New Publication Defines Documentation Burden and Introduces the Concept of Excessive Documentation Burden in Health Care

Washington DC – A new scoping review titled "Defining Documentation Burden (DocBurden) and Excess DocBurden for All Health Professionals" was published in the journal Applied Clinical Informatics. This comprehensive review, authored by AMIA 25x5 Task Force members Deborah Levy, MD, MPH, MS, Jennifer Withall, PhD, and colleagues, marks a significant advancement in healthcare research by clarifying and standardizing the concept of documentation burden across health professions. 

Documentation burden, long recognized as a source of stress and inefficiency for health professionals, has lacked a precise, universally accepted definition—until now. The definition and description of DocBurden and excessive DocBurden have tangible real-world impacts and clinical implications. A clear standardized definition is crucial for aligning efforts aimed at reducing both DocBurden and excessive DocBurden, as well as tracking progress towards this goal. This scoping review introduces an inclusive, interprofessional standardized definition of DocBurden, providing a foundation for future research, initiatives, and policies. Additionally, it enhances clarity on the evolving discourse surrounding excessive DocBurden within the U.S. healthcare system. 

Key findings: 

• The authors extracted 153 sources to evaluate existing definitions (n=28) and descriptions (n=125) of documentation burden in health care. 
• A standardized definition of "documentation burden" (DocBurden) was developed to bring clarity to the term and guide future efforts aimed at burden reduction. 
• The study introduced a new, emergent term—"excessive DocBurden"—defined as the unnecessary and stressful overload experienced when documentation systems are not adequately aligned with the needs of care delivery. 
• The research identified opportunities to mitigate both DocBurden and excessive DocBurden, with implications for improving clinician well-being and patient safety. 
• Future work can now focus on the rigorous measurement of both DocBurden and excessive DocBurden, paving the way for national and international interventions. 

The objective of the study was to align efforts to reduce DocBurden, such as the AMIA 25x5 Task Force Initiative and the National Burden Reduction Collaborative, with other national initiatives targeting clinician wellness and patient safety by providing a necessary standardized definition of documentation burden for health professionals. To achieve this, the authors conducted a scoping review of the literature, employing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extensions for Scoping Review (PRISMA-ScR) guidance to ensure a thorough and systematic approach. 

Using the American Nursing Informatics Association (ANIA)’s 6-Domains of Burden Framework to refine and group concepts, the team reviewed 153 scholarly and gray literature sources. While 82% of the sources described aspects of documentation burden, only 18% provided an explicit definition, highlighting a crucial gap in the literature. By addressing this gap, the authors were able to develop a much-needed standardized definition of both DocBurden and excessive DocBurden. 

Sarah Rossetti, RN, PhD, FACMI, FAMIA, FAAN, FIAHSI, Chair of the AMIA 25x5 Task Force, underscored the importance of a standardized definition: "The initial review identified more than 940 citations. While there is an abundance of peer-reviewed and gray literature, not all stakeholders talk consistently about documentation burden. It’s hard to move the needle and impactfully reduce documentation burden when all stakeholders are not universally approaching the problem. The goal of the 25x5 Task Force from the beginning was to facilitate a standard definition for more effective conversation around mitigating and reducing documentation burden." 

The AMIA 25x5 Task Force, charged with reducing excessive documentation burden to 25 percent of the current state, continues to develop the science around documentation burden. In addition to standardizing the necessary definitions, the task force utilizes data collected through the TrendBurden: Pulse Survey on Excessive Documentation Burden for Health Professionals© to measure and trend perceived documentation burden among all health professionals documenting patient care in the EHR. The TrendBurden open dataset is available for academic and clinical research. 

Additionally, Christoph Lehmann, MD, FAAP, FACMI, FIAHSI, ACI Editor-in-Chief emphasized the importance of this work. “We founded Applied Clinical Informatics, an endorsed journal of AMIA, on the premise that with important advances made through Electronic Health Records, we needed a home for the critical evaluation of Health Information Technology as well as a platform for sharing problems and their potential solutions. Here at Applied Clinical Informatics, we are thrilled AMIA and its members are continuing to leverage our journal to make Health Information Technology (HIT) better for providers and patients by exploring undesired HIT effects such as Documentation Burden and providing answers to these challenges.” 

The findings of this review have important implications for the healthcare industry. The definition of excessive DocBurden allows for the creation of more accurate and actionable measures, which can be used to better understand and address the issue on a global scale. Additionally, the study underscores the need for healthcare systems to improve the usability of documentation systems to reduce unnecessary stress and inefficiencies that detract from care delivery. 

This work opens the door for meaningful national conversations, providing a foundation for future efforts to measure, mitigate, and ultimately reduce the excessive burdens associated with documentation. By doing so, it contributes to improving health professionals' work environments and promoting better patient outcomes. 

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AMIA, the leading professional association for informatics professionals, is the center of action for 5,500 informatics professionals from more than 65 countries. As the voice of the nation’s top biomedical and health informatics professionals, AMIA and its members play a leading role in assessing the effect of health innovations on health policy and advancing the field of informatics. AMIA actively supports five domains in informatics: translational bioinformatics, clinical research informatics, clinical informatics, consumer health informatics, and public health informatics.