Reducing Clinician Burden

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 1st and 3rd Mondays each month through December 2020 - at 3PM ET (US). Starting in January 2021, the RCB Project Team will meet 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

• Reducing Clinician Burden Project Overview, updated 7 Dec 2020
• Burden Reduction Opportunities in the World of US Core Data for Interoperability (USCDI)? Presentation for Discussion, Gary Dickinson, updated 26 Oct 2020
• 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
• Reducing Clinical Burden thru Knowledge Engineering - Curating Clinical Knowledge, Frank Opelka MD FACS, American College of Surgeons, presented 21 Sep 2020
• Problem Concept Maps: An Ontology to Facilitate Auto-Summarization of Electronic Health Information, Joel Buchanan MD, University of Wisconsin/Madison, presented 21 Sep 2020
• The Problem-Oriented Health Record (POHR) and a Pathway to Reducing Clinician Burden (with Links), Lincoln Weed, Chris Weed, presented 17 Aug 2020
• The Problem-Oriented Health Record (POHR) and a Pathway to Reducing Clinician Burden (with Notes), Lincoln Weed, Chris Weed, presented 17 Aug 2020
• Payment Reform in the Era of Advanced Diagnostics, Artificial Intelligence and Machine Learning, James Sorace MD MS, presented 3 Aug 2020
• Examining the Health IT Vendor’s Perspective - Lessons learned as a physician working for a health IT vendor, Ryan Mullins MD CPE, presented 20 Jul 2020
• HL7 Da Vinci Project Overview (focused on Provider/Payer Exchange), Viet Nguyen MD, presented 18 May 2020
• HL7 Da Vinci Project Calendar, Viet Nguyen MD, presented 18 May 2020
• Data Quality and Clinician Burden - Overview, Examples, and Basic Recommendations, Reed Gelzer MD, presented 4 May and 1 Jun 2020
• Exploring FHIR to Reduce Burden for Quality Measurement, Floyd Eisenberg MD PhD, presented 20 Apr 2020
• Exploring FHIR to Reduce Burden for Quality Measurement - Survey Results, Floyd Eisenberg MD PhD, presented 20 Apr 2020
• Association between EHR Usability and Burnout, David Schlossman MD, presented 18 Nov 2019
• Increasing EHR System Usability Through Standards - As One Approach to Reducing Clinician Burden, David Schlossman MD, presented 7 Oct 2019
• Reducing Clinician Burden Project - New Directions in Alleviating Clinical Workflow and Documentation Burdens - Association of Medical Directors of Information Systems (AMDIS) Presentation, David Schlossman MD, presented 20 Jun 2019
• Update on HL7 EHR System Usability Functional Profile Project, HL7 Da Vinci Project, CMS Patients over Paperwork RFI, David Schlossman MD, presented 17 Jun 2019

HL7 RCB Project - Analysis Worksheets

• DRAFT Reducing Clinician Burden Analysis Worksheet, updated 16 Nov 2020

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.

• DRAFT Reducing Clinician Burden - Cause Matrix, updated 15 Jun 2020

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

• RCB-related Comments on ISO DIS 27269 - International Patient Summary, published 30 Mar 2020

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.

• DRAFT Clinical Documentation - Collect, Share, Use - Information Flow and Lifecycle Example - including Intersections with Clinician Burden and Safety Concerns, updated 30 Dec 2020

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.

• DRAFT Clinical Documentation - Ensuring End-to-End Fidelity, updated 30 Dec 2020

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.

• DRAFT Clinical Documentation - Collect, Share, Use - Data Segmentation for Clinical Integrity, updated 30 Dec 2020

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.

• “A Perspective on the History and Progression of EHR System Functionality Standards, Certification and Adoption”, updated 30 Jul 2020

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.

• "Data Usability Characteristics/Qualities", Gary Dickinson, submitted 16 Nov 2020

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.

• "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.

HL7 RCB Collaborative Project Candidate - Medication List Management and Reconciliation

• DRAFT Medication Reconciliation Overview, updated 12 Nov 2020
• DRAFT Medication Reconciliation Use Case Scenario Worksheet, updated 10 Dec 2020

The Medication Reconciliation Burden Reduction Focus Team meets most Thursdays at 5PM ET (US). Teleconference access is as noted above. Please join us.

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

• RCB Ballot Document - September 2020 Ballot Cycle - To Gain Insights/Input from the HL7 International Community on Workable Strategies for Clinician Burden Reduction
• RCB Ballot Comments (from Participants)

This ballot closed on Monday, 14 September 2020.

HL7 RCB Project - White Paper

• DRAFT Reducing Clinician Burden by Improving Electronic Health Record Usability and Support for Clinical Workflow, David Schlossman MD PhD, Lisa Masson MD, James Tcheng MD, Luann Whittenburg RN PhD, Barry Newman MD, Gary Dickinson FHL7, released 1 Jun 2020

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

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

• (US) Centers for Medicare and Medicaid Services (CMS) - Waivers and COVID-19 Response, Online Presentation, 7 April 2020
• (US) CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19, posted 22 Mar 2020
• (US) Trump Administration Makes Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge, posted 30 Mar 2020
• (US) Health Information Technology Advisory Committee (HITAC) Brainstorms Ways ONC Can Help Front-Line Providers in COVID-19 Response, published 27 Mar 2020
• (US Health Plan) Humana easing administrative, financial burdens on providers amid COVID-19 crisis, published 2 Apr 2020
• (US) CMS - COVID-19 Disaster Response Toolkit, posted 7 April 2020

• Logica COVID-19 Interoperability Project, posted 4 Apr 2020
• Logica COVID-19 FHIR Implementation Guide, posted 4 Apr 2020

"See What We Mean"

• "See What We Mean" Video Clips, developed by Medstar Health - National Center for Human Factors in Healthcare - EHR Safety and Usability Team

HL7 RCB Project - Reducing Burden - Success Stories

• DRAFT Reducing Clinician Burden - Success Story Template, updated 28 Jan 2019
• Duke University - Duke Heart Business Unit – Procedure Reporting, James E Tcheng MD FACC FSCAI, 4 Feb 2019
• Duke University - Reducing Clinician Burden - Cardiovascular Procedure Reporting at Duke, James E Tcheng MD FACC FSCAI, 18 Sep 2019 (Posted with Permission)
• University of Michigan - "Home for Dinner" - Reducing After Hours Documentation with Focused Training, Greta Branford MD, Marie Baldwin MSHROD, 26 Aug 2019 (Posted with Permission)
• National Health Service - Rotherham Foundation Trust (UK) - Benefits of SNOMED CT from a clinical perspective, The Rotherham experience, Monica Jones, 9 Apr 2019 (Posted with Permission)
• University of Pennsylvania - Getting Time Back in Your Day! Implementing a Multi-Faceted Approach to Optimizing Epic in the Ambulatory Setting, Jeff Tokazewski MD, Carole Rosen, Shane Thomas, 15 Jul 2019 (Posted with Permission)
• American Hospital Association - Well-Being Playbook, A Guide for Hospital and Health System Leaders, May 2019
• American Hospital Association - Well-Being Playbook Presentation, Elisa Arespacochaga, 19 Aug 2019 (Posted with Permission)
• Stanford University/Stanford Health Care - Understanding the Impact of the EHR on Physician Burnout and Wellness, Christopher Sharp MD, Lindsay Stevens MD, 28 Aug 2019 (Posted with Permission)
• SPRINT – An Organizational Strategy that Increases Satisfaction, Improves Teamwork and Reduces Burnout, Amber Sieja MD, University of Colorado School of Medicine, UCHealth (Posted with Permission)

HL7 RCB Project - Survey and Responses

• RCB Project Survey and Responses, dated 19 Aug 2019
• "The Value Expression" Presentation to CMS, Frank Opelka MD, Medical Director, American College of Surgeons, Quality and Health Policy, published Jun 2019 (Posted with Permission)

HL7 RCB Project - Focus Team Drafts

• DRAFT Reducing Clinician Burden - New Approaches to Clinical Workflow, Clinical Documentation, and Electronic Health Record Usability, Clinical Workflow and Documentation Focus Team Report, David Schlossman MD, Lisa Masson MD, Leads, updated 8 May 2019
• DRAFT Team Report - Clinical Documentation: Quality and Usability - Lisa Masson MD, Lead, updated 7 Jan 2019
• DRAFT Team Outline - Clinical decision support, medical logic, artificial intelligence + Alerts, reminders, notifications, inbox management + Information overload - Jim McClay MD, Lead, updated 17 Jan 2019
• DRAFT Team Report - Clinical Workflow (Usability Focus) - David Schlossman MD, Lead, updated 21 Jan 2019
• DRAFT Root Cause Analysis - Clinical Workflow - David Schlossman MD, Lead, updated 18 Mar 2019
• DRAFT Team Outline - Legal aspects and risks - Barry Newman MD, updated 1 April 2019
• DRAFT Team Report - Lock-In, Data Liquidity and Switching Costs - Michael Brody DPM, Lead, updated 15 Dec 2018
• DRAFT Team Report - Data Quality - Reed Gelzer MD, Lead, updated 4 Mar 2019

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

• ONC DRAFT Federal Health IT Strategic Plan, 2020-2025 - published 15 Jan 2020
• ONC FINAL "Strategy on Reducing Burden Relating to the Use of Health IT and EHRs", including Findings, Strategies and Recommendations, published 21 Feb 2020
• Summary of Public Comments on ONC DRAFT Strategy, published 26 Mar 2019
• HL7 Comments on ONC DRAFT Strategy, compiled by HL7 Policy Advisory Committee, submitted 28 Jan 2019
• CentriHealth Comments on ONC DRAFT Strategy, submitted 28 Jan 2019
• ONC/Urban Institute - Health Policy Center - DRAFT Electronic Health Record Reporting Program, published Jun 2020
• EHR Standards Consulting - Comments on the ONC/Urban Institute DRAFT Electronic Health Record Reporting Program, submitted 10 Aug 2020

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

• FINAL RULE - Medicare and Medicaid Programs; Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction..., 20 Sep 2019

More RCB Perspectives and Resources

• Video - An EHR State of Mind, Zubin Damania MD, posted 19 Oct 2015
• Video - Professional Satisfaction – Saturday Night Belongs to Epic, Christine Sinsky MD, VP/American Medical Association, posted 27 Jan 2016
• Video - Professional Satisfaction – EHR Should Make Our Lives Delightful, Christine Sinsky MD, VP/American Medical Association, posted 27 Jan 2016
• Video - Creating Joy in Medical Practice - An Interview, Christine Sinsky MD, VP/American Medical Association, posted 25 Jan 2018
• Video - Strategies to Address Burnout Must be Practical and Local, Christine Sinsky MD, VP/American Medical Association, posted 25 Jan 2018
• Video - AMDIS/HIMSS Physician Executive Symposium - An Interview, Christine Sinsky MD, VP/American Medical Association, posted 28 March 2018
• American Medical Association - Education Hub - Electronic Health Record Optimization: Strategies for Thriving - Strategies to help health care organizations maximize the benefits and minimize the burdens of the EHR, published 30 Aug 2018
• Video - Freeing physicians to do their jobs - 2019 EHR National Symposium - Stanford Medicine, posted 28 Oct 2019
• Statista - Stress and burnout - Statistics & Facts, John Elflein, published 16 Aug 2019
• World Health Organization - Safe Health Workers, Safe Patients?, posted 16 Sep 2020

HL7 RCB Project - Reference Sources

• 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
• Healthcare Innovation - Why Informatics Leaders Are Key to Reducing IT-Caused Clinician Burnout, Rajiv Leventhal, published 22 Dec 2020
• Healthcare IT News - U.S. clinicians spend 50% more time in EHR than those in other countries, Kat Jercich, published 17 Dec 2020
• Healthcare IT News - Pandemic-era burnout: How EHR vendors are redesigning UI and UX to battle stress, Bill Siwicki, published 14 Dec 2020
• UCHealth launches OurNotes: how patients co-author clinic progress notes, C.T. Lin, published 11 Nov 2020
• 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
• EHR Intelligence - Docs Add 1 Hour of Administrative Work for EHR Inbox Management, Christopher Jason, published 22 Oct 2020
• Healthcare IT News - Hidden in plain sight - Clinicians may not spot EHR cancer risk info, Kat Jercich, published 21 Sep 2020
• 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
• Healthcare IT News - EHR user experience tool helps reduce clinician burden, Bill Siwicki, published 18 Sep 2020
• 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
• Health Affairs - Practice And Policy Reset Post-COVID-19: Reversion, Transition, Or Transformation? Christine Sinsky MD, Mark Linzer MD, published Aug 2020
• EHR Intelligence - High EHR Inbox Volume is the Leading Cause of Clinician Burnout - Outside of the copy and paste method EHR efficiency tools do not reduce clinician burnout, Christopher Jason, published 29 Jul 2020
• EHR Intelligence - Vanderbilt Launches Program to Mitigate EHR Alerts and Clinician Burnout - Program has already reduced the weekly average of EHR alerts by 10 percent - Reducing clinician burnout at Vanderbilt University Medical Center, Christopher Jason, published 21 Jul 2020
• HealthLeaders Media - Physician Fatigue linked to Electronic Health Record Use, Christopher Cheney, published 20 Jul 2020
• American Medical Association - How to create better EHR usability to enhance physicians’ lives, Sara Berg, published 16 Jul 2020
• American Nursing Informatics Association Board of Directors - The Six Domains of Burden: A Conceptual Framework to Address the Burden of Documentation in the Electronic Health Record, Patricia P. Sengstack DNP RN-BC FAAN, Bonnie Adrian PhD RN-BC, David L Boyd DNP RN CNS RN-BC, Avaretta Davis DNP RN-BC, Mary Hook PhD RN-BC, Shannon Lea Hulett DNP RN CNL, Eva Karp DHA MBA RN-BC FACHE, Rosemary Kennedy PhD RN MBA FAAN, Laura Heermann Langford PhD RN, Teresa Ann Niblett RN MS RN-BC, published 23 Jun 2020
• US Centers for Medicare and Medicaid Services Unveils Major Organizational Change to Reduce Provider and Clinician Burden and Improve Patient Outcomes, published 23 Jun 2020
• Harvard Business Review - It’s Time for a New Kind of Electronic Health Record, John Glaser MD, published 20 Jun 2020
• Healio/Psychiatry - EHR-related fatigue may lead to inefficient use among physicians, Joe Gramigna MA, published 16 Jun 2020
• Health Data Management - AHA calls on CMS to reduce clinical documentation burden, Greg Slabodkin, published 6 Jun 2020
• EHR Intelligence - EHR Implementation Leads to Significant Physician Burnout and Anxiety - Notable changes in the workplace (such as EHR implementation and adoption) are leading causes of physician burnout, Christopher Jason, published 5 Jun 2020
• Healthcare IT News - To fight nurse burnout, EHRs must use AI, reflect RN-specific workflows, Bill Siwicki, published 2 Jun 2020
• Healthcare IT News - EHRs still posing big safety risks in many hospitals, Kat Jercich, published 2 Jun 2020
• Journal of the American Medical Association - Commercial Influences on Electronic Health Records and Adverse Effects on Clinical Decision Making, Julie K Taitsman MD JD, Andrew VanLandingham JD, Christi A Grimm MPA, published 11 May 2020
• EHR Intelligence - Heavy EHR Workload Leads to Higher Clinician Burnout and Exhaustion - Researchers found that clinicians are engaging with over 300 messages in the EHR on a weekly basis, resulting in clinician burnout, Christopher Jason, published 7 Apr 2020
• Journal of Medical Informatics Research - Information Overload in Emergency Medicine Physicians - A Multisite Case Study Exploring the Causes, Impact, and Solutions in Four North England National Health Service Trusts, Laura Sbaffi1 BSc MSc MA DPhil, James Walton BSc MBChB MRCEM FRCEM John Blenkinsopp BA, Graham Walton BSc MA MBA DPhil. published 4 Apr 2020
• Health Affairs - To Measure The Burden Of EHR Use, Audit Logs Offer Promise - But Not Without Further Collaboration, Genna Cohen, Llewelyn Brown, Megan Fitzgerald, Anita Somplasky, published 28 Feb 2020
• American Medical Association - Practice Management - 10 medical specialties, 10 different ways to cut physician burnout, Sara Berg, published 13 Feb 2020
• BMC Medical Informatics and Decision Making - A qualitative study of physician perspectives on adaptation to electronic health records, Cynthia J Sieck, Nicole Pearl, Tiffani J Bright, Po-Yin Yen, published 10 Feb 2020
• Journal of the American Medical Informatics Association - Metrics for assessing physician activity using electronic health record log data, Christine A Sinsky, Adam Rule, Genna Cohen, Brian G Arndt, Tait D Shanafelt, Christopher D Sharp, Sally L Baxter, Ming Tai-Seale, Sherry Yan, You Chen, Julia Adler-Milstein, Michelle Hribar, published 6 Feb 2020
• Washington Post - Too many tests, too little time: Doctors say they face ‘moral injury’ because of a business model that interferes with patient care, Melissa Bailey, published 1 Feb 2020
• Scientific American - Electronic Health Records Need a Shot in the Arm, Cassandra Willyard, published 1 Feb 2020
• International Journal of Medical Informatics - Physicians' and nurses’ experiences on EHR usability: Comparison between the professional groups by employment sector and system brand, Johanna Kaipioa, Anne Kuusistob, Hannele Hyppönenc, Tarja Heponiemic, Tinja Lääverid, published Feb 2020
• Medscape - (US) National Physician Burnout & Suicide Report 2020 - The Generational Divide, Leslie Kane MA, published 15 Jan 2020
• Forbes - How Doctors May Be Spending More Time With Electronic Health Records Than Patients, Bruce Y Lee, published 13 Jan 2020
• New York Times - Doctors, Nurses and the Paperwork Crisis That Could Unite Them, Theresa Brown, Stephen Bergman, published 31 Dec 2019
• 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
• Radiology Business - 80% of healthcare pros believe AI is reducing burnout, Marty Stempniak, published 16 Dec 2019
• 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
• US Agency for Health Research and Quality - Evidence-based Care Transformation Support (ACTS) Initiative, published 18 Nov 2019
• US Federal Register - Medicare Program; CY 2020 Revisions to Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies..., published 15 Nov 2019
• Becker's Healthcare - AMA study - Physicians give EHR usability an 'F' rating, Jackie Drees, published 14 Nov 2019
• Health Data Management - CMS final rule aims to reduce physician billing and coding burdens, Greg Slabodkin, published 4 Nov 2019
• National Academy of Medicine - Taking Action Against Clinician Burnout, 23 Oct 2019
• Healthcare Innovation - Preventing Physician Burnout on the Front Lines: HIT Execs Share Their Perspectives (Part 2), Rajiv Leventhal, 24 Oct 2019
• Healthcare Innovation - Preventing Physician Burnout on the Front Lines: HIT Execs Share Their Perspectives (Part 1), Rajiv Leventhal, 22 Oct 2019
• Health Data Management - EHR Modifications, Data Analysis become Tools to Fight Doc Burnout, Fred Bazzoli, 17 Oct 2019
• Medical Economics - 2019 EHR Scorecard: Physicians rate their EHR systems, 16 Oct 2019
• Medical Economics - Fixing EHRs, Todd Shryock, 14 Oct 2019
• Medscape - Clinical Effect of Burnout Difficult to Measure: Meta-analysis, Tara Haelle, 7 Oct 2019
• Mayo Clinic Proceedings - The Association Between Perceived Electronic Health Record Usability and Professional Burnout Among US Physicians, Edward R Melnick MD MHS, Liselotte N Dyrbye MD MHPE, Christine A Sinsky MD, Mickey Trockel MD PhD, Colin P West MD PhD, Laurence Nedelec PhD, Michael A Tutty PhD, Tait Shanafelt MD, published 24 Sep 2019
• Journal of the American Medical Association - Electronic Health Records: A System Only as Beneficial as Its Data, Nathalie Jetté MD MSc FRCPC, Churl-Su Kwon MD MPH FRSPH, 18 Sep 2019
• Medscape - Physician Burnout and Sadness: Powerful Expressions, Keith L Martin, 12 Sep 2019
• Medscape - Why Is Physician Well-being Declining? It's the System, Stupid, Peter M Yellowlees MD MBBS, 6 Sep 2019
• Journal of the American Medical Association - Association of Electronic Health Record Design and Use Factors With Clinician Stress and Burnout, Philip J Kroth MD MS, Nancy Morioka-Douglas MD, Sharry Veres MD, 16 Aug 2019
• Journal of the American Medical Association - Redefining the Physician’s Role in Cost-Conscious Care - The Potential Role of the Electronic Health Record, Brian J Miller MD MBA MPH, Jennifer M Slota, Jesse M Ehrenfeld MD MPH, published 15 July 2019
• Healthcare Innovation - Burnout is Prevalent, but Clinicians Believe Health Systems Don’t Properly Address It, Rajiv Leventhal, published 11 July 2019
• Healthcare Dive - EHR messaging, workflow can be redesigned to address burnout, Ron Shinkman, published 1 Jul 2019
• Annals of Family Medicine - Powering-Up Primary Care Teams: Advanced Team Care With In-Room Support, Christine A Sinsky, Thomas Bodenheimer MD MPH, Jul 2019
• Spok - Clinician Burnout in Healthcare: A Report for Healthcare Leaders, published Jul 2019
• Health Affairs - Physicians’ Well-Being Linked To In-Basket Messages Generated By Algorithms In Electronic Health Records, Ming Tai-Seale, Ellis C Dillon, Yan Yang, Robert Nordgren, Ruth L Steinberg, Teresa Nauenberg, Tim C Lee, Amy Meehan, Jinnan Li, Albert Solomon Chan, and Dominick L Frosch, published Jul 2019
• Health Data Management - Why the movement toward a patient identifier is only a start, Dan Cidon, published 17 Jun 2019
• Health Data Management - Why EHRs are flawed, and how they can be fixed, David Lareau, published 13 Jun 2019
• Healthcare Innovation - What Can Healthcare IT Leaders Do To Flip the Script on Physician Burnout?, Mark Hagland, published 3 Jun 2019
• Becker's Healthcare - Nearly half of physicians think EHRs have decreased quality of care, survey finds, Jackie Drees, published 1 May 2019
• TechTarget - Kaiser Permanente - Physician burnout eased with homegrown tech, Makenzie Holland, published 24 Apr 2019
• Journal of the American Medical Informatics Association - The complex case of EHRs: examining the factors impacting the EHR user experience, Michael A Tutty, Lindsey E Carlasare, Stacy Lloyd, Christine A Sinsky, published 2 Apr 2019
• Health Affairs - What The Inspector General Gets Wrong About Reforming Observation Hospital Care, Ann M Sheehy, Charles F S Locke, Bradley Flansbaum, published 25 Mar 2019
• Fortune and Kaiser Health News - Death by a Thousand Clicks: Where Electronic Health Records Went Wrong, Erika Fry and Fred Schulte, published 18 Mar 2019
• Henry J Kaiser Family Foundation - Public’s Experiences With Electronic Health Records, Cailey Muñana, Ashley Kirzinger, Mollyann Brodie, 18 Mar 2019
• HIStalk - To Douse the Flames of Physician Burnout, Target the Four Biggest Time-Wasters in the EHR, David Butler MD, published 13 Mar 2019
• Healthcare Innovation Group - EHR-Related Issues Top Patient Safety Concern List, David Raths, published 12 Mar 2019
• Healthcare IT News - Epic CEO Judy Faulkner on Apple, docs who actually like their EHRs..., Mike Miliard, published 13 Feb 2019
• Journal of Medical Internet Research - Unintended Consequences of Nationwide Electronic Health RecordAdoption: Challenges and Opportunities in the Post-MeaningfulUse Era, Tiago K Colicchio PhD MBA, James J Cimino MD, Guilherme Del Fiol MD PhD, published Jan 2019
• Thrive Global - Here’s Why Physician Burnout is Officially “A Public Health Crisis”, Jane Burnett, published 31 Jan 2019
• US Office of the National Coordinator for Health Information Technology (ONC) - DRAFT FOR COMMENT - Strategy on Reducing Burden Relating to the Use of Health IT and EHRs, published 28 Nov 2018, comments due 28 Jan 2019
• Massachusetts Medical Society, Massachusetts Health and Hospital Association, Harvard T.H. Chan School of Public Health, Harvard Global Health Institute - A Crisis in Health Care: A Call to Action on Physician Burnout, published 18 Nov 2018
• Health Data Management, AMA president calls for end to electronic health record abuse, Greg Slabodkin, published 14 Nov 2018
• The New Yorker/Annals of Medicine - Why Doctors Hate Their Computers, Atul Gawande, published 12 Nov 2018
• US Centers for Medicare/Medicaid Services - Clinician Letter - Reducing Documentation Burden and Coding Reform, Seema Verma, published 8 Nov 2018
• Health Data Management - Study links stress from EHR use to physician burnout, Greg Slabodkin, 6 Nov 2018
• Thoughts on addressing the clinician burden issue, Alpo Värri, Tampere University of Technology (Tampere, Finland), CEN TC251 WG II, published 16 Oct 2018
• Reducing Clinician Burden - Baltimore Presentation, David J Freedman DPM FACFAS FASPS CPC CPMA, published 4 Oct 2018
• Health Affairs - Patient-Centered, Value-Based Health Care Is Incompatible With The Current Climate Of Excessive Regulation, John O'Shea, published 3 Oct 2018
• National Academy of Medicine - Implementing Optimal Team-Based Care to Reduce Clinician Burnout, Cynthia D. Smith, Celynne Balatbat, Susan Corbridge, Anna Legreid Dopp, Jessica Fried, Ron Harter, Seth Landefeld, Christina Y. Martin, Frank Opelka, Lew Sandy, Luke Sato, Christine Sinsky, published 17 Sep 2018
• American College of Surgeons - EHRs add to surgeons’ administrative burdens - The ACS responds, Vinita Ollapally JD, published 1 Sep 2018
• Association of American Medical Colleges, AAMCNews - Electronic health records: What will it take to make them work? Peter Jaret, published 21 Aug 2018
• HIMSS Analytics Research Findings - Frequent Interruptions Distract Clinicians from Patient Care, Contribute to Stress and Burnout, published 22 May 2018
• Annals of Internal Medicine - Physician Burnout in the Electronic Health Record Era: Are We Ignoring the Real Cause? N Lance Downing MD, David W Bates MD MSc, Christopher A Longhurst MD MS, published 8 May 2018
• EHR Intelligence - Physicians urge CMS to Adjust the 2018 MIPS Reporting Period from One Year to 90 days for Reduced Administrative Burden, Kate Monica, published 23 Apr 2018
• Health Data Management - Seven Challenges Physicians Face Accessing Patient Data, Joseph Goedert, published 18 Apr 2018
• Predictors of physicians’ stress related to information systems: A nine-year follow-up survey study. BMC Health Services Research, Tarja Heponiemi, Hannele Hyppönen, Sari Kujala, Anna-Mari Aalto, Tuulikki Vehko, Jukka Vänskä, Marko Elovainio, published 13 Apr 2018
• EHR Intelligence - NQF Advises CMS Align Quality Measures, Cut Administrative Burden, Kate Monica, published 3 Apr 2018
• Journal of General Internal Medicine - Keystrokes, Mouse Clicks, and Gazing at the Computer: How Physician Interaction with the EHR Affects Patient Participation, Richard L. Street Jr, Lin Liu, Neil J. Farber, Yunan Chen, Alan Calvitti, Nadir Weibel, Mark T. Gabuzda, Kristin Bell, Barbara Gray, Steven Rick, Shazia Ashfaq, Zia Agha, published Apr 2018
• Physician Practice - Reducing Clinician Burnout in Five EHR-Related Areas, Gabriel Perna, published 9 Mar 2018
• Healthcare Informatics - Clinicians to CMS, ONC: “Right the Ship” to Simplify Reporting, Ease Regulatory Burdens, Heather Landi, published 13 Feb 2018
• Journal of General Internal Medicine - Electronic Health Records: a “Quadruple Win,” a “Quadruple Failure,” or Simply Time for a Reboot?, Michael Hochman, published 5 Feb 2018
• American Academy of Family Physicians - AAFP (letter to CMS/ONC regarding) Recommendations to Reduce Clinician Burden from Health Information Technology, John Meigs MD, published 2 Feb 2018
• American College of Surgeons - Regulatory Burden Reduction, Lauren Foe MPH, published 1 Feb 2018
• EHR Intelligence - EHR Use, Administrative Burden Accelerating Physician Burnout, Kate Monica, published 16 Jan 2018
• Applied Clinical Informatics - Consensus Statement: Feature and Function Recommendations to Optimize Clinician Usability of Direct Interoperability to Enhance Patient Care, Steven R Lane, Holly Miller, Elizabeth Ames, Lawrence Garber, David C Kibbe, Joseph H Schneider, Christoph U Lehmann, published 21 Jan 2018
• Stanford Medicine/The Harris Poll - How Doctors Feel About Electronic Health Records, Results of a national physician poll, 2018
• Dark Daily - EHR Systems Continue to Cause Burnout, Physician Dissatisfaction, and Decreased Face-to-Face Patient Care, published 22 Dec 2017
• EHR Intelligence - American Association of Physician Assistants - AAPA EHR Toolkit Offers Best Practices for EHR Design, Usability , Kate Monica, published 8 Dec 2017
• HITECH Answers - CMS Finalizes Policies that Reduce Provider Burden and Lower Drug Prices, published 2 Nov 2017
• Finnish physicians’ stress related to information systems keeps increasing: A longitudinal three wave survey study, Tarja Heponiemi, Hannele Hyppönen, Tuulikki Vehko, Sari Kujala, Anna-Mari Aalto, Jukka Vänskä, Marko Elovainio, published 17 Oct 2017
• Annals of Family Medicine - Tethered to the EHR: Primary Care Physician Workload Assessment Using EHR Event Log Data and Time-Motion Observations, Brian G. Arndt, MD, John W. Beasley, MD, Michelle D. Watkinson, MPH, Jonathan L. Temte, MD, PhD, Wen-Jan Tuan, MS, MPH, Christine A. Sinsky, MD, Valerie J. Gilchrist, MD, published Sep 2017
• National Academy of Medicine - Burnout Among Health Care Professionals: A Call to Explore and Address This Underrecognized Threat to Safe, High-Quality Care, Lotte N. Dyrbye, Tait D. Shanafelt, Christine A. Sinsky, Pamela F. Cipriano, Jay Bhatt, Alexander Ommaya, Colin P. West, and David Meyers, published 5 Jul 2017
• American College of Physicians - Putting Patients First by Reducing Administrative Tasks in Health Care, Shari M. Erickson MPH, Brooke Rockwern MPH, Michelle Koltov MPH, Robert M. McLean MD, published 2 May 2017
• Mayo Clinic - Executive Leadership and Physician Well-being: Nine Organizational Strategies to Promote Engagement and Reduce Burnout, Tait D Shanafelt MD, John H. Noseworthy MD, published Jan 2017
• Deloitte Survey of US Physicians - Findings on health information technology and electronic health records, published 3 Oct 2016
• EHR Intelligence - Tips for Reversing Physician Burnout Caused by EHR Use, Sheri Stoltenberg, published 16 Oct 2016
• FierceHealthcare - Intermountain's Marc Probst - We're not close to solving interoperability, Dan Bowman, published 28 Sep 2016
• EHR Burden Weighs Heavily on Physicians, Leads to Burnout, Diana Phillips, published 6 Sep 2016
• EHR Intelligence - EHR Use Continues to Contribute to Physician Burnout, Kyle Murphy PhD, published 20 Jun 2016
• Five Usability Barriers Preventing Health IT From Supporting Clinician Needs, David M. Schlossman, MD, PhD, FACP, MS (Informatics), CPHIMS and Nancy Staggers, PhD, RN, FAAN, published 16 Jun 2016
• Health Affairs - Make The Clinician Burnout Epidemic A National Priority; Andrew Shin, Tejal Gandhi, Shoshana Herzig; published 21 Apr 2016
• Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine, Lisa Rosenbaum, M.D.; published 22 Oct 2015
• An EHR State of Mind (Video), Zubin Damania MD, posted 19 Oct 2015
• Electronic Health Record Vendor Adherence to Usability Certification Requirements and Testing Standards, Raj M Ratwani PhD, Natalie C Benda BS, A Zachary Hettinger MD MS, published 8 Sep 2015
• Alliance for Nursing Informatics/Computers Informatics Nursing - Nursing centric technology and usability: A call to action, Nancy Staggers PhD RN FAAN, Beth L Elias PhD MS, Jane R Hunt MS BSN RN, Ellen Makar MS RN-BC CCM CPHIMS CENP, Gregory L Alexander PhD RN FAAN, published Aug 2015
• Journal for Electronic Health Data and Methods - Improving Clinical Workflow in Ambulatory Care: Implemented Recommendations in an Innovation Prototype for the Veteran’s Health Administration, Emily S Patterson PhD, Svetlana Z Lowry PhD, Mala Ramaiah MD, Michael C Gibbons MD, David Brick, MD, Robert Calco, Greg Matton JD, Anne Miller PhD, Ellen Makar MSN RN-BC CPHIMS CCM, and Jorge A Ferrer MD MBA LSA, published 9 Jul 2015
• Journal of the American Medical Informatics Association - Electronic health record usability: analysis of the user-centered design processes of eleven electronic health record vendors, Raj M Ratwani, Rollin J Fairbanks, A Zachary Hettinger, Natalie C Benda, published 6 Jun 2015
• American Medical Informatics Association - Report of the AMIA EHR-2020 Task Force on the status and future direction of EHRs; Thomas H Payne, Sarah Corley, Theresa A Cullen, Tejal K Gandhi, Linda Harrington, Gilad J Kuperman, John E Mattison, David P McCallie, Clement J McDonald, Paul C Tang; published 26 May 2015
• Journal of the American Board of Family Medicine - Physician Information Needs and Electronic Health Records (EHRs): Time to Reengineer the Clinic Note, Richelle J. Koopman MD MS, Linsey M. Barker Steege PhD, Joi L. Moore PhD, Martina A. Clarke MS, Shannon M. Canfield MPH, Min S. Kim PhD and Jeffery L. Belden MD, published May 2015
• Annals of Internal Medicine, American College of Physicians - Clinical Documentation in the 21st Century, Thomson Kuhn, MA; Peter Basch, MD; Michael Barr, MD, MBA; Thomas Yackel, MD, MPH, MS, published 17 Feb 2015
• Indianapolis Business Journal - The tragedy of electronic medical records, JK Wall, 23 Oct 2014
• American Medical Association - Improving Care: Priorities to Improve Electronic Health Record Usability, published 2014
• RAND Report - Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy, Mark W. Friedberg, Peggy G. Chen, Kristin R. Van Busum, Frances Aunon, Chau Pham, John Caloyeras, Soeren Mattke, Emma Pitchforth, Denise D. Quigley, Robert H. Brook, F. Jay Crosson, Michael Tutty, published 2013
• Population Health Management - The Complexity of Disease Combinations in the Medicare Population, James Sorace, Hui–Hsing Wong, Chris Worrall, Jeffrey Kelman, Shahin Saneinejad, and Thomas MaCurdy, published 11 Aug 2011
• Journal of the American Medical Informatics Association - Health information technology: fallacies and sober realities, Ben-Tzion Karsh, Matthew B Weinger Patricia A Abbott, and Robert L Wears, published 30 Apr 2010
• CMS/ONC Reducing Clinician Burden Conference - Comments Submitted by CentriHealth, Gary Dickinson, dated 22 Feb 2018