Washington, D.C. — Leaders from professional informatic societies, standards organizations, and federal health agencies gathered during the American Medical Informatics Association (AMIA) 2024 Annual Symposium, November 9-13, 2024, in San Francisco. The third annual National Burden Reduction Collaborative (NBRC) meeting, sponsored this year by Nabla, placed a central focus on measuring documentation burden. Additional underlying topics across the discussion included patient-centered strategies to alleviate burden and the critical role of artificial intelligence (AI) in reducing documentation and administrative burden.
Thought leaders examined the emerging science of burden measurement. Excessive documentation burden or ExcessDoc Burden—defined as the stress and undue workload placed on health professionals when documentation systems and activities do not effectively support patient care delivery—remains widespread in healthcare. Reliable, generalizable, and scalable measures are necessary to benchmark and monitor documentation burden, ensuring targeted efforts to reduce it. AMIA 25x5 Task Force Chair Sarah Rossetti, RN, PhD, FACMI, FAMIA, outlined potential measures to identify, classify, and address ExcessDoc Burden, emphasizing a point aligned with conclusions from the Agency for Health Care Research and Quality (AHRQ) Technical Brief that documentation that does not serve patient needs should be eliminated and AI-driven solutions are needed to manage secondary tasks like billing and administration. "To truly support healthcare professionals, we must take immediate steps using data driven science to identify for elimination non-essential manual data capture and documentation tasks by health professionals and leverage AI for secondary needs. This two-step approach ensures that documentation is patient-centered and reduces unnecessary workload on health care professionals” said Dr. Rossetti.
The meeting agenda included updates from the newly restructured Office of the Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP) and the Centers for Medicare & Medicaid Services, Office of Burden Reduction and Health Informatics (CMS/OBRHI). The ASTP provided updates on recent federal advancements in health technology policy, including the Health IT Interoperability 2 (HTI-2) initiative, which is designed to streamline information-sharing across systems. This initiative, along with the Optimizing Care Delivery Framework for care delivery being developed by the CMS/OBRHI, is expected to play a transformative role in reshaping healthcare delivery to be more efficient and less burdensome.
Participating organizations shared organizational initiatives and priorities aimed at alleviating the daily demands placed on healthcare providers and patients. Participants explored the potential for AI to address the demands of documentation and in-basket management, two of the most significant contributors to clinician fatigue. Connor Bice, Senior Director of Insights at KLAS, presented their extensive research on the positive impact of training and support on burden reduction. Their data is based on surveys from hundreds of thousands of clinicians using EHRs through the KLAS Arch Collaborative. Howard Landa, MD, Chairperson of AMDIS and Chief Medical Informatics Officer of Adventist Health, discussed the burden associated with the use of EHR in-baskets. Emerging AI is showing some mitigation of burden in this area, but patient expectation and consumerism in healthcare is pushing in the other direction. Dr. Landa suggested that evaluating and morphing current care paradigms to better match the way patients want to receive care with how clinicians prefer to deliver it will be of paramount importance. Technology needs to improve to support these evolving care models as well as empowering patients to manage their care more effectively in alignment with their healthcare professionals.
An important agenda item addressed the role of patients as partners in burden reduction. Participants engaged in discussion to address the essential role of patients as partners in burden reduction, reflecting on progress across our nation in fulfilling the provisions of the 21st Century Cures Act. Gaps still exist in enabling patients to securely access their electronic health information, without special effort, through smartphone applications of their choice through standardized APIs, and request a restriction on the use or disclosure of their health information. “Advances in burden reduction must include patients, ensuring they are active participants in their own care journey. Through technology and policy reform, we can create a healthcare ecosystem that respects the time and well-being of both patients and providers” remarked Susan Hull, co-chair, The Alliance for Nursing Informatics.
The NBRC, directed by The American Medical Informatics Association (AMIA), Association of Medical Directors of Information Systems (AMDIS), and Alliance for Nursing Informatics (ANI), convenes leaders in healthcare informatics, professional societies, standards organizations, and federal health agencies, to share organizational priorities and align efforts aimed at addressing documentation burden and clinician burnout in healthcare. NBRC meetings serve as platforms for sharing research, knowledge, and best practices, fostering continuous improvement and innovation in healthcare documentation.
Participants in the collaborative include:
- Agency for Healthcare Research and Quality (AHRQ)
- Alliance for Nursing Informatics (ANI)*
- American College of Medical Informatics (ACMI)
- American Medical Association (AMA)
- American Medical Informatics Association (AMIA)*
- American Organization for Nursing Leadership (AONL)
- Assistant Secretary for Technology Policy (ASTP)
- Association of Medical Directors of Information Systems (AMDIS)*
- Center for Medicare & Medicaid OBRHI (CMS/OBRHI)
- Electronic Health Records Association (EHRA)
- Healthcare Information and Management Systems Society (HIMSS)
- HL7 International/ HL7 DaVinci Project
- National Committee for Quality Assurance (NCQA)
- Office of the Surgeon General (OSG)
- The Joint Commission/National Quality Forum (TJC/NQF)
*Pacesetter and Convener