The burden of clinical documentation on professionals, such as work done in the EHR, has had a proven negative impact on health care. This burden leads to a variety of negative outcomes including clinician burnout and decreased job satisfaction, increased medical errors and hospital-acquired conditions.
In December 2021, AMIA assumed leadership responsibility for the 25x5 initiative to address this nation-wide problem by leveraging the collective expertise of key stakeholders in health care, industry, and policy to prioritize and implement the Calls to Action and Recommendations established by the 25x5 Symposium.
Calls to Action
Chaired by Sarah Rossetti, RN, PhD, FACMI, FAMIA AMIA, the 25x5 Task Force and 25x5 student subcommittee held a kickoff meeting on April 14, 2022. The task force membership is structured around three workstreams:
- Providers/Health Systems
- Health IT vendors
Task Force Mission
Reduce documentation burden for U.S. Clinicians to 25% of current state in the next five years1 and optimize electronic health record (EHR) and related vendor solutions by prioritizing and implementing the 25x5 Symposium Calls to Action/Recommendations2 through partnerships and advocacy with health systems, professional societies, and public/private sector organizations in order to spread these solutions across the U.S. health system.
To accomplish the mission, each workstream has developed short-term work plans with goals and milestones that are achievable this year and are currently developing robust longer-term workplans for action within five years.
Short-term Work Plan
Providers/Health Systems Workstream
The Providers/Health Systems workstream is creating a toolkit to guide organizations through the process of reducing documentation burden. The toolkit is intended to provide resources related to governance of EHR optimization, implementation of solutions to reduce burden, and approaches to measure burden reduction.
The Provider/Health System workstream is also working toward the creation of a national learning collaborative to bring providers and health systems together to identify and share effective interventions and establish a mechanism to pilot and measure success of new interventions.
Health IT Vendors Workstream
The Health IT Vendors workstream is partnering with vendors to educate current EHR users about existing functionality, tools and services that can streamline data entry and reduce the length of documentation making it easier for clinicians to identify important information within the record. EHR and non-EHR IT vendors are being asked to aggregate and synthesize training materials that show how to avoid over documentation and more efficiently document only what is necessary. Vendors are identifying existing clients in ambulatory setting willing to participate in the intervention.
The Health IT Vendors workstream is also building a five-year roadmap of HIT initiatives to reduce documentation burden. While there are a wealth of ideas and efforts within the HIT community to reduce documentation burden, many of these do not achieve their full potential due to challenges in changing dominant documentation practices in place today and structural barriers, such as interoperability. The workstream is seeking concrete ideas from the broader health care community that are aligned to the 25x5 priorities for inclusion on the roadmap.
The Policy/Advocacy workstream is conducting an environmental scan of existing efforts to reduce documentation burden and meeting with regulatory and accreditation groups to identify areas to support or expand upon, avoid duplicative efforts, and identify any current gaps. A policy brief is anticipated in early 2023. Additionally, the workstream will support the initiatives of the other two workstreams through policy and advocacy efforts.
Adoption of 25x5 is the culmination of a series of thought-leadership activities driven by AMIA members to acknowledge and respond to the emergent crisis. Columbia University, Vanderbilt University, and the American Medical Informatics Association (AMIA), through support from the National Library of Medicine (NLM), convened the 25x5 Symposium of decision-makers and influencers representing clinical settings, academia, industry, government, payers, professional organizations, and patients to establish strategies and approaches to reduce documentation burden on U.S. clinicians by 75%.
The symposium series included more than 30 presentations from stakeholders across healthcare ecosystem. The Final Summary Report and Executive Summary describing this work includes current challenges, exemplars, and 82 specific calls to action describe in detail.
The 82 action items were then further synthesized and prioritized into Calls to Action for three stakeholder groups: Providers and Health Systems, Vendors, and Policy and Advocacy.
1 5-year period of 1/1/2022-12/31/2026