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Sloss EA, Abdul S, Aboagyewah MA, Beebe A, Kendle K, Marshall K, Rosenbloom ST, Rossetti S, Grigg A, Smith KD, Mishuris RG. Toward Alleviating Clinician Documentation Burden: A Scoping Review of Burden Reduction Efforts. Appl Clin Inform 2024; 15:446-455. [PMID: 38839063 PMCID: PMC11152769 DOI: 10.1055/s-0044-1787007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 04/17/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Studies have shown that documentation burden experienced by clinicians may lead to less direct patient care, increased errors, and job dissatisfaction. Implementing effective strategies within health care systems to mitigate documentation burden can result in improved clinician satisfaction and more time spent with patients. However, there is a gap in the literature regarding evidence-based interventions to reduce documentation burden. OBJECTIVES The objective of this review was to identify and comprehensively summarize the state of the science related to documentation burden reduction efforts. METHODS Following Joanna Briggs Institute Manual for Evidence Synthesis and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, we conducted a comprehensive search of multiple databases, including PubMed, Medline, Embase, CINAHL Complete, Scopus, and Web of Science. Additionally, we searched gray literature and used Google Scholar to ensure a thorough review. Two reviewers independently screened titles and abstracts, followed by full-text review, with a third reviewer resolving any discrepancies. Data extraction was performed and a table of evidence was created. RESULTS A total of 34 articles were included in the review, published between 2016 and 2022, with a majority focusing on the United States. The efforts described can be categorized into medical scribes, workflow improvements, educational interventions, user-driven approaches, technology-based solutions, combination approaches, and other strategies. The outcomes of these efforts often resulted in improvements in documentation time, workflow efficiency, provider satisfaction, and patient interactions. CONCLUSION This scoping review provides a comprehensive summary of health system documentation burden reduction efforts. The positive outcomes reported in the literature emphasize the potential effectiveness of these efforts. However, more research is needed to identify universally applicable best practices, and considerations should be given to the transfer of burden among members of the health care team, quality of education, clinician involvement, and evaluation methods.
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Affiliation(s)
- Elizabeth A. Sloss
- Division of Health Systems and Community Based Care, College of Nursing, University of Utah, Utah, United States
| | - Shawna Abdul
- John D. Dingell VA Medical Center, Detroit, Michigan, United States
| | - Mayfair A. Aboagyewah
- Case Management, Mount Sinai Health System, MSH Main Campus, New York, New York, United States
| | - Alicia Beebe
- Saint Luke's Health System (MO), Kansas City, Missouri, United States
| | - Kathleen Kendle
- Section of Health Informatics, El Paso VA Health Care System, El Paso, Texas, United States
| | - Kyle Marshall
- Department of Emergency Medicine, Geisinger, Danville, Pennsylvania, United States
| | - S. Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Sarah Rossetti
- Biomedical Informatics and Nursing, Columbia University Irving Medical Center, New York, New York, United States
| | - Aaron Grigg
- Department of Informatics, Grande Ronde Hospital, La Grande, Oregon, United States
| | - Kevin D. Smith
- Department of Pediatrics, University of Chicago Medicine, Chicago, Illinois, United States
| | - Rebecca G. Mishuris
- Digital, Mass General Brigham, Somerville, Massachusetts, United States
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States
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2
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Fogleman BM, Goldman M, Holland AB, Dyess G, Patel A. Charting Tomorrow's Healthcare: A Traditional Literature Review for an Artificial Intelligence-Driven Future. Cureus 2024; 16:e58032. [PMID: 38738104 PMCID: PMC11088287 DOI: 10.7759/cureus.58032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Electronic health record (EHR) systems have developed over time in parallel with general advancements in mainstream technology. As artificially intelligent (AI) systems rapidly impact multiple societal sectors, it has become apparent that medicine is not immune from the influences of this powerful technology. Particularly appealing is how AI may aid in improving healthcare efficiency with note-writing automation. This literature review explores the current state of EHR technologies in healthcare, specifically focusing on possibilities for addressing EHR challenges through the automation of dictation and note-writing processes with AI integration. This review offers a broad understanding of existing capabilities and potential advancements, emphasizing innovations such as voice-to-text dictation, wearable devices, and AI-assisted procedure note dictation. The primary objective is to provide researchers with valuable insights, enabling them to generate new technologies and advancements within the healthcare landscape. By exploring the benefits, challenges, and future of AI integration, this review encourages the development of innovative solutions, with the goal of enhancing patient care and healthcare delivery efficiency.
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Affiliation(s)
- Brody M Fogleman
- Internal Medicine, Edward Via College of Osteopathic Medicine - Carolinas, Spartanburg, USA
| | - Matthew Goldman
- Neurological Surgery, Houston Methodist Hospital, Houston, USA
| | - Alexander B Holland
- General Surgery, Edward Via College of Osteopathic Medicine - Carolinas, Spartanburg, USA
| | - Garrett Dyess
- Medicine, University of South Alabama College of Medicine, Mobile, USA
| | - Aashay Patel
- Neurological Surgery, University of Florida College of Medicine, Gainesville, USA
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3
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Overhage JM, Qeadan F, Choi EHE, Vos D, Kroth PJ. Explaining Variability in Electronic Health Record Effort in Primary Care Ambulatory Encounters. Appl Clin Inform 2024; 15:212-219. [PMID: 38508654 PMCID: PMC10954376 DOI: 10.1055/s-0044-1782228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/30/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Electronic health record (EHR) user interface event logs are fast providing another perspective on the value and efficiency EHR technology brings to health care. Analysis of these detailed usage data has demonstrated their potential to identify EHR and clinical process design factors related to user efficiency, satisfaction, and burnout. OBJECTIVE This study aimed to analyze the event log data across 26 different health systems to determine the variability of use of a single vendor's EHR based on four event log metrics, at the individual, practice group, and health system levels. METHODS We obtained de-identified event log data recorded from June 1, 2018, to May 31, 2019, from 26 health systems' primary care physicians. We estimated the variability in total Active EHR Time, Documentation Time, Chart Review Time, and Ordering Time across health systems, practice groups, and individual physicians. RESULTS In total, 5,444 physicians (Family Medicine: 3,042 and Internal Medicine: 2,422) provided care in a total of 2,285 different practices nested in 26 health systems. Health systems explain 1.29, 3.55, 3.45, and 3.30% of the total variability in Active Time, Documentation Time, Chart Review Time, and Ordering Time, respectively. Practice-level variability was estimated to be 7.96, 13.52, 8.39, and 5.57%, respectively, and individual physicians explained the largest proportion of the variability for those same outcomes 17.09, 27.49, 17.51, and 19.75%, respectively. CONCLUSION The most variable physician EHR usage patterns occurs at the individual physician level and decreases as you move up to the practice and health system levels. This suggests that interventions to improve individual users' EHR usage efficiency may have the most potential impact compared with those directed at health system or practice levels.
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Affiliation(s)
| | - Fares Qeadan
- Department of Public Health Sciences, Loyola University Chicago, Chicago, Illinois, United States
| | - Eun Ho Eunice Choi
- University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
| | - Duncan Vos
- Division of Epidemiology and Biostatistics, Department of Biomedical Sciences, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, United States
| | - Philip J. Kroth
- Department of Biomedical Informatics, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, United States
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4
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Kang C, Sarkar IN. Interventions to Reduce Electronic Health Record-Related Burnout: A Systematic Review. Appl Clin Inform 2024; 15:10-25. [PMID: 37923381 PMCID: PMC10764123 DOI: 10.1055/a-2203-3787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Electronic health records are a significant contributing factor in clinician burnout, which negatively impacts patient care. OBJECTIVES To identify and appraise published solutions that aim to reduce EHR-related burnout in clinicians. METHODS A literature search strategy was developed following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Six databases were searched for articles published between January 1950 and March 2023. The inclusion criteria were peer-reviewed, full-text, English language articles that described interventions targeting EHR-related burnout in any type of clinician, with reported outcomes related to burnout, wellness, EHR satisfaction, or documentation workload. Studies describing interventions without an explicit focus on reducing burnout or enhancing EHR-related satisfaction were excluded. RESULTS We identified 44 articles describing interventions to reduce EHR-related burnout. These interventions included the use of scribes, EHR training, and EHR modifications. These interventions were generally well received by the clinicians and patients, with subjective improvements in documentation time and EHR satisfaction, although objective data were limited. CONCLUSION The findings of this review underscore the potential benefits of interventions to reduce EHR-related burnout as well as the need for further research with more robust study designs involving randomized trials, control groups, longer study durations, and validated, objective outcome measurements.
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Affiliation(s)
- Chaerim Kang
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, United States
| | - Indra Neil Sarkar
- Center for Biomedical Informatics, Brown University, Providence, Rhode Island, United States
- Rhode Island Quality Institute, Providence, Rhode Island, United States
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Abda R, Pietrzyk G, Scott PW, Fennimore L. Taking Action Against Clinician Burnout Through Reducing the Documentation Burden With an Operating Room Supply Scanning Approach. Comput Inform Nurs 2024; 42:14-20. [PMID: 37607689 DOI: 10.1097/cin.0000000000001058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Documenting surgical supply items in the operating room can be a burdensome task for circulating nurses because of manual input within the electronic medical record. This can lead to documentation fatigue and contribute to nursing burnout. The aim of this quality improvement project was to design and implement a supply item scanning process and evaluate the effect on intraoperative documentation completion time, room turnover time, picklist documentation accuracy, nurse satisfaction, and burnout. The sample included nine acute care hospitals throughout the United States, with 189 total circulating nurses and 31 718 procedures occurring during the study timeframe of 8 months. Results indicated that nurses were able to complete documentation on average 37.33 minutes sooner, and the operating room turnover time decreased by 1.88 minutes. Although nurses reported that their perceived picklist documentation accuracy did not improve, and the presence of new scanning technology did not influence their hospital employment decision, subjective feedback was mostly positive, with most responses citing the helpfulness of scanning for documentation. This study shows that an interdisciplinary team can effectively work to optimize documentation efficiency and performance improvement using a scanning intervention. Lessons learned through this process can translate into optimizations elsewhere in the electronic medical record.
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Affiliation(s)
- Robert Abda
- Author Affiliations: University of Pittsburgh School of Nursing, Pittsburgh, PA (Drs Abda, Scott, and Fennimore); and Universal Health Services Inc., King of Prussia, PA (Dr Pietrzyk)
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Payne TH, Turner GK. I'm not burned out. This is how I write notes. JAMIA Open 2023; 6:ooad099. [PMID: 38033784 PMCID: PMC10684266 DOI: 10.1093/jamiaopen/ooad099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/27/2023] [Accepted: 11/13/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives We describe an automated transcription system that addresses many documentation problems and fits within scheduled clinical hours. Materials and methods During visits, the provider listens to the patient while maintaining eye contact and making brief notes on paper. Immediately after the visit conclusion and before the next, the provider makes a short voice recording on a smartphone which is transmitted to the system. The system uses a public domain general language model, and a hypertuned provider-specific language model that is iteratively refined as each produced note is edited by the physician, followed by final automated processing steps to add any templated text to the note. Results The provider leaves the clinic having completed all voice files, median duration 3.4 minutes. Created notes are formatted as preferred and are a median of 363 words (range 125-1175). Discussion This approach permits documentation to occur almost entirely within scheduled clinic hours, without copy-forward errors, and without interference with patient-provider interaction. Conclusion Though no documentation method is likely to appeal to all, this approach may appeal to many physicians and avoid many current problems with documentation.
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Affiliation(s)
- Thomas H Payne
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98104-2499, United States
- Department of Biomedical Informatics & Medical Education, University of Washington School of Medicine, Seattle, WA 98104-2499, United States
| | - Grace K Turner
- Department of Biomedical Informatics & Medical Education, University of Washington School of Medicine, Seattle, WA 98104-2499, United States
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7
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Baratta LR, Harford D, Sinsky CA, Kannampallil T, Lou SS. Characterizing the Patterns of Electronic Health Record-Integrated Secure Messaging Use: Cross-Sectional Study. J Med Internet Res 2023; 25:e48583. [PMID: 37801359 PMCID: PMC10589827 DOI: 10.2196/48583] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/14/2023] [Accepted: 08/29/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Communication among health care professionals is essential for the delivery of safe clinical care. Secure messaging has rapidly emerged as a new mode of asynchronous communication. Despite its popularity, relatively little is known about how secure messaging is used and how such use contributes to communication burden. OBJECTIVE This study aims to characterize the use of an electronic health record-integrated secure messaging platform across 14 hospitals and 263 outpatient clinics within a large health care system. METHODS We collected metadata on the use of the Epic Systems Secure Chat platform for 6 months (July 2022 to January 2023). Information was retrieved on message volume, response times, message characteristics, messages sent and received by users, user roles, and work settings (inpatient vs outpatient). RESULTS A total of 32,881 users sent 9,639,149 messages during the study. Median daily message volume was 53,951 during the first 2 weeks of the study and 69,526 during the last 2 weeks, resulting in an overall increase of 29% (P=.03). Nurses were the most frequent users of secure messaging (3,884,270/9,639,149, 40% messages), followed by physicians (2,387,634/9,639,149, 25% messages), and medical assistants (1,135,577/9,639,149, 12% messages). Daily message frequency varied across users; inpatient advanced practice providers and social workers interacted with the highest number of messages per day (median 19). Conversations were predominantly between 2 users (1,258,036/1,547,879, 81% conversations), with a median of 2 conversational turns and a median response time of 2.4 minutes. The largest proportion of inpatient messages was from nurses to physicians (972,243/4,749,186, 20% messages) and physicians to nurses (606,576/4,749,186, 13% messages), while the largest proportion of outpatient messages was from physicians to nurses (344,048/2,192,488, 16% messages) and medical assistants to other medical assistants (236,694/2,192,488, 11% messages). CONCLUSIONS Secure messaging was widely used by a diverse range of health care professionals, with ongoing growth throughout the study and many users interacting with more than 20 messages per day. The short message response times and high messaging volume observed highlight the interruptive nature of secure messaging, raising questions about its potentially harmful effects on clinician workflow, cognition, and errors.
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Affiliation(s)
- Laura R Baratta
- Division of Biology and Biomedical Sciences, Washington University School of Medicine, Saint Louis, MO, United States
| | - Derek Harford
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, United States
| | | | - Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, United States
| | - Sunny S Lou
- Department of Anesthesiology, Washington University School of Medicine, Saint Louis, MO, United States
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8
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Levy DR, Moy AJ, Apathy N, Adler-Milstein J, Rotenstein L, Nath B, Rosenbloom ST, Kannampallil T, Mishuris RG, Alexanian A, Sieja A, Hribar MR, Patel JS, Sinsky CA, Melnick ER. Identifying and Addressing Barriers to Implementing Core Electronic Health Record Use Metrics for Ambulatory Care: Virtual Consensus Conference Proceedings. Appl Clin Inform 2023; 14:944-950. [PMID: 37802122 PMCID: PMC10686750 DOI: 10.1055/a-2187-3243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023] Open
Abstract
Precise, reliable, valid metrics that are cost-effective and require reasonable implementation time and effort are needed to drive electronic health record (EHR) improvements and decrease EHR burden. Differences exist between research and vendor definitions of metrics. PROCESS: We convened three stakeholder groups (health system informatics leaders, EHR vendor representatives, and researchers) in a virtual workshop series to achieve consensus on barriers, solutions, and next steps to implementing the core EHR use metrics in ambulatory care. CONCLUSION: Actionable solutions identified to address core categories of EHR metric implementation challenges include: (1) maintaining broad stakeholder engagement, (2) reaching agreement on standardized measure definitions across vendors, (3) integrating clinician perspectives, and (4) addressing cognitive and EHR burden. Building upon the momentum of this workshop's outputs offers promise for overcoming barriers to implementing EHR use metrics.
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Affiliation(s)
- Deborah R Levy
- Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, Connecticut, United States
- Section of Biomedical Informatics and Data Sciences, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Amanda J Moy
- Department of Biomedical Informatics, Columbia University, New York, New York, United States
| | - Nate Apathy
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, District of Columbia, United States
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Iowa, United States
| | - Julia Adler-Milstein
- Department of Medicine, Center for Clinical Informatics and Improvement Research, University of California, San Francisco, California, United States
| | - Lisa Rotenstein
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - Bidisha Nath
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States
| | - Thomas Kannampallil
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, United States
- Institute for Informatics, Data Science, and Biostatistics (I2DB), Washington University School of Medicine, St. Louis, Missouri, United States
| | - Rebecca G Mishuris
- Division of General Internal Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
- Digital, Mass General Brigham, Boston, Massachusetts, United States
| | | | - Amber Sieja
- Department of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, United States
| | - Michelle R Hribar
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, United States
| | - Jigar S Patel
- Oracle Corporation, Kansas City, Missouri, United States
| | | | - Edward R Melnick
- Section of Biomedical Informatics and Data Sciences, Yale University School of Medicine, New Haven, Connecticut, United States
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
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9
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Moy AJ, Withall J, Hobensack M, Yeji Lee R, Levy DR, Rossetti SC, Rosenbloom ST, Johnson K, Cato K. Eliciting Insights From Chat Logs of the 25X5 Symposium to Reduce Documentation Burden: Novel Application of Topic Modeling. J Med Internet Res 2023; 25:e45645. [PMID: 37195741 PMCID: PMC10233429 DOI: 10.2196/45645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/03/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Addressing clinician documentation burden through "targeted solutions" is a growing priority for many organizations ranging from government and academia to industry. Between January and February 2021, the 25 by 5: Symposium to Reduce Documentation Burden on US Clinicians by 75% (25X5 Symposium) convened across 2 weekly 2-hour sessions among experts and stakeholders to generate actionable goals for reducing clinician documentation over the next 5 years. Throughout this web-based symposium, we passively collected attendees' contributions to a chat functionality-with their knowledge that the content would be deidentified and made publicly available. This presented a novel opportunity to synthesize and understand participants' perceptions and interests from chat messages. We performed a content analysis of 25X5 Symposium chat logs to identify themes about reducing clinician documentation burden. OBJECTIVE The objective of this study was to explore unstructured chat log content from the web-based 25X5 Symposium to elicit latent insights on clinician documentation burden among clinicians, health care leaders, and other stakeholders using topic modeling. METHODS Across the 6 sessions, we captured 1787 messages among 167 unique chat participants cumulatively; 14 were private messages not included in the analysis. We implemented a latent Dirichlet allocation (LDA) topic model on the aggregated dataset to identify clinician documentation burden topics mentioned in the chat logs. Coherence scores and manual examination informed optimal model selection. Next, 5 domain experts independently and qualitatively assigned descriptive labels to model-identified topics and classified them into higher-level categories, which were finalized through a panel consensus. RESULTS We uncovered ten topics using the LDA model: (1) determining data and documentation needs (422/1773, 23.8%); (2) collectively reassessing documentation requirements in electronic health records (EHRs) (252/1773, 14.2%); (3) focusing documentation on patient narrative (162/1773, 9.1%); (4) documentation that adds value (147/1773, 8.3%); (5) regulatory impact on clinician burden (142/1773, 8%); (6) improved EHR user interface and design (128/1773, 7.2%); (7) addressing poor usability (122/1773, 6.9%); (8) sharing 25X5 Symposium resources (122/1773, 6.9%); (9) capturing data related to clinician practice (113/1773, 6.4%); and (10) the role of quality measures and technology in burnout (110/1773, 6.2%). Among these 10 topics, 5 high-level categories emerged: consensus building (821/1773, 46.3%), burden sources (365/1773, 20.6%), EHR design (250/1773, 14.1%), patient-centered care (162/1773, 9.1%), and symposium comments (122/1773, 6.9%). CONCLUSIONS We conducted a topic modeling analysis on 25X5 Symposium multiparticipant chat logs to explore the feasibility of this novel application and elicit additional insights on clinician documentation burden among attendees. Based on the results of our LDA analysis, consensus building, burden sources, EHR design, and patient-centered care may be important themes to consider when addressing clinician documentation burden. Our findings demonstrate the value of topic modeling in discovering topics associated with clinician documentation burden using unstructured textual content. Topic modeling may be a suitable approach to examine latent themes presented in web-based symposium chat logs.
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Affiliation(s)
- Amanda J Moy
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - Jennifer Withall
- School of Nursing, Columbia University, New York, NY, United States
| | - Mollie Hobensack
- School of Nursing, Columbia University, New York, NY, United States
| | - Rachel Yeji Lee
- School of Nursing, Columbia University, New York, NY, United States
| | - Deborah R Levy
- School of Medicine, Yale University, New Haven, CT, United States
- Veteran's Affairs Connecticut Health Care System, Pain, Research, Informatics, Multi-morbidities Education Center, West Haven, CT, United States
| | - Sarah C Rossetti
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
- School of Nursing, Columbia University, New York, NY, United States
| | - S Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University, Nashville, TN, United States
| | - Kevin Johnson
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania, Philadelphia, PA, United States
- Department of Computer and Information Science, University of Pennsylvania, Philadelphia, PA, United States
| | - Kenrick Cato
- School of Nursing, Columbia University, New York, NY, United States
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, United States
- Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
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10
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Abid M, Schneider AB. Clinical Informatics and the Electronic Medical Record. Surg Clin North Am 2023; 103:247-258. [PMID: 36948716 DOI: 10.1016/j.suc.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
The electronic medical record has fundamentally altered the way surgeons participate and practice medicine. There is now a wealth of data, once hidden behind paper records, that is, now available to surgeons to provide superior care to their patients. This article reviews the history of the electronic medical record, discusses use cases of additional data resources, and highlights the pitfalls of this relatively new technology.
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Affiliation(s)
- Mustafa Abid
- Department of Surgery, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514, USA
| | - Andrew B Schneider
- Department of Surgery, University of North Carolina, 101 Manning Drive, Chapel Hill, NC 27514, USA.
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Levy DR, Sloss EA, Chartash D, Corley ST, Mishuris RG, Rosenbloom ST, Tiase VL. Reflections on the Documentation Burden Reduction AMIA Plenary Session through the Lens of 25 × 5. Appl Clin Inform 2023; 14:11-15. [PMID: 36356593 PMCID: PMC9812582 DOI: 10.1055/a-1976-2052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/06/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Deborah R. Levy
- Department of Veterans Affairs, Pain Research, Multimorbidities, and Education (PRIME) Center, VA-Connecticut, United States
- Yale University School of Medicine, New Haven, Connecticut, United States
| | - Elizabeth A. Sloss
- College of Nursing, University of Utah, Salt Lake City, Utah, United States
| | - David Chartash
- Center for Medical Informatics, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Sarah T. Corley
- MITRE Corporation, Center for Government Effectiveness and Modernization, Center Office, McLean, Virginia, United States
| | - Rebecca G. Mishuris
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, United States
| | - S. Trent Rosenbloom
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Victoria L. Tiase
- Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, United States
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12
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Turer RW, Champion JC, Rothman BS, Dunn HS, Jenkins KM, Everham O, Barrett TW, Jones ID, Ward MJ, Miller NM. Decision Support to Improve Critical Care Services Documentation in an Academic Emergency Department. Appl Clin Inform 2022; 13:1100-1107. [PMID: 36162434 PMCID: PMC9668511 DOI: 10.1055/a-1950-9032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/20/2022] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES Critical care services (CCS) documentation affects billing, operations, and research. No studies exist on documentation decision support (DDS) for CCS in the emergency department (ED). We describe the design, implementation, and evaluation of a DDS tool built to improve CCS documentation at an academic ED. METHODS This quality improvement study reports the prospective design, implementation, and evaluation of a novel DDS tool for CCS documentation at an academic ED. CCS-associated ED diagnoses triggered a message to appear within the physician note attestation workflow for any patient seen in the adult ED. The alert raised awareness of CCS-associated diagnoses without recommending specific documentation practices. The message disappeared from the note automatically once signed. We measured current procedural terminology (CPT) codes 99291 or 99292 (representing CCS rendered) for 8 months before and after deployment to identify CCS documentation rates. We performed state-space Bayesian time-series analysis to evaluate the causal effect of our intervention on CCS documentation capture. We used monthly ED volume and monthly admission rates as covariate time-series for model generation. RESULTS The study included 92,350 ED patients with an observed mean proportion CCS of 3.9% before the intervention and 5.8% afterward. The counterfactual model predicted an average response of 3.9% [95% CI 3.5-4.3%]. The estimated absolute causal effect of the intervention was 2.0% [95% CI 1.5-2.4%] (p = 0.001). CONCLUSION A DDS tool measurably increased ED CCS documentation. Attention to user workflows and collaboration with compliance and billing teams avoided alert fatigue and ensures compliance.
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Affiliation(s)
- Robert W. Turer
- Department of Emergency Medicine and Clinical Informatics Center, UT Southwestern Medical Center, Dallas, Texas, United States
| | - John C. Champion
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Brian S. Rothman
- Department of Anesthesiology, Vanderbilt Medical Center, Nashville, Tennessee, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Heather S. Dunn
- Department of Finance, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Kenneth M. Jenkins
- Department of Compliance, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Olayinka Everham
- Health IT, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Tyler W. Barrett
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Ian D. Jones
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Health IT, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Michael J. Ward
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
- Geriatric Research, Education, and Clinical Center, Tennessee Valley Healthcare System (Veterans Affairs), Nashville, Tennessee, United States
| | - Nathaniel M. Miller
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Gesner E, Dykes PC, Zhang L, Gazarian P. Documentation Burden in Nursing and Its Role in Clinician Burnout Syndrome. Appl Clin Inform 2022; 13:983-990. [PMID: 36261113 PMCID: PMC9581587 DOI: 10.1055/s-0042-1757157] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 08/01/2022] [Indexed: 11/02/2022] Open
Abstract
OBJECTIVES The purpose of this study is to understand the relationship between documentation burden and clinician burnout syndrome in nurses working in direct patient care. The Office of the National Coordinator considers documentation burden a high priority problem. However, the presence of documentation burden in nurses working in direct patient care is not well known. Furthermore, the presence of documentation burden has not been linked to the development of clinician burnout syndrome. METHODS This paper reports that the results of a cross-sectional survey study comprised of three tools: (1) The burden of documentation for nurses and mid-wives survey, (2) the system usability scale, and (3) Maslach's burnout inventory for medical professionals. RESULTS Documentation burden has a weak to moderate correlation to clinician burnout syndrome. Furthermore, poor usability of the electronic health record (EHR) is also associated with documentation burden and clinician burnout syndrome. CONCLUSION This study suggests that there is a relationship between documentation burden and clinician burnout syndrome. The correlation of poor usability and domains of clinician burnout syndrome implies the need for more work on improving the usability of EHR for nursing documentation. Further study regarding the presence of documentation burden and its correlation to clinician burnout syndrome should focus on specific areas of nursing to understand the drivers of documentation burden variation within and across specialty domains.
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Affiliation(s)
- Emily Gesner
- University of Massachusetts-Dartmouth, North Darmouth, Massachusetts, United States
| | - Patricia C. Dykes
- Brigham and Women's Hospital, Massachusetts, United States
- Harvard Medical School, Massachusetts, United States
| | - Lingling Zhang
- University of Massachusetts-Boston, Bostan, Massachusetts, United States
| | - Priscilla Gazarian
- University of Massachusetts-Boston, Bostan, Massachusetts, United States
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14
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Ebbers T, Kool RB, Smeele LE, Takes RP, van den Broek GB, Dirven R. Quantifying the Electronic Health Record Burden in Head and Neck Cancer Care. Appl Clin Inform 2022; 13:857-864. [PMID: 36104154 PMCID: PMC9474268 DOI: 10.1055/s-0042-1756422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background
Although the main task of health care providers is to provide patient care, studies show that increasing amounts of time are spent on documentation.
Objective
To quantify the time and effort spent on the electronic health record (EHR) in head and neck cancer care.
Methods
Cross-sectional time–motion study. Primary outcomes were the percentages of time spent on the EHR and the three main tasks (chart review, input, placing orders), number of mouse events, and keystrokes per consultation. Secondary outcome measures were perceptions of health care providers regarding EHR documentation and satisfaction.
Results
In total, 44.0% of initial oncological consultation (IOC) duration and 30.7% of follow-up consultation (FUC) duration are spent on EHR tasks. During 80.0% of an IOC and 67.9% of a FUC, the patient and provider were actively communicating. Providers required 593 mouse events and 1,664 keystrokes per IOC and 140 mouse events and 597 keystrokes per FUC, indicating almost 13 mouse clicks and close to 40 keystrokes for every minute of consultation time. Less than a quarter of providers indicated that there is enough time for documentation.
Conclusion
This study quantifies the widespread concern of high documentation burden for health care providers in oncology, which has been related to burnout and a decrease of patient–clinician interaction. Despite excessive time and effort spent on the EHR, health care providers still felt this was insufficient for proper documentation. However, the need for accurate and complete documentation is high, as reuse of information becomes increasingly important. The challenge is to decrease the documentation burden while increasing the quality of EHR data.
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Affiliation(s)
- Tom Ebbers
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rudolf B Kool
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ludi E Smeele
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Robert P Takes
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guido B van den Broek
- Department of Otorhinolaryngology and Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Richard Dirven
- Department of Head and Neck Oncology and Surgery, Antoni van Leeuwenhoek, Amsterdam, The Netherlands
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