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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).
  
 
Please subscribe to the HL7 EHR WG listserver for meeting announcements, agendas and updates regarding current work.
 
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
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The RCB Project team meets via teleconference on the 2nd and 4th Mondays each month - at 3PM ET (US).
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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.
 
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 - Overview and Analysis Worksheet==
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==HL7 RCB Project - Presentations and Reports==
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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]]
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*[[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]]
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*[[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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*[https://www.dropbox.com/s/bythlco0ss8j89g/RCB%20Opelka%202020.pdf?dl=0 Reducing Clinical Burden thru Knowledge Engineering - Curating Clinical Knowledge, Frank Opelka MD FACS, American College of Surgeons, presented 21 Sep 2020]
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*[https://www.dropbox.com/s/kcgqrfs8yhnxnew/Review%20of%20Problem%20Concept%20Maps%2C%20HL7%20EHR%20Work%20Group%2C...pdf?dl=0 Problem Concept Maps: An Ontology to Facilitate Auto-Summarization of Electronic Health Information, Joel Buchanan MD, University of Wisconsin/Madison, presented 21 Sep 2020]
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*[[media:POHR_and_reducing_clinician_burden_2020-08-17_wLinks.pdf|The Problem-Oriented Health Record (POHR) and a Pathway to Reducing Clinician Burden (with Links), Lincoln Weed, Chris Weed, presented 17 Aug 2020]]
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*[[media:POHR_and_reducing_clinician_burden_2020-08-17_wNotes.pdf|The Problem-Oriented Health Record (POHR) and a Pathway to Reducing Clinician Burden (with Notes), Lincoln Weed, Chris Weed, presented 17 Aug 2020]]
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*[[media:V3Diagnostic_Advanced_Payment_ModelsHL7.pdf|Payment Reform in the Era of Advanced Diagnostics, Artificial Intelligence and Machine Learning, James Sorace MD MS, presented 3 Aug 2020]]
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*[[media:HL7_RCB_Presentation-Mullins-20200720.pdf|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]]
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*[https://confluence.hl7.org/download/attachments/39160937/20200518%20Da%20Vinci%20-%20RCB%20Presentation.pptx?version=1&modificationDate=1589915917527&api=v2 HL7 Da Vinci Project Overview (focused on Provider/Payer Exchange), Viet Nguyen MD, presented 18 May 2020]
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*[https://confluence.hl7.org/display/DVP/Da+Vinci+2020+Calendar HL7 Da Vinci Project Calendar, Viet Nguyen MD, presented 18 May 2020]
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*[[media:DQ_and_RCB_Complexity_Simplified_May_4_2020.pdf|Data Quality and Clinician Burden - Overview, Examples, and Basic Recommendations, Reed Gelzer MD, presented 4 May and 1 Jun 2020]]
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*[[media:EHR_WG_Update_20April2020.pdf|Exploring FHIR to Reduce Burden for Quality Measurement, Floyd Eisenberg MD PhD, presented 20 Apr 2020]]
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*[[media:HL7_Interactive_fhir_FINAL_14April2020_with_results-1.pdf|Exploring FHIR to Reduce Burden for Quality Measurement - Survey Results, Floyd Eisenberg MD PhD, presented 20 Apr 2020]]
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*[[media:Association_Between_EHR_Usability_and_Burnout_DS_20191118.pdf|Association between EHR Usability and Burnout, David Schlossman MD, presented 18 Nov 2019]]
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*[[media:HL7_EHR-S_FM_Usability_FP_Relationship_to_RCB_Project_DS_20191007.pdf|Increasing EHR System Usability Through Standards - As One Approach to Reducing Clinician Burden, David Schlossman MD, presented 7 Oct 2019]]
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*[[media:Schlossman_AMDIS_RCB_Presentation_final.pdf|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]]
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*[[media:HL7_EHR_S_and_Usability_DS_20190617.pdf|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]]
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==HL7 RCB Project - Analysis, Derivations and Worksheets==
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*[[media:Reducing_Clinician_Burden_Analysis_Worksheet-20210222.xlsx|DRAFT Reducing Clinician Burden Analysis Worksheet, updated 22 Feb 2021]]
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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.
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*[[media:Reducing_Clinician_Burden-Cause_Matrix-20210125.pdf|DRAFT Reducing Clinician Burden - Cause Matrix, updated 25 Jan 2021]]
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This one page DRAFT outlines key causal factors for clinician burden and is offered for review and comment.
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*[[media:IPS-Burden_Comments-20200330.pdf|RCB-related Comments on ISO DIS 27269 - International Patient Summary, published 30 Mar 2020]]
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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.
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*[[media:Reducing_Clinician_Burden-Clinical_Documentation_Lifecycle-20201230.xlsx|DRAFT Clinical Documentation - Collect, Share, Use - Information Flow and Lifecycle Example - including Intersections with Clinician Burden and Safety Concerns, updated 30 Dec 2020]]
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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.
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*[[media:Reducing_Clinician_Burden-End_to_End_Fidelity_Clinical_Documentation-20201230.pdf|DRAFT Clinical Documentation - Ensuring End-to-End Fidelity, updated 30 Dec 2020]]
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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.
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*[[media:Reducing_Clinician_Burden-Data_Segmentation_for_Clinical_Integrity-20201230.pdf|DRAFT Clinical Documentation - Collect, Share, Use - Data Segmentation for Clinical Integrity, updated 30 Dec 2020]]
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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.
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*[[media:HL7_EHR_WG-A_Perspective_on_History_and_the_Future-20200730.pdf|“A Perspective on the History and Progression of EHR System Functionality Standards, Certification and Adoption”, updated 30 Jul 2020]]
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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.
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*[[media:Sequoia-Data_Usability_Characteristics-20201116.pdf|"Data Usability Characteristics/Qualities", Gary Dickinson, submitted 16 Nov 2020]]
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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.
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*[[media:Re-envisioning_HL7-Gary_Dickinson-20201130.pdf|"Re-Envisioning HL7", Gary Dickinson, submitted 30 Nov 2020]]
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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.
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==HL7 RCB Collaborative Project Candidate - Medication List Management and Reconciliation==
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*[[media:Reducing_Clinician_Burden-Medication_Reconciliation_Project-20201112.pdf|DRAFT Medication Reconciliation Overview, updated 12 Nov 2020]]
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*[[media:EHR-RCB-Medication_Reconciliation-Use_Case_Scenario_Worksheet-20210119.xlsx|DRAFT Medication Reconciliation Use Case Scenario Worksheet, updated 19 Jan 2021]]
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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.
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==HL7 RCB Project - Reducing Clinician Burden "Comment Only" Ballot==
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*[[media:HL7_RCB_R1_O1_2020SEP.pdf|RCB Ballot Document - September 2020 Ballot Cycle - To Gain Insights/Input from the HL7 International Community on Workable Strategies for Clinician Burden Reduction]]
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*[[media:Reducing_Clinician_Burden-Ballot_Comments-20200914.xlsx|RCB Ballot Comments (from Participants)]]
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This ballot closed on Monday, 14 September 2020.
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==HL7 RCB Project - White Paper==
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*[[media:RCB_Project_Clinical_Workflow_Paper_JMIR_Format_21Jan2020-Final.docx|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]]
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This White Paper has been released for Project Team review and comment.
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==HL7 RCB Project - Reducing Burden - Success Stories==
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*[[media:Reducing_Clinician_Burden-Success_Story_Template-20190128.docx|DRAFT Reducing Clinician Burden - Success Story Template, updated 28 Jan 2019]]
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*[[media:RCB_Story_-_Duke_Heart_Procedures.docx|Duke University - Duke Heart Business Unit – Procedure Reporting, James E Tcheng MD FACC FSCAI, 4 Feb 2019]]
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*[[media:19_HL7_RCB_Duke-dist.pdf|Duke University - Reducing Clinician Burden - Cardiovascular Procedure Reporting at Duke, James E Tcheng MD FACC FSCAI, 18 Sep 2019 (Posted with Permission)]]
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*[[media:UGM_2019_ProviderBurnoutandEd_final-resized.pdf|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)]]
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*[[media:Monica_Jones-SNOMED_Clinical_Forum-20190409a.pdf|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)]]
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*[[media:HL7_-_CCA_Optimization_Presentation_7.15.19.pdf|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)]]
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*[[media:AHA-well-being-playbook.pdf|American Hospital Association - Well-Being Playbook, A Guide for Hospital and Health System Leaders, May 2019]]
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*[[media:AHA-HL7_Burnout_Webinar-Arespacochaga-20190818.pdf|American Hospital Association - Well-Being Playbook Presentation, Elisa Arespacochaga, 19 Aug 2019 (Posted with Permission)]]
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*[[media:UGM040_Understanding_the_Impact_of_the_EHR_on_Physician_Wellness_and_Burnout.pdf|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)]]
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*[https://www.dropbox.com/s/vxz2gywht2d0r9p/amber%20sieja-univ%20colorado-hl7%20talk%20-%20sprint%20ehr%20optimization%20program-20191216.pdf?dl=0 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)]
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*[[media:CAMH_Toronto-HL7_Burnout_Presentation-FINAL-20210125.pdf|Addressing EHR-related burnout at the Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada, Gillian Strudwick RN PhD FAMIA,Tania Tajirian MD CCFP FCFP DTMPH, Brian Lo MHI, 25 Jan 2021 (Posted with Permission)]]
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==Burden Reduction (and other) Initiatives in Response to the COVID-19 Pandemic==
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*[https://www.cms.gov/files/document/cms-waivers-and-covid-19-response.pdf (US) Centers for Medicare and Medicaid Services (CMS) - Waivers and COVID-19 Response, Online Presentation, 7 April 2020]
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*[https://www.cms.gov/newsroom/press-releases/cms-announces-relief-clinicians-providers-hospitals-and-facilities-participating-quality-reporting (US) CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19, posted 22 Mar 2020]
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*[https://www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid-19 (US) Trump Administration Makes Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge, posted 30 Mar 2020]
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*[https://www.hcinnovationgroup.com/interoperability-hie/standards/article/21131620/hitac-brainstorms-ways-onc-can-help-frontline-providers-in-covid19-response (US) Health Information Technology Advisory Committee (HITAC) Brainstorms Ways ONC Can Help Front-Line Providers in COVID-19 Response, published 27 Mar 2020]
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*[https://www.fiercehealthcare.com/payer/humana-aims-to-ease-administrative-financial-burdens-providers-amid-covid-19-crisis?utm_medium=nl&utm_source=internal&mrkid=4643083&mkt_tok=eyJpIjoiWmpNME1HRmlPV1E0TkRBeiIsInQiOiJPVXlncCtyNWVqZWdvNFZwQUxxQlpPOWFlOUNwUExHeVZuR2hCV1E4clV4MVVuMXZVQUNQTzIySWpmbEN6N2pkYXhnUkMwSEg1a0V4TTNyaEw1YjE0bnFZdm02Y2Ewb1djeSszUTlKcytjbldJSU9JTVZRQVFsSm1wa1N3bVlBVyJ9 (US Health Plan) Humana easing administrative, financial burdens on providers amid COVID-19 crisis, published 2 Apr 2020]
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*[https://www.medicaid.gov/resources-for-states/disaster-response-toolkit/coronavirus-disease-2019-covid-19/index.html (US) CMS - COVID-19 Disaster Response Toolkit, posted 7 April 2020]
  
*[[media:Reducing_Clinician_Burden-Overview-20190508.pdf|DRAFT Reducing Clinician Burden Project Overview, dated 8 May 2019]]
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*[https://www.logicahealth.org/covid-19-interoperability-project/ Logica COVID-19 Interoperability Project, posted 4 Apr 2020]
*[[media:Reducing_Clinician_Burden_Analysis_Worksheet-20190508.xlsx|DRAFT Reducing Clinician Burden Analysis Worksheet, DRAFT IN PROGRESS - COMMENTS ARE WELCOME!!, dated 8 May 2019]]
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*[https://covid-19-ig.logicahealth.org/?mc_cid=709e81f39c&mc_eid=10d45eb01b Logica COVID-19 FHIR Implementation Guide, posted 4 Apr 2020]
  
 
=="See What We Mean"==
 
=="See What We Mean"==
 
*[https://ehrseewhatwemean.org/ "See What We Mean" Video Clips, developed by Medstar Health - National Center for Human Factors in Healthcare - EHR Safety and Usability Team]
 
*[https://ehrseewhatwemean.org/ "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==
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==HL7 RCB Project - Survey and Responses==
*[[media:Reducing_Clinician_Burden-Success_Story_Template-20190128.docx|DRAFT Reducing Clinician Burden - Success Story Template, updated 28 Jan 2019]]
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*[[media:Reducing_Clinician_Burden-Survey_Responses-20190819.docx|RCB Project Survey and Responses, dated 19 Aug 2019]]
*[[media:RCB_Story_-_Duke_Heart_Procedures.docx|Duke Heart Business Unit – Procedure Reporting, James Tcheng MD, Duke University, posted 4 Feb 2019]]
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*[[media:ACS-CMS_Mango_v3.0-Opelka-201906.pdf|"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)]]
*[[media:Greta_Branford-UMich-HIMSS_2019.pdf|Burnout: How EHR Usability Improves Efficiency & Satisfaction, Greta Branford MD, University of Michigan, 14 Feb 2019]]
 
*[[media:ClinAC128 Optimization in the Ambulatory Setting.pdf|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, May 2019]]
 
  
 
==HL7 RCB Project - Focus Team Drafts==
 
==HL7 RCB Project - Focus Team Drafts==
*[[media:Schlossman_HL7_RCB_Project_Focus_Teams_Report_20190508.pdf|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 Mass MD, Leads, updated 8 May 2019]]
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*[[media:Schlossman_HL7_RCB_Project_Focus_Teams_Report_20190508.pdf|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]]
 
*[https://drive.google.com/drive/folders/113pFh5kjX-dLR2K8jLlG-FJkLm-_5IN4?ogsrc=32 DRAFT Team Report - Clinical Documentation: Quality and Usability - Lisa Masson MD, Lead, updated 7 Jan 2019]
 
*[https://drive.google.com/drive/folders/113pFh5kjX-dLR2K8jLlG-FJkLm-_5IN4?ogsrc=32 DRAFT Team Report - Clinical Documentation: Quality and Usability - Lisa Masson MD, Lead, updated 7 Jan 2019]
 
*[[media:EHR_based_cognitive_support_to_Enhance_the_clinician_experience.pdf|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]]
 
*[[media:EHR_based_cognitive_support_to_Enhance_the_clinician_experience.pdf|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]]
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*[[media:Data_Quality_interest_group_report_for_March_4_RCB_Meeting.docx|DRAFT Team Report - Data Quality - Reed Gelzer MD, Lead, updated 4 Mar 2019]]
 
*[[media:Data_Quality_interest_group_report_for_March_4_RCB_Meeting.docx|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"==
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==US Office of National Coordinator for Health Information Technology (ONC) Strategy for Reducing Burden==
*[https://www.healthit.gov/topic/usability-and-provider-burden/strategy-reducing-burden-relating-use-health-it-and-ehrs 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]
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*[https://www.healthit.gov/topic/2020-2025-federal-health-it-strategic-plan ONC DRAFT Federal Health IT Strategic Plan, 2020-2025 - published 15 Jan 2020]
*[https://healthit.gov/burdencomments Summary of Public Comments for Draft Strategy, published 26 Mar 2019]
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*[https://www.healthit.gov/topic/usability-and-provider-burden/strategy-reducing-burden-relating-use-health-it-and-ehrs ONC FINAL "Strategy on Reducing Burden Relating to the Use of Health IT and EHRs", including Findings, Strategies and Recommendations, published 21 Feb 2020]
*[[media:HL7_Response_Letter_ONC_Reducing_Burden_Strategy_FINAL.docx|HL7 Comments on ONC Draft Strategy, compiled by HL7 Policy Advisory Committee, submitted 28 Jan 2019]]
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*[https://healthit.gov/burdencomments Summary of Public Comments on ONC DRAFT Strategy, published 26 Mar 2019]
*[[media:CentriHealth-Comments_on_ONC_DRAFT_Burden_Reduction_Strategy.pdf|CentriHealth (UnitedHealth Group) Comments on ONC Draft Strategy, submitted 28 Jan 2019]]
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*[[media:HL7_Response_Letter_ONC_Reducing_Burden_Strategy_FINAL.docx|HL7 Comments on ONC DRAFT Strategy, compiled by HL7 Policy Advisory Committee, submitted 28 Jan 2019]]
 +
*[[media:CentriHealth-Comments_on_ONC_DRAFT_Burden_Reduction_Strategy.pdf|CentriHealth Comments on ONC DRAFT Strategy, submitted 28 Jan 2019]]
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*[https://www.urban.org/policy-centers/health-policy-center/projects/electronic-health-record-reporting-program ONC/Urban Institute - Health Policy Center - DRAFT Electronic Health Record Reporting Program, published Jun 2020]
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*[[media:Ehr_draft_voluntary_user-reported_criteria-GLD-20200810.pdf|EHR Standards Consulting - Comments on the ONC/Urban Institute DRAFT Electronic Health Record Reporting Program, submitted 10 Aug 2020]]
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 +
==US Department of Health and Human Services (HHS) Patients over Paperwork Initiative==
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*[https://www.govinfo.gov/content/pkg/FR-2019-09-30/pdf/2019-20736.pdf FINAL RULE - Medicare and Medicaid Programs; Regulatory Provisions To Promote Program Efficiency, Transparency, and Burden Reduction..., 20 Sep 2019]
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==More RCB Perspectives and Resources==
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*[https://www.youtube.com/watch?v=xB_tSFJsjsw Video - An EHR State of Mind, Zubin Damania MD, posted 19 Oct 2015]
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*[https://www.youtube.com/watch?v=tpu5qcqspGA Video - Professional Satisfaction – Saturday Night Belongs to Epic, Christine Sinsky MD, VP/American Medical Association, posted 27 Jan 2016]
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*[https://www.youtube.com/watch?v=LMdxi7Hky-s&feature=youtu.be Video - Professional Satisfaction – EHR Should Make Our Lives Delightful, Christine Sinsky MD, VP/American Medical Association, posted 27 Jan 2016]
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*[https://www.youtube.com/watch?v=POZvCRdNbI8 Video - Creating Joy in Medical Practice - An Interview, Christine Sinsky MD, VP/American Medical Association, posted 25 Jan 2018]
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*[https://www.youtube.com/watch?v=dmIe4idZE6U Video - Strategies to Address Burnout Must be Practical and Local, Christine Sinsky MD, VP/American Medical Association, posted 25 Jan 2018]
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*[https://www.youtube.com/watch?v=FIFnY5mzXF0 Video - AMDIS/HIMSS Physician Executive Symposium - An Interview, Christine Sinsky MD, VP/American Medical Association, posted 28 March 2018]
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*[https://edhub.ama-assn.org/steps-forward/module/2702761 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]
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*[https://www.youtube.com/watch?v=CCZlFE_R5yg Video - Freeing physicians to do their jobs - 2019 EHR National Symposium - Stanford Medicine, posted 28 Oct 2019]
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*[https://www.statista.com/topics/2099/stress-and-burnout/ Statista - Stress and burnout - Statistics & Facts, John Elflein, published 16 Aug 2019]
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*[https://www.youtube.com/watch?time_continue=120&v=NMa1tomIM7c&feature=emb_logo World Health Organization - Safe Health Workers, Safe Patients?, posted 16 Sep 2020]
  
 
==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]
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*[https://ehrintelligence.com/news/docs-add-1-hour-of-administrative-work-for-ehr-inbox-management EHR Intelligence - Docs Add 1 Hour of Administrative Work for EHR Inbox Management, Christopher Jason, published 22 Oct 2020]
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*[https://www.healthcareitnews.com/news/hidden-plain-sight-clinicians-may-not-spot-ehr-cancer-risk-info Healthcare IT News - Hidden in plain sight - Clinicians may not spot EHR cancer risk info, Kat Jercich, published 21 Sep 2020]
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*[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]
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*[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://ehrintelligence.com/news/high-ehr-inbox-volume-is-the-leading-cause-of-clinician-burnout 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]
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*[https://ehrintelligence.com/news/vanderbilt-launches-program-to-mitigate-ehr-alerts-clinician-burnout 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]
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*[https://www.healthleadersmedia.com/clinical-care/physician-fatigue-linked-electronic-health-record-use HealthLeaders Media - Physician Fatigue linked to Electronic Health Record Use, Christopher Cheney, published 20 Jul 2020]
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*[https://www.ama-assn.org/practice-management/digital/how-create-better-ehr-usability-enhance-physicians-lives American Medical Association - How to create better EHR usability to enhance physicians’ lives, Sara Berg, published 16 Jul 2020]
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*[https://www.ania.org/assets/documents/position/ehrBurdenPosition.pdf 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]
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*[https://hbr.org/2020/06/its-time-for-a-new-kind-of-electronic-health-record Harvard Business Review - It’s Time for a New Kind of Electronic Health Record, John Glaser MD, published 20 Jun 2020]
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*[https://www.healio.com/news/psychiatry/20200616/ehrrelated-fatigue-may-lead-to-inefficient-use-among-physicians Healio/Psychiatry - EHR-related fatigue may lead to inefficient use among physicians, Joe Gramigna MA, published 16 Jun 2020]
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*[https://www.healthdatamanagement.com/news/aha-calls-on-cms-to-further-reduce-clinical-documentation-burden Health Data Management - AHA calls on CMS to reduce clinical documentation burden, Greg Slabodkin, published 6 Jun 2020]
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*[https://ehrintelligence.com/news/ehr-implementation-leads-to-significant-physician-burnout-anxiety 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]
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*[https://www.healthcareitnews.com/news/fight-nurse-burnout-ehrs-must-use-ai-reflect-rn-specific-workflows Healthcare IT News - To fight nurse burnout, EHRs must use AI, reflect RN-specific workflows, Bill Siwicki, published 2 Jun 2020]
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*[https://www.healthcareitnews.com/news/ehrs-still-posing-big-safety-risks-many-hospitals Healthcare IT News - EHRs still posing big safety risks in many hospitals, Kat Jercich, published 2 Jun 2020]
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*[https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2764862 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]
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*[https://ehrintelligence.com/news/heavy-ehr-workload-leads-to-higher-clinician-burnout-exhaustion 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]
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*[https://www.jmir.org/2020/7/e19126/ 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]
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*[https://www.healthaffairs.org/do/10.1377/hblog20200226.453011/full/?mi=3u3irl&af=R&ConceptID=891&content=blog&countTerms=true&target=topic-blog& 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]
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*[https://www.ama-assn.org/practice-management/physician-health/10-medical-specialties-10-different-ways-cut-physician-burnout American Medical Association - Practice Management - 10 medical specialties, 10 different ways to cut physician burnout, Sara Berg, published 13 Feb 2020]
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*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7008538/ 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]
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*[https://academic.oup.com/jamia/article/27/4/639/5728718#.XjyP35UizZQ.twitter 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]
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*[https://www.washingtonpost.com/health/too-many-tests-too-little-time-doctors-say-they-face-moral-injury-because-of-a-business-model-that-interferes-with-patient-care/2020/01/31/c00e9d58-3d3a-11ea-8872-5df698785a4e_story.html 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]
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*[https://www.scientificamerican.com/article/electronic-health-records-need-a-shot-in-the-arm/ Scientific American - Electronic Health Records Need a Shot in the Arm, Cassandra Willyard, published 1 Feb 2020]
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*[https://www.sciencedirect.com/science/article/pii/S1386505619306835 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]
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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]
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*[https://www.healthdatamanagement.com/news/ehr-modifications-data-analysis-become-tools-to-fight-doc-burnout?position=editorial_1&campaignname=HDM_Daily_Morning%20Rounds-10172019&utm_source=newsletter&utm_medium=email&utm_campaign=HDM_Daily_Morning+Rounds%2B%27-%27%2B10172019&bt_ee=MHt2YkAQ5i9G4y903zoSSHvYc6pmcLwBRwIAAGjMr2r0NmWUFNj5bacNZsSq1QeD0yR4iuo2xvZCx5SnRCL6Jw%3D%3D&bt_ts=1571306014948 Health Data Management - EHR Modifications, Data Analysis become Tools to Fight Doc Burnout, Fred Bazzoli, 17 Oct 2019]
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*[https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2748054?guestAccessKey=f27e1ae2-ac6d-4819-bfc4-21e295754472&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jamanetworkopen&utm_term=mostread&utm_content=olf-widget_09052019 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]
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*[https://www.healthaffairs.org/doi/10.1377/hlthaff.2018.05509 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]
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*[https://www.healthdatamanagement.com/opinion/why-the-movement-toward-a-patient-identifier-is-only-a-start?utm_campaign=second%20opinions-jun%2017%202019&utm_medium=email&utm_source=newsletter Health Data Management - Why the movement toward a patient identifier is only a start, Dan Cidon, published 17 Jun 2019]
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*[https://www.healthdatamanagement.com/opinion/why-ehrs-are-flawed-and-how-they-can-be-fixed?utm_campaign=second%20opinions-jun%2013%202019&utm_medium=email&utm_source=newsletter Health Data Management - Why EHRs are flawed, and how they can be fixed, David Lareau, published 13 Jun 2019]
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*[https://www.hcinnovationgroup.com/clinical-it/electronic-health-record-electronic-medical-record-ehr-emr/article/21083058/what-can-healthcare-it-leaders-do-to-flip-the-script-on-physician-burnout Healthcare Innovation - What Can Healthcare IT Leaders Do To Flip the Script on Physician Burnout?, Mark Hagland, published 3 Jun 2019]
 
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*[https://www.beckershospitalreview.com/ehrs/nearly-half-of-physicians-think-ehrs-have-decreased-quality-of-care-survey-finds.html?origin=qualitye&utm_source=qualitye Becker's Healthcare - Nearly half of physicians think EHRs have decreased quality of care, survey finds, Jackie Drees, published 1 May 2019]
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*[https://academic.oup.com/jamia/advance-article/doi/10.1093/jamia/ocz021/5426085 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]
 
*[https://www.healthaffairs.org/do/10.1377/hblog20190320.244258/full/?utm_source=Newsletter&utm_medium=email&utm_content=Reforming+Observation+Hospital+Care%3B+Price+Transparency%3B+CMS+Report+On+Risk+Adjustment%3B+Medicaid+Programs+That+Incentivize+Health-Promoting+Behaviors&utm_campaign=HAT+3-25-19 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]
 
*[https://www.healthaffairs.org/do/10.1377/hblog20190320.244258/full/?utm_source=Newsletter&utm_medium=email&utm_content=Reforming+Observation+Hospital+Care%3B+Price+Transparency%3B+CMS+Report+On+Risk+Adjustment%3B+Medicaid+Programs+That+Incentivize+Health-Promoting+Behaviors&utm_campaign=HAT+3-25-19 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]
 
*[http://fortune.com/longform/medical-records/ 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]
 
*[http://fortune.com/longform/medical-records/ 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]
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*[https://www.hcinnovationgroup.com/clinical-it/patient-safety/news/21071783/ehrrelated-issues-top-patient-safety-concern-list Healthcare Innovation Group - EHR-Related Issues Top Patient Safety Concern List, David Raths, published 12 Mar 2019]
 
*[https://www.hcinnovationgroup.com/clinical-it/patient-safety/news/21071783/ehrrelated-issues-top-patient-safety-concern-list Healthcare Innovation Group - EHR-Related Issues Top Patient Safety Concern List, David Raths, published 12 Mar 2019]
 
*[https://www.healthcareitnews.com/news/epic-ceo-judy-faulkner-apple-docs-who-actually-their-ehrs-and-warren-buffett Healthcare IT News - Epic CEO Judy Faulkner on Apple, docs who actually like their EHRs..., Mike Miliard, published 13 Feb 2019]
 
*[https://www.healthcareitnews.com/news/epic-ceo-judy-faulkner-apple-docs-who-actually-their-ehrs-and-warren-buffett Healthcare IT News - Epic CEO Judy Faulkner on Apple, docs who actually like their EHRs..., Mike Miliard, published 13 Feb 2019]
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*[https://www.researchgate.net/publication/332691992_Unintended_consequences_of_nationwide_electronic_health_record_adoption_challenges_and_opportunities_in_the_post-Meaningful_Use_era 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]
 
*[https://thriveglobal.com/stories/physician-burnout-public-health-crisis-solutions-report/?utm_source=HR19000+WHCC+Care+Delivery+Integration+02012019&utm_medium=email&utm_campaign=HR19000 Thrive Global - Here’s Why Physician Burnout is Officially “A Public Health Crisis”, Jane Burnett, published 31 Jan 2019]
 
*[https://thriveglobal.com/stories/physician-burnout-public-health-crisis-solutions-report/?utm_source=HR19000+WHCC+Care+Delivery+Integration+02012019&utm_medium=email&utm_campaign=HR19000 Thrive Global - Here’s Why Physician Burnout is Officially “A Public Health Crisis”, Jane Burnett, published 31 Jan 2019]
 
*[https://www.healthit.gov/sites/default/files/page/2018-11/Draft%20Strategy%20on%20Reducing%20Regulatory%20and%20Administrative%20Burden%20Relating.pdf 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]
 
*[https://www.healthit.gov/sites/default/files/page/2018-11/Draft%20Strategy%20on%20Reducing%20Regulatory%20and%20Administrative%20Burden%20Relating.pdf 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]
 +
*[http://www.massmed.org/News-and-Publications/MMS-News-Releases/Physician-Burnout-Report-2018/ 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]
 
*[https://www.healthdatamanagement.com/news/ama-president-calls-for-end-to-electronic-health-record-abuse Health Data Management, AMA president calls for end to electronic health record abuse, Greg Slabodkin, published 14 Nov 2018]
 
*[https://www.healthdatamanagement.com/news/ama-president-calls-for-end-to-electronic-health-record-abuse Health Data Management, AMA president calls for end to electronic health record abuse, Greg Slabodkin, published 14 Nov 2018]
 
*[https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers The New Yorker/Annals of Medicine - Why Doctors Hate Their Computers, Atul Gawande, published 12 Nov 2018]
 
*[https://www.newyorker.com/magazine/2018/11/12/why-doctors-hate-their-computers The New Yorker/Annals of Medicine - Why Doctors Hate Their Computers, Atul Gawande, published 12 Nov 2018]
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*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5899365/ 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]
 
*[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5899365/ 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]
 
*[https://ehrintelligence.com/news/nqf-advises-cms-align-quality-measures-cut-administrative-burden EHR Intelligence - NQF Advises CMS Align Quality Measures, Cut Administrative Burden, Kate Monica, published 3 Apr 2018]
 
*[https://ehrintelligence.com/news/nqf-advises-cms-align-quality-measures-cut-administrative-burden EHR Intelligence - NQF Advises CMS Align Quality Measures, Cut Administrative Burden, Kate Monica, published 3 Apr 2018]
*[https://link.springer.com/article/10.1007/s11606-017-4228-2 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]
+
*[https://link.springer.com/article/10.1007/s11606-017-4228-2 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]
 
*[http://www.physicianspractice.com/himss/reducing-clinician-burnout-five-ehr-related-areas Physician Practice - Reducing Clinician Burnout in Five EHR-Related Areas, Gabriel Perna, published 9 Mar 2018]
 
*[http://www.physicianspractice.com/himss/reducing-clinician-burnout-five-ehr-related-areas Physician Practice - Reducing Clinician Burnout in Five EHR-Related Areas, Gabriel Perna, published 9 Mar 2018]
 
*[https://www.healthcare-informatics.com/article/ehr/clinicians-cms-onc-right-ship-simplify-reporting-ease-regulatory-burdens Healthcare Informatics - Clinicians to CMS, ONC: “Right the Ship” to Simplify Reporting, Ease Regulatory Burdens, Heather Landi, published 13 Feb 2018]
 
*[https://www.healthcare-informatics.com/article/ehr/clinicians-cms-onc-right-ship-simplify-reporting-ease-regulatory-burdens Healthcare Informatics - Clinicians to CMS, ONC: “Right the Ship” to Simplify Reporting, Ease Regulatory Burdens, Heather Landi, published 13 Feb 2018]
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*[https://www.healthaffairs.org/do/10.1377/hblog20160421.054511/full/ Health Affairs - Make The Clinician Burnout Epidemic A National Priority; Andrew Shin, Tejal Gandhi, Shoshana Herzig; published 21 Apr 2016]
 
*[https://www.healthaffairs.org/do/10.1377/hblog20160421.054511/full/ Health Affairs - Make The Clinician Burnout Epidemic A National Priority; Andrew Shin, Tejal Gandhi, Shoshana Herzig; published 21 Apr 2016]
 
*[https://www.nejm.org/doi/full/10.1056/NEJMp1509961 Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine, Lisa Rosenbaum, M.D.; published 22 Oct 2015]
 
*[https://www.nejm.org/doi/full/10.1056/NEJMp1509961 Transitional Chaos or Enduring Harm? The EHR and the Disruption of Medicine, Lisa Rosenbaum, M.D.; published 22 Oct 2015]
 +
*[https://www.youtube.com/watch?v=xB_tSFJsjsw An EHR State of Mind (Video), Zubin Damania MD, posted 19 Oct 2015]
 
*[https://jamanetwork.com/journals/jama/fullarticle/2434673? 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]
 
*[https://jamanetwork.com/journals/jama/fullarticle/2434673? 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]
 
*[https://journals.lww.com/cinjournal/Citation/2015/08000/Nursing_Centric_Technology_and_Usability_A_Call_to.1.aspx 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]
 
*[https://journals.lww.com/cinjournal/Citation/2015/08000/Nursing_Centric_Technology_and_Usability_A_Call_to.1.aspx 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]

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