitted 30 Nov 2020]]
 
*[[media:Re-envisioning_HL7-Gary_Dickinson-20201130.pdf|"Re-Envisioning HL7", Gary Dickinson, submitted 30 Nov 2020]]
 
These comments were submitted to HL7 leadership as part of the ongoing effort to re-envision HL7 and are derived (in part) from analysis of the RCB Project.
 
These comments were submitted to HL7 leadership as part of the ongoing effort to re-envision HL7 and are derived (in part) from analysis of the RCB Project.
 
==HL7 RCB Project - Conversations==
 
*[[media:HL7_Reducing_Clinician_Burden-AMA_Conversation-20210125.pdf|Conversation with the American Medical Association, Questions and Topics for Collaboration, updated 25 Jan 2021]]
 
*[[media:Reducing_Clinician_Burden-Burden_Impact_Statement-20210120.pdf|DRAFT Burden Impact Statement, updated 20 Jan 2021]]
 
Based on our conversation with the AMA, we have drafted a Burden Impact Statement, designed for consideration by HL7 Work Groups and Project Teams as new HL7 Work Items are introduced.  This has yet to be formalized and is offered as a DRAFT for review and comment.
 
  
 
==HL7 RCB Collaborative Project Candidate - Medication List Management and Reconciliation==
 
==HL7 RCB Collaborative Project Candidate - Medication List Management and Reconciliation==
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==HL7 RCB Project - Reference Sources==
 
==HL7 RCB Project - Reference Sources==
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*[https://academic.oup.com/jamia/advance-article/doi/10.1093/jamia/ocaa320/6135062?searchresult=1 Journal of the American Medical Informatics Association - A retrospective look at the predictions and recommendations from the 2009 AMIA policy meeting: did we see EHR-related clinician burnout coming? Justin B Starren MD PhD, William M Tierney MD, Marc S Williams, Paul Tang MD, Charlene Weir, Ross Koppel PhD, Philip Payne, George Hripcsak, Don E Detmer MD, published 15 Feb 2021]
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*[https://www.healthaffairs.org/do/10.1377/hblog20210105.661344/full/ Health Affairs - Improving Interoperability By Moving From Perfection To Pragmatism, Julia Adler-Milstein, Aaron B Neinstein, Russell J. Cucina, published 13 Jan 2021]
 
*[https://www.jmir.org/2020/12/e23382/ Journal of Medical Internet Research - Perceived Electronic Health Record Usability as a Predictor of Task Load and Burnout Among US Physicians: Mediation Analysis, Edward R Melnick MD MHS, Elizabeth Harry MD, Christine A Sinsky MD, Liselotte N Dyrbye MD MHPE, Hanhan Wang MPS, Mickey Todd Trockel MD PhD, Colin P West MD PhD, Tait Shanafelt MD, published 22 Dec 2020]
 
*[https://www.jmir.org/2020/12/e23382/ Journal of Medical Internet Research - Perceived Electronic Health Record Usability as a Predictor of Task Load and Burnout Among US Physicians: Mediation Analysis, Edward R Melnick MD MHS, Elizabeth Harry MD, Christine A Sinsky MD, Liselotte N Dyrbye MD MHPE, Hanhan Wang MPS, Mickey Todd Trockel MD PhD, Colin P West MD PhD, Tait Shanafelt MD, published 22 Dec 2020]
 
*[https://www.hcinnovationgroup.com/clinical-it/physician-burnout/article/21203684/why-informatics-leaders-are-key-to-reducing-itcaused-clinician-burnout?utm_source=HI+Daily+NL&utm_medium=email&utm_campaign=CPS201223026&o_eid=8765B7190445D3C&rdx.ident%5Bpull%5D=omeda%7C8765B7190445D3C&oly_enc_id=8765B7190445D3C Healthcare Innovation - Why Informatics Leaders Are Key to Reducing IT-Caused Clinician Burnout, Rajiv Leventhal, published 22 Dec 2020]
 
*[https://www.hcinnovationgroup.com/clinical-it/physician-burnout/article/21203684/why-informatics-leaders-are-key-to-reducing-itcaused-clinician-burnout?utm_source=HI+Daily+NL&utm_medium=email&utm_campaign=CPS201223026&o_eid=8765B7190445D3C&rdx.ident%5Bpull%5D=omeda%7C8765B7190445D3C&oly_enc_id=8765B7190445D3C Healthcare Innovation - Why Informatics Leaders Are Key to Reducing IT-Caused Clinician Burnout, Rajiv Leventhal, published 22 Dec 2020]
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*[https://www.healthcareitnews.com/news/pandemic-era-burnout-how-ehr-vendors-are-redesigning-ui-and-ux-battle-stress Healthcare IT News - Pandemic-era burnout: How EHR vendors are redesigning UI and UX to battle stress, Bill Siwicki, published 14 Dec 2020]
 
*[https://www.healthcareitnews.com/news/pandemic-era-burnout-how-ehr-vendors-are-redesigning-ui-and-ux-battle-stress Healthcare IT News - Pandemic-era burnout: How EHR vendors are redesigning UI and UX to battle stress, Bill Siwicki, published 14 Dec 2020]
 
*[https://www.healthcareitnews.com/news/female-physicians-spent-33-more-minutes-day-ehrs Healthcare IT News - Female physicians spent 33 more minutes per day in EHRs, Kat Jercich, published 11 Dec 2020]
 
*[https://www.healthcareitnews.com/news/female-physicians-spent-33-more-minutes-day-ehrs Healthcare IT News - Female physicians spent 33 more minutes per day in EHRs, Kat Jercich, published 11 Dec 2020]
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*[https://www.healthit.gov/sites/default/files/page/2020-11/2020-11-17_ICAD_TF_FINAL_Report_HITAC.pdf >>A Path Toward Further Clinical and Administrative Data Integration - Final Report of the Health Information Technology Advisory Committee's Intersection of Clinical and Administrative Data Task Force to the National Coordinator for Health Information Technology, published 17 Nov 2020]
 
*[https://ctlin.blog/2020/11/11/uchealth-launches-ournotes-how-patients-co-author-clinic-progress-notes/amp/ UCHealth launches OurNotes: how patients co-author clinic progress notes, C.T. Lin, published 11 Nov 2020]
 
*[https://ctlin.blog/2020/11/11/uchealth-launches-ournotes-how-patients-co-author-clinic-progress-notes/amp/ UCHealth launches OurNotes: how patients co-author clinic progress notes, C.T. Lin, published 11 Nov 2020]
 
*[https://www.longwoods.com/content/26332/healthcare-quarterly/electronic-health-record-related-burnout-among-clinicians-practical-recommendations-from-the-litera Longwoods Healthcare Quarterly - Electronic Health Record-Related Burnout among Clinicians: Practical Recommendations for Canadian Healthcare Organizations, Brian Lo, Jessica Kemp, Clare Cullen, Tania Tajirian, Damian Jankowicz, Gillian Strudwick, published 23 Oct 2020]
 
*[https://www.longwoods.com/content/26332/healthcare-quarterly/electronic-health-record-related-burnout-among-clinicians-practical-recommendations-from-the-litera Longwoods Healthcare Quarterly - Electronic Health Record-Related Burnout among Clinicians: Practical Recommendations for Canadian Healthcare Organizations, Brian Lo, Jessica Kemp, Clare Cullen, Tania Tajirian, Damian Jankowicz, Gillian Strudwick, published 23 Oct 2020]
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*[https://www.healthcareitnews.com/news/pandemic-era-burnout-one-consumer-s-tiring-tech-enabled-journey-find-memory-care-parent Healthcare IT News - Pandemic-era burnout: One consumer’s tiring, tech-enabled journey to find memory care for a parent, Bill Siwicki, published 21 Sep 2020]
 
*[https://www.healthcareitnews.com/news/pandemic-era-burnout-one-consumer-s-tiring-tech-enabled-journey-find-memory-care-parent Healthcare IT News - Pandemic-era burnout: One consumer’s tiring, tech-enabled journey to find memory care for a parent, Bill Siwicki, published 21 Sep 2020]
 
*[https://www.healthcareitnews.com/news/rwjbarnabas-health-ehr-user-experience-tool-helps-reduce-clinician-burden Healthcare IT News - EHR user experience tool helps reduce clinician burden, Bill Siwicki, published 18 Sep 2020]
 
*[https://www.healthcareitnews.com/news/rwjbarnabas-health-ehr-user-experience-tool-helps-reduce-clinician-burden Healthcare IT News - EHR user experience tool helps reduce clinician burden, Bill Siwicki, published 18 Sep 2020]
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*[https://www.nejm.org/doi/pdf/10.1056/NEJMp2011027?articleTools=true >>New England Journal of Medicine - Preventing a Parallel Pandemic — A National Strategy to Protect Clinicians’ Well-Being, Victor J. Dzau MD, Darrell Kirch MD, and Thomas Nasca MD, published 6 Aug 2020]
 
*[https://nam.edu/electronic-health-record-optimization-and-clinician-well-being-a-potential-roadmap-toward-action/ National Academy of Medicine - Electronic Health Record Optimization and Clinician Well-Being: A Potential Roadmap Toward Action, Tina Shah MD MPH, Andrea Borondy Kitts MS MPH, Jeffrey A Gold MD, Keith Horvath MD, Alex Ommaya DSc, Frank Opelka MD FACS, Luke Sato MD, Gretchen Schwarze MD MPP FACS, Mark Upton MD, Lew Sandy MD MBA, published 3 Aug 2020]
 
*[https://nam.edu/electronic-health-record-optimization-and-clinician-well-being-a-potential-roadmap-toward-action/ National Academy of Medicine - Electronic Health Record Optimization and Clinician Well-Being: A Potential Roadmap Toward Action, Tina Shah MD MPH, Andrea Borondy Kitts MS MPH, Jeffrey A Gold MD, Keith Horvath MD, Alex Ommaya DSc, Frank Opelka MD FACS, Luke Sato MD, Gretchen Schwarze MD MPP FACS, Mark Upton MD, Lew Sandy MD MBA, published 3 Aug 2020]
 
*[https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00612 Health Affairs - Practice And Policy Reset Post-COVID-19: Reversion, Transition, Or Transformation? Christine Sinsky MD, Mark Linzer MD, published Aug 2020]
 
*[https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00612 Health Affairs - Practice And Policy Reset Post-COVID-19: Reversion, Transition, Or Transformation? Christine Sinsky MD, Mark Linzer MD, published Aug 2020]
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*[https://www.nytimes.com/2019/12/31/opinion/doctors-nurses-and-the-paperwork-crisis-that-could-unite-them.html New York Times - Doctors, Nurses and the Paperwork Crisis That Could Unite Them, Theresa Brown, Stephen Bergman, published 31 Dec 2019]
 
*[https://www.nytimes.com/2019/12/31/opinion/doctors-nurses-and-the-paperwork-crisis-that-could-unite-them.html New York Times - Doctors, Nurses and the Paperwork Crisis That Could Unite Them, Theresa Brown, Stephen Bergman, published 31 Dec 2019]
 
*[https://fortune.com/longform/electronic-health-records-fraud/ Fortune Magazine/Kaiser Health News - Electronic Health Records Creating a ‘New Era’ of Health Care Fraud, Officials Say, Fred Schulte and Erika Fry, published 23 Dec 2019]
 
*[https://fortune.com/longform/electronic-health-records-fraud/ Fortune Magazine/Kaiser Health News - Electronic Health Records Creating a ‘New Era’ of Health Care Fraud, Officials Say, Fred Schulte and Erika Fry, published 23 Dec 2019]
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*[https://edhub.ama-assn.org/steps-forward/module/2757858#section-247203549 >>American Medical Association - Steps Forward - Getting Rid of Stupid Stuff (GROSS), Melinda Ashton MD, Hawaii Pacific Health, published 19 Dec 2019]
 
*[https://www.radiologybusiness.com/topics/leadership/healthcare-artificial-intelligence-burnout Radiology Business - 80% of healthcare pros believe AI is reducing burnout, Marty Stempniak, published 16 Dec 2019]
 
*[https://www.radiologybusiness.com/topics/leadership/healthcare-artificial-intelligence-burnout Radiology Business - 80% of healthcare pros believe AI is reducing burnout, Marty Stempniak, published 16 Dec 2019]
 
*[https://fortune.com/longform/medical-records-government-regulation-patient-risk/ Fortune Magazine/Kaiser Health News - No Safety Switch: How Lax Oversight of Electronic Health Records Puts Patients at Risk - Special interests and congressional inaction doomed efforts to regulate electronic medical records, putting patients at risk, Fred Schulte and Erika Fry, published 21 Nov 2019]
 
*[https://fortune.com/longform/medical-records-government-regulation-patient-risk/ Fortune Magazine/Kaiser Health News - No Safety Switch: How Lax Oversight of Electronic Health Records Puts Patients at Risk - Special interests and congressional inaction doomed efforts to regulate electronic medical records, putting patients at risk, Fred Schulte and Erika Fry, published 21 Nov 2019]

Latest revision as of 00:08, 5 March 2021

Current Content related to this page can be found on Confluence Here

The Reducing Clinician Burden (RCB) Project is an activity of the HL7 Electronic Health Record Work Group (EHR WG).

Please subscribe to the HL7 EHR WG listserver for meeting announcements, agendas and updates regarding current work.

The RCB Project team meets via teleconference on the 2nd and 4th Mondays each month - at 3PM ET (US).

To join RCB teleconferences: https://global.gotomeeting.com/meeting/join/798931918

NOTE: DRAFT documents may be incomplete and are posted for Team review and discourse. Please take care to note their draft (tentative) status if referencing or sharing with others.


HL7 RCB Project - Presentations and Reports

Additional presentations are included in the "Success Stories" section below.

HL7 RCB Project - Analysis, Derivations and Worksheets

NOTE that all reference sources up through #122 have been reviewed and are incorporated in this version. See "References" Tab.

Proposed HL7 Burden Impact Statement (BIS) targets HL7 Projects – to assess potential impact on clinician burden and identify possible benefits toward burden reduction. Intended for inclusion as part of HL7 Project Scope Statements (new projects) and within HL7 Standards and Implementation Guides. The BIS is a collaboration with the American Medical Association.

This one page DRAFT outlines key causal factors for clinician burden and is offered for review and comment.

These comments on the DRAFT International Patient Summary were prepared in correspondence with findings of the HL7 RCB Project and clinician burdens associated with patient summary creation, exchange and use, particularly with regard to aspects of information overload, data integrity, patient/provider identity matching, preservation of clinical data context, reconciliation of medications, medication allergies, all allergies, problems/diagnoses and more.

This worksheet shows a typical end-to-end information flow for clinical documentation, starting at the point of origination (authorship) of a health record entry - following with points of update, verification, attestation, exchange (transmit and receipt) - ending at the point where record entry content is accessed/used for subsequent patient care, interventions and decision making.

This graphic asks the question "How Might We Ensure End-to-End Fidelity as We Collect, Share and Use Clinical Documentation?", considering what the author sees/intends and how that corresponds to what the end user sees.

This graphic shows a Clinical Documentation Instance and subsequent clinical and non-clinical flow based on its segments: •provenance, •clinical facts, findings and observations, •order detail, •prior authorization detail, •billing/claims detail, •quality/performance data, •public health data, •administrative data, •finance/cost data, •registry data... Each segment represents a purpose of collection and a corresponding purpose of use, based on stakeholder needs.

This document is part of an initial dialogue between the HL7 RCB Project and the US Centers for Medicare and Medicaid Services (CMS) Office of Burden Reduction and Health Informatics and offers a timeline of HL7 EHR WG standards development activities from 2000 until the present.

These comments were submitted to the Sequoia Project, Data Usability Workgroup, as part of their consideration of characteristics/qualities of health data that make it usable - for particular end uses/end users (e.g., clinicians in clinical practice) and are derived from analysis of the RCB Project.

These comments were submitted to HL7 leadership as part of the ongoing effort to re-envision HL7 and are derived (in part) from analysis of the RCB Project.

HL7 RCB Collaborative Project Candidate - Medication List Management and Reconciliation

The Medication Reconciliation Burden Reduction Focus Team meets most Thursdays at 5PM ET (US). Teleconference access is as noted above. If you are a clinician with medication reconciliation experience, please join us.

HL7 RCB Project - Reducing Clinician Burden "Comment Only" Ballot

This ballot closed on Monday, 14 September 2020.

HL7 RCB Project - White Paper

This White Paper has been released for Project Team review and comment.

HL7 RCB Project - Reducing Burden - Success Stories

Burden Reduction (and other) Initiatives in Response to the COVID-19 Pandemic

"See What We Mean"

HL7 RCB Project - Survey and Responses

HL7 RCB Project - Focus Team Drafts

US Office of National Coordinator for Health Information Technology (ONC) Strategy for Reducing Burden

US Department of Health and Human Services (HHS) Patients over Paperwork Initiative

More RCB Perspectives and Resources

HL7 RCB Project - Reference Sources