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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 through December 2020 - at 3PM ET (US).
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The RCB Project team meets via teleconference on the 2nd and 4th Mondays each month - at 3PM ET (US).
Starting in January 2021, the RCB Project Team will meet via teleconference on the 2nd and 4th Mondays each month - at 3PM ET (US).
 
  
 
To join RCB teleconferences:  https://global.gotomeeting.com/meeting/join/798931918
 
To join RCB teleconferences:  https://global.gotomeeting.com/meeting/join/798931918
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==HL7 RCB Project - Presentations==
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==HL7 RCB Project - Presentations and Reports==
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Additional presentations are included in the "Success Stories" section below.
  
*[[media:Reducing_Clinician_Burden-Overview-20201207.pdf|Reducing Clinician Burden Project Overview, updated 7 Dec 2020]]
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*[[media:Reducing_Clinician_Burden-Overview-20210222.pdf|Reducing Clinician Burden Project - Overview, updated 22 Feb 2021]]
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*[[media:HL7_Reducing_Clinician_Burden-Progress_Report-20210222.pdf|Reducing Clinician Burden Project - Progress Report, updated 22 Feb 2021]]
 
*[[media:Reducing_Clinician_Burden-US_Core_Data_for_Interoperability-20201026.pdf|Burden Reduction Opportunities in the World of US Core Data for Interoperability (USCDI)? Presentation for Discussion, Gary Dickinson, updated 26 Oct 2020]]
 
*[[media:Reducing_Clinician_Burden-US_Core_Data_for_Interoperability-20201026.pdf|Burden Reduction Opportunities in the World of US Core Data for Interoperability (USCDI)? Presentation for Discussion, Gary Dickinson, updated 26 Oct 2020]]
 
*[[media:Burden_Reduction_OBRHI_9-21-2020.pdf|Interoperability and Burden Reduction - Emerging Opportunities for Collaborative Care, Denise St Clair PhD, US Centers for Medicare and Medicaid Services, Office of Burden Reduction and Health Informatics, presented 21 Sep 2020]]
 
*[[media:Burden_Reduction_OBRHI_9-21-2020.pdf|Interoperability and Burden Reduction - Emerging Opportunities for Collaborative Care, Denise St Clair PhD, US Centers for Medicare and Medicaid Services, Office of Burden Reduction and Health Informatics, presented 21 Sep 2020]]
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*[[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]]
 
*[[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]]
  
==HL7 RCB Project - Analysis Worksheets==
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==HL7 RCB Project - Analysis, Derivations and Worksheets==
*[[media:Reducing_Clinician_Burden_Analysis_Worksheet-20201116.xlsx|DRAFT Reducing Clinician Burden Analysis Worksheet, updated 16 Nov 2020]]
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*[[media:Reducing_Clinician_Burden_Analysis_Worksheet-20210222.xlsx|DRAFT Reducing Clinician Burden Analysis Worksheet, updated 22 Feb 2021]]
This version of the RCB Analysis Worksheet includes the ONC FINAL "Strategy on Reducing Burden Relating to the Use of Health IT and EHRs".  Each of the four ONC Initiatives(I), along with Strategies(S) and Recommendations(R) are inserted within the related RCB topic area and are identified as Ix.Sx.Rx.  NOTE also that all reference sources up through #122 have been reviewed and are incorporated in this version.  See "References" Tab.
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NOTE that all reference sources up through #122 have been reviewed and are incorporated in this version.  See "References" Tab.
*[[media:Reducing_Clinician_Burden-Clinical_Documentation_Lifecycle-20201207.xlsx|DRAFT Clinical Documentation - Collect, Share, Use - Information Flow and Lifecycle Example - including Intersections with Clinician Burden and Safety Concerns, updated 7 Dec 2020]]
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*[[media:Reducing_Clinician_Burden-Burden_Impact_Statement-20210222.pdf|DRAFT Burden Impact Statement, updated 22 Feb 2021]]
This two tab worksheet shows:  1) typical end-to-end information flow of clinical documentation, starting at the point of origination of health record entry and ending at the point where record entry content is accessed/used for subsequent patient care, interventions and decision making; 2) the potential to segment health record entry into a segment supporting direct care and separate segment(s) for other uses/users of clinical documentation (including payors, public health, quality/performance entities, administration, finance, clinical registries...).
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Proposed HL7 Burden Impact Statement (BIS) targets HL7 Projects – to assess potential impact on clinician burden and identify possible benefits toward burden reduction. Intended for inclusion as part of HL7 Project Scope Statements (new projects) and within HL7 Standards and Implementation Guides. The BIS is a collaboration with the American Medical Association.
*[[media:Reducing_Clinician_Burden-Clinical_Documentation_Lifecycle-20201207a.pdf|DRAFT Clinical Documentation - Collect, Share, Use - Data Segmentation for Clinical Integrity, updated 7 Dec 2020]]
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*[[media:Reducing_Clinician_Burden-Cause_Matrix-20210125.pdf|DRAFT Reducing Clinician Burden - Cause Matrix, updated 25 Jan 2021]]
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...
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This one page DRAFT outlines key causal factors for clinician burden and is offered for review and comment.
*[[media:Reducing_Clinician_Burden-Cause_Matrix-20200615.pdf|DRAFT Reducing Clinician Burden - Cause Matrix, updated 15 Jun 2020]]
 
This one page DRAFT outlines key causal factors for clinician burden and is offered for your review and comment.
 
 
*[[media:IPS-Burden_Comments-20200330.pdf|RCB-related Comments on ISO DIS 27269 - International Patient Summary, published 30 Mar 2020]]
 
*[[media:IPS-Burden_Comments-20200330.pdf|RCB-related Comments on ISO DIS 27269 - International Patient Summary, published 30 Mar 2020]]
 
These comments on the DRAFT International Patient Summary were prepared in correspondence with findings of the HL7 RCB Project and clinician burdens associated with patient summary creation, exchange and use, particularly with regard to aspects of information overload, data integrity, patient/provider identity matching, preservation of clinical data context, reconciliation of medications, medication allergies, all allergies, problems/diagnoses and more.
 
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.
 
*[[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]]
 
*[[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]]
 
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.
 
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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==HL7 RCB Collaborative Project Candidate - Medication List Management and Reconciliation==
 
==HL7 RCB Collaborative Project Candidate - Medication List Management and Reconciliation==
 
*[[media:Reducing_Clinician_Burden-Medication_Reconciliation_Project-20201112.pdf|DRAFT Medication Reconciliation Overview, updated 12 Nov 2020]]
 
*[[media:Reducing_Clinician_Burden-Medication_Reconciliation_Project-20201112.pdf|DRAFT Medication Reconciliation Overview, updated 12 Nov 2020]]
*[[media:EHR-RCB-Medication_Reconciliation-Use_Case_Scenario_Worksheet-20201210.xlsx|DRAFT Medication Reconciliation Use Case Scenario Worksheet, updated 10 Dec 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]]
The Medication Reconciliation Burden Reduction Focus Team meets most Thursdays at 5PM ET (US).  Teleconference access is as noted above.  Please join us.
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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.
  
 
==HL7 RCB Project - Reducing Clinician Burden "Comment Only" Ballot==
 
==HL7 RCB Project - Reducing Clinician Burden "Comment Only" Ballot==
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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]]
 
*[[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]]
 
This White Paper has been released for Project Team review and comment.
 
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)]]
  
 
==Burden Reduction (and other) Initiatives in Response to the COVID-19 Pandemic==
 
==Burden Reduction (and other) Initiatives in Response to the COVID-19 Pandemic==
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=="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==
 
*[[media:Reducing_Clinician_Burden-Success_Story_Template-20190128.docx|DRAFT Reducing Clinician Burden - Success Story Template, updated 28 Jan 2019]]
 
*[[media:RCB_Story_-_Duke_Heart_Procedures.docx|Duke University - Duke Heart Business Unit – Procedure Reporting, James E Tcheng MD FACC FSCAI, 4 Feb 2019]]
 
*[[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)]]
 
*[[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)]]
 
*[[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)]]
 
*[[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)]]
 
*[[media:AHA-well-being-playbook.pdf|American Hospital Association - Well-Being Playbook, A Guide for Hospital and Health System Leaders, May 2019]]
 
*[[media:AHA-HL7_Burnout_Webinar-Arespacochaga-20190818.pdf|American Hospital Association - Well-Being Playbook Presentation, Elisa Arespacochaga, 19 Aug 2019 (Posted with Permission)]]
 
*[[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)]]
 
*[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)]
 
  
 
==HL7 RCB Project - Survey and Responses==
 
==HL7 RCB Project - Survey and Responses==
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==HL7 RCB Project - Reference Sources==
 
==HL7 RCB Project - Reference Sources==
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*[https://academic.oup.com/jamia/advance-article/doi/10.1093/jamia/ocaa320/6135062?searchresult=1 Journal of the American Medical Informatics Association - A retrospective look at the predictions and recommendations from the 2009 AMIA policy meeting: did we see EHR-related clinician burnout coming? Justin B Starren MD PhD, William M Tierney MD, Marc S Williams, Paul Tang MD, Charlene Weir, Ross Koppel PhD, Philip Payne, George Hripcsak, Don E Detmer MD, published 15 Feb 2021]
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*[https://www.healthaffairs.org/do/10.1377/hblog20210105.661344/full/ Health Affairs - Improving Interoperability By Moving From Perfection To Pragmatism, Julia Adler-Milstein, Aaron B Neinstein, Russell J. Cucina, published 13 Jan 2021]
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*[https://www.jmir.org/2020/12/e23382/ Journal of Medical Internet Research - Perceived Electronic Health Record Usability as a Predictor of Task Load and Burnout Among US Physicians: Mediation Analysis, Edward R Melnick MD MHS, Elizabeth Harry MD, Christine A Sinsky MD, Liselotte N Dyrbye MD MHPE, Hanhan Wang MPS, Mickey Todd Trockel MD PhD, Colin P West MD PhD, Tait Shanafelt MD, published 22 Dec 2020]
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*[https://www.hcinnovationgroup.com/clinical-it/physician-burnout/article/21203684/why-informatics-leaders-are-key-to-reducing-itcaused-clinician-burnout?utm_source=HI+Daily+NL&utm_medium=email&utm_campaign=CPS201223026&o_eid=8765B7190445D3C&rdx.ident%5Bpull%5D=omeda%7C8765B7190445D3C&oly_enc_id=8765B7190445D3C Healthcare Innovation - Why Informatics Leaders Are Key to Reducing IT-Caused Clinician Burnout, Rajiv Leventhal, published 22 Dec 2020]
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*[https://www.healthcareitnews.com/news/us-clinicians-spend-50-more-time-ehr-those-other-countries Healthcare IT News - U.S. clinicians spend 50% more time in EHR than those in other countries, Kat Jercich, published 17 Dec 2020]
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*[https://www.healthcareitnews.com/news/pandemic-era-burnout-how-ehr-vendors-are-redesigning-ui-and-ux-battle-stress Healthcare IT News - Pandemic-era burnout: How EHR vendors are redesigning UI and UX to battle stress, Bill Siwicki, published 14 Dec 2020]
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*[https://www.healthcareitnews.com/news/female-physicians-spent-33-more-minutes-day-ehrs Healthcare IT News - Female physicians spent 33 more minutes per day in EHRs, Kat Jercich, published 11 Dec 2020]
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*[https://www.healthit.gov/sites/default/files/page/2020-11/2020-11-17_ICAD_TF_FINAL_Report_HITAC.pdf >>A Path Toward Further Clinical and Administrative Data Integration - Final Report of the Health Information Technology Advisory Committee's Intersection of Clinical and Administrative Data Task Force to the National Coordinator for Health Information Technology, published 17 Nov 2020]
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*[https://ctlin.blog/2020/11/11/uchealth-launches-ournotes-how-patients-co-author-clinic-progress-notes/amp/ UCHealth launches OurNotes: how patients co-author clinic progress notes, C.T. Lin, published 11 Nov 2020]
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*[https://www.longwoods.com/content/26332/healthcare-quarterly/electronic-health-record-related-burnout-among-clinicians-practical-recommendations-from-the-litera Longwoods Healthcare Quarterly - Electronic Health Record-Related Burnout among Clinicians: Practical Recommendations for Canadian Healthcare Organizations, Brian Lo, Jessica Kemp, Clare Cullen, Tania Tajirian, Damian Jankowicz, Gillian Strudwick, published 23 Oct 2020]
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*[https://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]
 
*[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]
 
*[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]
 
*[https://www.healthcareitnews.com/news/pandemic-era-burnout-one-consumer-s-tiring-tech-enabled-journey-find-memory-care-parent Healthcare IT News - Pandemic-era burnout: One consumer’s tiring, tech-enabled journey to find memory care for a parent, Bill Siwicki, published 21 Sep 2020]
 
*[https://www.healthcareitnews.com/news/pandemic-era-burnout-one-consumer-s-tiring-tech-enabled-journey-find-memory-care-parent Healthcare IT News - Pandemic-era burnout: One consumer’s tiring, tech-enabled journey to find memory care for a parent, Bill Siwicki, published 21 Sep 2020]
 
*[https://www.healthcareitnews.com/news/rwjbarnabas-health-ehr-user-experience-tool-helps-reduce-clinician-burden Healthcare IT News - EHR user experience tool helps reduce clinician burden, Bill Siwicki, published 18 Sep 2020]
 
*[https://www.healthcareitnews.com/news/rwjbarnabas-health-ehr-user-experience-tool-helps-reduce-clinician-burden Healthcare IT News - EHR user experience tool helps reduce clinician burden, Bill Siwicki, published 18 Sep 2020]
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*[https://www.nejm.org/doi/pdf/10.1056/NEJMp2011027?articleTools=true >>New England Journal of Medicine - Preventing a Parallel Pandemic — A National Strategy to Protect Clinicians’ Well-Being, Victor J. Dzau MD, Darrell Kirch MD, and Thomas Nasca MD, published 6 Aug 2020]
 
*[https://nam.edu/electronic-health-record-optimization-and-clinician-well-being-a-potential-roadmap-toward-action/ National Academy of Medicine - Electronic Health Record Optimization and Clinician Well-Being: A Potential Roadmap Toward Action, Tina Shah MD MPH, Andrea Borondy Kitts MS MPH, Jeffrey A Gold MD, Keith Horvath MD, Alex Ommaya DSc, Frank Opelka MD FACS, Luke Sato MD, Gretchen Schwarze MD MPP FACS, Mark Upton MD, Lew Sandy MD MBA, published 3 Aug 2020]
 
*[https://nam.edu/electronic-health-record-optimization-and-clinician-well-being-a-potential-roadmap-toward-action/ National Academy of Medicine - Electronic Health Record Optimization and Clinician Well-Being: A Potential Roadmap Toward Action, Tina Shah MD MPH, Andrea Borondy Kitts MS MPH, Jeffrey A Gold MD, Keith Horvath MD, Alex Ommaya DSc, Frank Opelka MD FACS, Luke Sato MD, Gretchen Schwarze MD MPP FACS, Mark Upton MD, Lew Sandy MD MBA, published 3 Aug 2020]
 
*[https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00612 Health Affairs - Practice And Policy Reset Post-COVID-19: Reversion, Transition, Or Transformation? Christine Sinsky MD, Mark Linzer MD, published Aug 2020]
 
*[https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00612 Health Affairs - Practice And Policy Reset Post-COVID-19: Reversion, Transition, Or Transformation? Christine Sinsky MD, Mark Linzer MD, published Aug 2020]
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*[https://www.nytimes.com/2019/12/31/opinion/doctors-nurses-and-the-paperwork-crisis-that-could-unite-them.html New York Times - Doctors, Nurses and the Paperwork Crisis That Could Unite Them, Theresa Brown, Stephen Bergman, published 31 Dec 2019]
 
*[https://www.nytimes.com/2019/12/31/opinion/doctors-nurses-and-the-paperwork-crisis-that-could-unite-them.html New York Times - Doctors, Nurses and the Paperwork Crisis That Could Unite Them, Theresa Brown, Stephen Bergman, published 31 Dec 2019]
 
*[https://fortune.com/longform/electronic-health-records-fraud/ Fortune Magazine/Kaiser Health News - Electronic Health Records Creating a ‘New Era’ of Health Care Fraud, Officials Say, Fred Schulte and Erika Fry, published 23 Dec 2019]
 
*[https://fortune.com/longform/electronic-health-records-fraud/ Fortune Magazine/Kaiser Health News - Electronic Health Records Creating a ‘New Era’ of Health Care Fraud, Officials Say, Fred Schulte and Erika Fry, published 23 Dec 2019]
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*[https://edhub.ama-assn.org/steps-forward/module/2757858#section-247203549 >>American Medical Association - Steps Forward - Getting Rid of Stupid Stuff (GROSS), Melinda Ashton MD, Hawaii Pacific Health, published 19 Dec 2019]
 
*[https://www.radiologybusiness.com/topics/leadership/healthcare-artificial-intelligence-burnout Radiology Business - 80% of healthcare pros believe AI is reducing burnout, Marty Stempniak, published 16 Dec 2019]
 
*[https://www.radiologybusiness.com/topics/leadership/healthcare-artificial-intelligence-burnout Radiology Business - 80% of healthcare pros believe AI is reducing burnout, Marty Stempniak, published 16 Dec 2019]
 
*[https://fortune.com/longform/medical-records-government-regulation-patient-risk/ Fortune Magazine/Kaiser Health News - No Safety Switch: How Lax Oversight of Electronic Health Records Puts Patients at Risk - Special interests and congressional inaction doomed efforts to regulate electronic medical records, putting patients at risk, Fred Schulte and Erika Fry, published 21 Nov 2019]
 
*[https://fortune.com/longform/medical-records-government-regulation-patient-risk/ Fortune Magazine/Kaiser Health News - No Safety Switch: How Lax Oversight of Electronic Health Records Puts Patients at Risk - Special interests and congressional inaction doomed efforts to regulate electronic medical records, putting patients at risk, Fred Schulte and Erika Fry, published 21 Nov 2019]

Latest revision as of 00:08, 5 March 2021

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

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

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

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

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

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


HL7 RCB Project - Presentations and Reports

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

HL7 RCB Project - Analysis, Derivations and Worksheets

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

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

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

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

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

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

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

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

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

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

HL7 RCB Collaborative Project Candidate - Medication List Management and Reconciliation

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

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

This ballot closed on Monday, 14 September 2020.

HL7 RCB Project - White Paper

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

HL7 RCB Project - Reducing Burden - Success Stories

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

"See What We Mean"

HL7 RCB Project - Survey and Responses

HL7 RCB Project - Focus Team Drafts

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

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

More RCB Perspectives and Resources

HL7 RCB Project - Reference Sources