The Effect of Electronic Health Record Burden on Pediatricians' Work–Life Balance and Career Satisfaction

Frintner, Mary Pat; Kaelber, David C.; Kirkendall, Eric S.; Lourie, Eli M.; Somberg, Chloe; Lehmann, Christoph U.

doi:10.1055/s-0041-1732402

Cited by 29 publications

(19 citation statements)

References 33 publications

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“…19 The results of this Symposium support previous literature connecting increased documentation requirements to burden being placed on clinicians. 2,34 Our actions items aim to provide tangible steps to refine documentations requirements and have the potential to reduce burden on clinicians related to documentation workload.…”

Section: Discussionmentioning

confidence: 99%

25 × 5 Symposium to Reduce Documentation Burden: Report-out and Call for Action

et al. 2022

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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.

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Section: Discussionmentioning

confidence: 99%

25 × 5 Symposium to Reduce Documentation Burden: Report-out and Call for Action

et al. 2022

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“…Studies have looked at the documentation burden of EHR use for pediatricians estimating that pediatricians spend approximately 3.4 hours a day on care documentation. 3,37 However, it is unknown how much of that burden and time is related to communication and documentation for school health-related forms. When the school nurse can access school forms in the EHR independently, it can help decrease the time and lessen the burden of EHR use for the pediatricians and health care staff.…”

Section: Discussionmentioning

confidence: 99%

Facilitating Health Information Exchange to Improve Health Outcomes for School-Aged Children: School Nurse Electronic Health Record Access

et al. 2022

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Background and Objectives: School-aged children with chronic conditions require care coordination for health needs at school. Access to the student's accurate, real-time medical information is essential for school nurses to maximize their care of students. We aim to analyze school nurse access to medical records in a hospital-based electronic health record (EHR) and the effect on patient outcomes. We hypothesized that EHR access would decrease emergency department (E.D.) visits and inpatient hospitalizations. Methods: This retrospective secondary data analysis was conducted using EHR data six months pre- and post-school nurse access to students' hospital-based EHR. The main outcome measures were the E.D. visits and inpatient hospitalizations. Results: For the sample of 336 students in the study, there was a 34% decrease in E.D. visits from 190 visits before access to 126 ED visits after access (p<.01). Inpatient hospitalizations decreased by 44% from 176 before access to 99 after access (p<.001). The incident rate of E.D. visits decreased (IRR: 0.66; 95% CI: 0.53-0.83; p= 0.00035), and hospitalizations decreased (IRR: 0.56; 95% CI: 0.44-0.72; p<0.0001) from pre to post access. These findings suggest school nurse access to medical records is a positive factor in improving school-aged patient outcomes. Conclusions: School nurse access to medical records through the hospital-based EHR may be a factor to improve patient outcomes by utilizing health information technology for more efficient and effective communication and care coordination for school-aged children with chronic medical conditions. Keywords- Health Information Exchange; Electronic Health Records; Child; Outcome Assessment, Health Care; School Nursing

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“…Beyond institutional policies and EHR technical capabilities, the health care provider can adopt new documentation workflows when information blocking is legally acceptable. For example, the health care provider could create one note that is appropriate to share with all users and another that includes the information which is then blocked (ie, shadow charting); however, this solution is time-consuming and burdensome and unlikely to be adopted as clinical documentation has already been shown to be a significant contributor to burnout among health care providers [42][43][44][45][46]. Further, duplicate documentation would also be error-prone, jeopardizing safety and creating additional work and confusion for other health care providers on the treatment team relying on documentation to support patient care.…”

Section: Information Blocking In the Multiuser Ehrmentioning

confidence: 99%

The 21st Century Cures Act and Multiuser Electronic Health Record Access: Potential Pitfalls of Information Release

Arvisais-Anhalt¹,

Lau²,

Lehmann³

et al. 2022

J Med Internet Res

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Although the Office of The National Coordinator for Health Information Technology’s (ONC) Information Blocking Provision in the Cures Act Final Rule is an important step forward in providing patients free and unfettered access to their electronic health information (EHI), in the contexts of multiuser electronic health record (EHR) access and proxy access, concerns on the potential for harm in adolescent care contexts exist. We describe how the provision could erode patients’ (both adolescent and older patients alike) trust and willingness to seek care. The rule’s preventing harm exception does not apply to situations where the patient is a minor and the health care provider wishes to restrict a parent’s or guardian’s access to the minor’s EHI to avoid violating the minor’s confidentiality and potentially harming patient-clinician trust. This may violate previously developed government principles in the design and implementation of EHRs for pediatric care. Creating legally acceptable workarounds by means such as duplicate “shadow charting” will be burdensome (and prohibitive) for health care providers. Under the privacy exception, patients have the opportunity to request information to not be shared; however, depending on institutional practices, providers and patients may have limited awareness of this exception. Notably, the privacy exception states that providers cannot “improperly encourage or induce a patient’s request to block information.” Fearing being found in violation of the information blocking provisions, providers may feel that they are unable to guide patients navigating the release of their EHI in the multiuser or proxy access setting. ONC should provide more detailed guidance on their website and targeted outreach to providers and their specialty organizations that care for adolescents and other individuals affected by the Cures Act, and researchers should carefully monitor charting habits in these multiuser or proxy access situations.

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The Effect of Electronic Health Record Burden on Pediatricians' Work–Life Balance and Career Satisfaction

Cited by 29 publications

References 33 publications

25 × 5 Symposium to Reduce Documentation Burden: Report-out and Call for Action

25 × 5 Symposium to Reduce Documentation Burden: Report-out and Call for Action

Facilitating Health Information Exchange to Improve Health Outcomes for School-Aged Children: School Nurse Electronic Health Record Access

The 21st Century Cures Act and Multiuser Electronic Health Record Access: Potential Pitfalls of Information Release

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