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 - at 3PM ET (US). To join the teleconference: 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

• DRAFT Reducing Clinician Burden Project Overview, dated 18 Nov 2019
• 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, DRAFT IN PROGRESS - COMMENTS ARE WELCOME!! dated 4 Nov 2019
• Reducing Clinician Burden - Patient Summary - Analysis Worksheet, DRAFT IN PROGRESS - COMMENTS ARE WELCOME!! dated 4 Nov 2019
• DRAFT Data Quality Burden, dated 21 Oct 2019

"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)

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) DRAFT "Strategy on Reducing Burden"

• ONC DRAFT "Strategy on Reducing Burden Relating to the Use of Health IT and EHRs", including Findings, Strategies and Recommendations, published 28 Nov 2018, comment period closed 28 Jan 2019
• Summary of Public Comments for 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

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

HL7 RCB Project - Reference Sources

• Fortune Magazine - 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
• AHRQ 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
• 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
• 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 July 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 April 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 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
• 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 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
• 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