Reducing Clinician Burden Project Overview. Health Level Seven (HL7) Electronic Health Record Work Group (EHR WG) 3 December 2018
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1 Reducing Clinician Burden Project Overview Health Level Seven (HL7) Electronic Health Record Work Group (EHR WG) 3 December 2018
2 Quantifying the EHR Burden Surveys Say... 3 out of 4 physicians believe that EHRs increase practice costs, outweighing any efficiency savings Deloitte Survey of US Physicians, out of 10 physicians think that EHRs reduce their productivity Deloitte 4 in 10 primary care physicians (40%) believe there are more challenges with EHRs than benefits Stanford Medicine/Harris Poll, out of 10 physicians (71%) agree that EHRs greatly contribute to physician burnout Stanford/Harris 6 out of 10 physicians (59%) think EHRs need a complete overhaul Stanford/Harris Only 8% say the primary value of their EHR is clinically related Stanford/Harris 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 2
3 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 3
4 Assessing the Burden Focus on clinician burdens including time and data quality burdens associated with: Use/engagement of EHR/HIT systems Capture, exchange and use of health information Consider: Regulatory, accreditation, administrative, payor mandates EHR/HIT system design, functionality, usability and implementation Data quality and usability Gather details from many reference sources: Trade publications, professional society journals, articles, studies, personal experience Goal is not to boil the ocean, rather to understand the extent of the burden. 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 4
5 Defining Terms (DRAFT) Reducing (reduce) Clinician Burden To bring down, as in extent, amount, or degree; diminish, and To gain control of... [to] conquer, and To simplify the form of... without changing the value, also To restore... to a normal condition or position The Free Dictionary To lower in... intensity Dictionary.com To narrow down, also To bring to a specified state or condition Merriam-Webster A health professional whose practice is based on direct observation and treatment of a patient Mosby's Medical Dictionary An expert clinical practitioner and teacher Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health A health professional, such as a physician, psychologist, or nurse, who is directly involved in patient care American Heritage Medical Dictionary A source of great worry or stress, and [Something that] cause[s] difficulty [or] distress, also To load or overload The Free Dictionary Something that is carried, [as in a] duty [or] responsibility, also Something oppressive or worrisome Merriam-Webster Dictionary 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 5
6 Defining Terms (DRAFT) Clinician Burden Anything that hinders patient care, either directly of indirectly [such as]: 1) Undue cost or loss of revenue, 2) Undue time, 3) Undue effort, 4) Undue complexity of workflow, 5) Undue cognitive burden, 6) [Uncertain quality/reliability of data/record content,] 7) Anything that contributes to burnout, lack of productivity, inefficiency, etc., 8) Anything that gets in the way of a productive clinician-patient relationship. -- Peter Goldschmidt 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 6
7 Source: Health Data Management 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 7
8 Source: 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 8
9 Project Outreach + Expressed Interest Standards Developers Joint Initiative Council (JIC), comprising HL7, ISO TC215 (HIT), CEN TC251 (HIT/Europe), DICOM (Diagnostic Imaging), CDISC (Clinical Research), GS1 (IDs/Labeling), SNOMED (Clinical Vocabulary), IHE (Standards Profiling), PCHCA (Personal Connectivity) International Healthcare Community Australia, Canada, Finland, Italy, Netherlands, New Zealand, Sweden, United Kingdom Government US Centers for Medicare and Medicaid Services (CMS) US Office of National Coordinator for HIT (ONC) US National Institutes of Health (NIH) US Veterans Administration (VA) UK National Health Service (NHS) Accreditation Bodies Joint Commission Professional Societies American College of Physicians (ACP) American College of Surgeons (ACS) American Nurses Association (ANA) Providers Adventist Health, Beth Isreal/Deaconess, Cedars-Sinai Medical Center, Duke University, Intermountain Healthcare, Kaiser Permanente, Loma Linda University, Mayo, Sutter Health, University of Arkansas, University of Nebraska, VA Payers UnitedHealth Group EHR/HIT System Developers CentriHealth, Cerner, Epic, TLD Systems Consortia Health Record Banking Alliance Health Services Platform Consortia Clinical Information Interoperability Council 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 9
10 Breaking It Down Topics/Categories (32) Administrative tasks Data entry requirements Scribes, data entry proxies Clinical documentation: quality and usability Prior authorization, verification, eligibility tasks Provider/patient Face to Face Interaction Communication Care coordination, team-based care Clinical work flow Disease management, care and treatment plans Clinical decision support, medical logic, artificial intelligence Alerts, reminders, notifications, inbox management Information overload Transitions of care Health information exchange, claimed interoperability Medical/personal device integration Orders for equipment and supplies Support for payment, claims and reimbursement Support for cost review Support for measures: administrative, operations, quality, performance Support for public and population health Legal aspects and risks User training, proficiency Common function/information models Software development priorities End-User Feedback Product transparency Product modularity Lock-in, data liquidity, switching costs Financial burden Security Professional Credentialing State of data content quality 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 10
11 Analysis Worksheet Tabs 1. Burdens 2. Time Burdens 3. Data Quality Burdens 4. Terms: Reducing, Clinician, Burden 5. Reference Sources 6. Contacts: EHR WG Co-Chairs 7. Acknowledgements: Reviewers + Contributors 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 11
12 Analysis Worksheet Columns B) Clinical Burdens Raw Input C) Recommendations Raw Input D) Reference Sources E) Targeted RCB Recommendation(s) refined from our reference (and other) sources F) RCB Proposals and Successful Solutions 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 12
13 Targeted Recommendations WHAT Burden Targeted Health Informatics Standards HL7 EHR System Functional Model/ Profiles Messages (HL7 v.2x), Documents (HL7 CCDA), Resources (HL7 FHIR) Implementation Guides Regulation, Policies Claims, Payment Policies System/Software Design System/Software Implementation Advisories WHO Might Best Address Burden Standards Developers/Profilers: DICOM, HL7, IHE, ISO TC215, NCPDP, ASC X12N... Standards Coordinating Bodies Joint Initiative Council Government, Accreditation Agencies Public and Private Payers EHR/HIT System Developers/Vendors System Implementers Professional Societies, Consultants With Engaged Clinicians 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 13
14 Project Plan Now Continue environmental scan to compile burden topics Engage small teams to address burden topics/categories Refine, develop targeted recommendations to reduce burdens Identify: What is the burden targeted? Are there existing recommendations for targeted burdens? Who might best address burden? Burdens already tackled: with proposals and/or successful solutions Then Publish and work to implement recommendations 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 14
15 Teams Engaged Clinical documentation, quality and usability Lead: Dr. Lisa Masson Clinical decision support, medical logic, artificial intelligence + Alerts, reminders, notifications, inbox management + Information overload Lead: Dr. James McClay (jmcclay@unmc.edu) Clinical workflow Lead: Dr. David Schlossman (dschloss39@gmail.com) System lock-in, data liquidity, switching costs Lead: Dr. Michael Brody (mbrody@tldsystems.com) State of data content quality Leads: Dr. Reed Gelzer (r.gelzer@snet.net), Gary Dickinson (gary.dickinson@ehr-standards.com) 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 15
16 Teams Engaged Anticipated: More teams to form (focused on RCB topics) To participate: Contact team lead Process is open, transparent and inclusive All are welcome! 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 16
17 Additional Tasks for Volunteers Review ONC DRAFT Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs Develop HL7 Comment Recommendations Review Recent US CMS Initiatives and Impact on RCB CMS Patients over Paperwork Initiative: Link 1 Link 2 CMS Meaningful Measures: Link CMS Evaluation and Management Guidelines: Link 1 Link 2 Refine Our RCB Terms 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 17
18 To Be Considered What are the risks if burden is not reduced? e.g., clinician burnout, clinicians choosing other roles/assignments If clinician burdens are reduced... Are burdens increased elsewhere (e.g., to other members of the healthcare team)? Are benefits to other aspects of the health/healthcare business model also reduced? What is the trade-off: Safety? Cost? Time? Efficiency? Effectiveness? 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 18
19 Schedule Bimonthly teleconferences, Monday at 3PM ET (US) 1st and 3rd Mondays each month (19 November, 3 and 17 December, 7 January) Register at GoToWebinar: (After registering, you will receive a confirmation containing information about joining the webinar.) Small teams meet independently: TBA Next face-to-face HL7 Meeting in San Antonio Thursday, 17 January December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 19
20 Contacts Comments on the DRAFT analysis worksheet are welcome (including additional reference sources) and should be addressed to the HL7 EHR WG Co-Chairs: Gary Dickinson FHL7, Lead: CentriHealth/UnitedHealth Group Michael Brody DPM: TLD Systems Stephen Hufnagel PhD: Apprio Inc Mark Janczewzki MD: Medical Networks LLC John Ritter FHL7: Pele Yu MD: Arkansas Children s Hospital 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 20
21 Reference Points Latest Project Documents Project overview DRAFT Analysis worksheet Links to reference sources Comments may also be directed to: US Centers for Medicare/Medicaid Services (CMS) 3 December 2018 HL7 EHR WG - "Reducing Clinician Burden" Project 21
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