Background The widespread adoption of electronic health records and a simultaneous increase in regulatory demands have led to an acceleration of documentation requirements among clinicians. The corresponding burden from documentation requirements is a central contributor to clinician burnout and can lead to an increased risk of suboptimal patient care. Objective To address the problem of documentation burden, the 25 by 5: Symposium to Reduce Documentation Burden on United States Clinicians by 75% by 2025 (Symposium) was organized to provide a forum for experts to discuss the current state of documentation burden and to identify specific actions aimed at dramatically reducing documentation burden for clinicians. Methods The Symposium consisted of six weekly sessions with 33 presentations. The first four sessions included panel presentations discussing the challenges related to documentation burden. The final two sessions consisted of breakout groups aimed at engaging attendees in establishing interventions for reducing clinical documentation burden. Steering Committee members analyzed notes from each breakout group to develop a list of action items. Results The Steering Committee synthesized and prioritized 82 action items into Calls to Action among three stakeholder groups: Providers and Health Systems, Vendors, and Policy and Advocacy Groups. Action items were then categorized into as short-, medium-, or long-term goals. Themes that emerged from the breakout groups' notes include the following: accountability, evidence is critical, education and training, innovation of technology, and other miscellaneous goals (e.g., vendors will improve shared knowledge databases). Conclusion The Symposium successfully generated a list of interventions for short-, medium-, and long-term timeframes as a launching point to address documentation burden in explicit action-oriented ways. Addressing interventions to reduce undue documentation burden placed on clinicians will necessitate collaboration among all stakeholders.

Documentation burden, defined as the excessive effort expended on healthcare documentation, is associated with a number of adverse outcomes, including clinician burnout, reduced quality of medical care, and disruption of clinical data contained in the electronic health record.[1] With the growing concern for the wellness of the clinical workforce, documentation burden is receiving national attention. The American Medical Informatics Association (AMIA) has taken the lead by establishing the 25 x 5 Task Force (“Task Force”) in December 2021, which aims to reduce clinician documentation burden to 25% of the current state in the coming 5 years. [2] Aligned with the timing of the Task Force launch, the AMIA Clinical Informatics Conference (CIC) 2022 co-chairs, Rosemary Kennedy (Connect America) and Paul Fu (City of Hope), conceptualized an opening plenary panel in a ‘fireside chat’ format focused on clinical documentation burden.[3] In this editorial, the authors describe the panel discussion, identify key themes from the panel, and offer recommendations to address documentation burden. The proceedings of the AMIA CIC 2022 Fireside Chat serve as an opportunity to acknowledge those who are engaged and passionate about addressing documentation burden from the vantage point of different stakeholders and institutions.

BACKGROUND Addressing clinician documentation burden through “targeted solutions” is a growing priority for many organizations including government, academia, and industry. Between January and February 2021, the 25 by 5: Symposium to Reduce Documentation Burden on U.S. Clinicians by 75% (25x5 Symposium) convened across six weekly, two-hour sessions among experts and stakeholders to generate actionable goals for reducing clinician documentation over the next five years. Throughout the virtual symposium, we passively collected—with their knowledge that the content would be deidentified and made publicly available—attendee contributions to a chat functionality. 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 on reducing clinician documentation burden. OBJECTIVE The objective of this study was to explore unstructured chat log content from the virtual 25x5 Symposium to elicit latent insights on clinician documentation burden among clinicians, healthcare leaders, and other stakeholders using topic modeling. METHODS Across the six sessions, we captured 1,787 messages among 167 unique chat participants cumulatively; fourteen 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. Five 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 (23.8%), (2) collectively reassessing documentation requirements in electronic health records (EHR) (14.2%), (3) focusing documentation on patient narrative (9.1%), (4) documentation that adds value (8.3%), (5) regulatory impact on clinician burden (8.0%), (6) improved EHR user interface and design (7.2%), (7) addressing poor usability (6.9%), (8) sharing 25x5 Symposium resources (6.9%), (9) capturing data related to clinician practice (6.4%), and (10) role of quality measures and technology on burnout (6.2%). Among these 10 topics, five high-level categories emerged: consensus building (46.3%), burden sources (20.6%), EHR design (14.1%), patient-centered care (9.1%), and symposium comments (6.9%). CONCLUSIONS We conducted a topic modeling analysis on 25x5 Symposium multi-participant chat logs to explore the feasibility of this novel application and to 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 virtual symposium chat logs.

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.