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==HL7 RCB Project - Reference Sources==
==HL7 RCB Project - Reference Sources==
*[ Becker's Healthcare - Nearly half of physicians think EHRs have decreased quality of care, survey finds, Jackie Drees, published 1 May 2019]
RCB Reference Sources (and related links) are available at the RCB Wiki:
*[ TechTarget - Kaiser Permanente - Physician burnout eased with homegrown tech, Makenzie Holland, published 24 April 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]
*[ 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]
*[ 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]
*[[media:ThoughtsOnAddressingTheClinicianBurdenIssueVarri2018.pdf|Thoughts on addressing the clinician burden issue, Alpo Värri, Tampere University of Technology (Tampere, Finland), CEN TC251 WG II, published 16 Oct 2018]]
*[[media:Dr_Freedman_2018-10-4_Reducing_Clinician_Burden-version2.pptx|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 April 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]
*[ 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]
*[[media:Reducing_Clinician_Burden-20180222.pdf|CMS/ONC Reducing Clinician Burden Conference - Comments Submitted by CentriHealth, Gary Dickinson, dated 22 Feb 2018]]

Revision as of 15:19, 15 May 2019

The HL7 Electronic Health Record (EHR) Interoperability Work Group is an activity of the HL7 EHR Work Group.

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

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 EHR/PHR Standards

System Functionality Standards

Record Interoperability Standards

HL7 "Reducing Clinician Burden" (RCB) Project

Project team meets via teleconference on the 1st and 3rd Mondays each month - at 3PM ET (US). To join the teleconference:

NOTE: We are migrating the RCB Section of this Wiki to its own page: For now the content of both pages is the same.

HL7 RCB Project - Overview and Analysis Worksheet

"See What We Mean"

HL7 RCB Project - Reducing Burden - Success Stories

HL7 RCB Project - Focus Team Drafts

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

HL7 RCB Project - Reference Sources

RCB Reference Sources (and related links) are available at the RCB Wiki:

CURRENT US Notices of Proposed Rule-Making

US Office of National Coordinator (ONC), Trusted Exchange Framework/Common Agreement (TEFCA)

US Office of National Coordinator (ONC), Technical Interoperability Forum, 15-16 August 2017

US Office of National Coordinator (ONC), Interoperability Forum, 6-8 August 2018

US Office of National Coordinator (ONC), "Record to Rely On" Workshop, 29 November 2016

Leads: Mark Knee JD, Elise Sweeney Anthony JD, Mike Lipinski JD

US Office of National Coordinator - Interoperability Standards Advisory (ISA)

HL7 FHIR Standard Release 4

FHIR EHR-S Record Lifecycle Event Implementation Guide

FHIR AuditEvent and Provenance Profiles

FHIR Five W's Pattern (Who, What, When, Where, Why)

FHIR Implementer's Safety Check List

Interoperability Assessment

Blockchain for Health/Healthcare (Public Journal)

International Patient Summary (INTERPAS/IPS)

PUBLICATION PACKAGE - Meaningful Use 2015 Edition Functional Profile

Leads: Gary Dickinson, Anneke Goossen, Michael Van Der Zel

Meaningful Use 2015 Edition Functional Profile (of ISO/HL7 10781 EHR-S FM Release 2)

Leads: Gary Dickinson, Mark Janczewski MD, Anneke Goossen

Meaningful Use 2014 Edition Functional Profile (of ISO/HL7 10781 EHR-S FM Release 2)

Leads: Gary Dickinson, Diana Warner, Hetty Kahn, Anneke Goossen

EHR as Legal Record Project

HL7 EHR and Records Management-Evidentiary Support (RM-ES) WGs

Leads: Gary Dickinson, Reed Gelzer MD, Diana Warner

Record Entry Lifecycle Event Metadata using FHIR (Fast Health Interoperable Resources) - Project Now Complete

Lead: Gary Dickinson

Record Lifecycle, Provenance and Vocabulary Alignment - Project Now Complete

Record Lifecycle, Security, Privacy, and Provenance Vocabulary Alignment

Leads: Reed Gelzer, MD, Diana Proud-Madruga


US ONC Standards and Interoperability Framework

2011-2016 Use Case Initiatives - Transitions of Care, Lab Results, Provider Directory, Digital Certificate, et al.

Cross Initiative Work Group - S&I Simplification

ISO/HL7 10781:2017 EHR-S FIM Release-3 2014-Planning

Gary Dickinson, co-chair and Steve Hufnagel PhD, project-facilitator

EHR-S FIM is EHR System Function-and-Information Model, release-3 planned for '2017 joint ISO/HL7-International ballot

EHR-S and PHR-S FIM, Release-3 2012 Prototype

Steve Hufnagel, Facilitator and Gary Dickinson, co-chair


- add conceptual information and data model for each Release 2.0 EHR-S FM function
- make the EHR-S FM easier  to use for architects, analysts and engineers
- verify and validate EHR-S FM Release 2.0
- DSTU demonstration for Service Aware Interoperability Framework (SAIF) 
- Support specific profiles (e.g., WG project DAMS, DIMS, DCMS).






US HITECH Act - EHR Incentive Program - Stage 1 - Final Regulations (2011 Edition)

US HITECH Act - EHR Incentive Program - Stage 2 - Final Regulations (2014 Edition)

US HITECH Act - EHR Incentive Program - Stage 3 - Final Regulations (2015 Edition)

US ONC Final 10 Year Interoperability Roadmap

US ONC Advance Notice of Proposed Rulemaking

Metadata Standards to Support Nationwide Electronic Health Information Exchange

ISO 16223 - Standards Convergence to Promote EHR Interoperability

Key Reference Documents

2009 ANSI HITSP Foundations Framework Simplification Strategy