Reducing the Clinician Burden: Shaping Health IT as an Asset
Andrew Gettinger and Teresa Zayas Cabán, PhD | March 4, 2021
Health IT has helped drive progress in health care over the last decade, but it has also introduced a variety of different challenges, many reported by the clinical community. As we explored in our latest article published in the Journal of the American Medical Informatics Association, ONC and other federal partners have taken and continue to take steps to reduce clinician burden when using health IT.
As adoption of health IT has increased, we have seen firsthand how usability issues associated with the underlying software, implementation choices made by practices and institutions, and lack of effective training can diminish the desired impact of health IT use. Well-meaning initiatives promoting field-defined, actionable data have led to “check the box” workflows and subsequent loss of the patient’s narrative.
Rectifying these issues requires coordinated attention to improved design of health IT systems, better system configuration decisions, and effective end-user training during implementation. These actions can help health IT to function as an asset instead of an obstacle, and positively impact usability, safety, clinician satisfaction with health IT, and care.
Reducing Clinician Burden
In 2016, Congress enacted the 21st Century Cures Act (Cures Act), which included requirements for the executive branch to examine and address clinician burden related to the use of electronic health records (EHRs). As a result, ONC engaged with the Centers for Medicare & Medicaid Services (CMS) and other federal partners to understand and document clinician burden challenges.
Based on these efforts, ONC released the Strategy on Reducing Regulatory and Administrative Burden Relating to the Use of Health IT and EHRs. This report identifies four major areas of concern:
- Documentation requirements for billing;
- Quality reporting requirements;
- Conflicting federal and state regulations; and
- Issues related to health IT, including usability.
We found several key usability issues with current health IT system design and implementation including ineffective cognitive support for users, issues with interface design and integrating health IT into physical environments, limitations of current functionality such as order entry, and how configuration and implementation decisions could impact usability and use. In the report, we outline four areas that need to be addressed to improve the usability of health IT:
- Better alignment of EHRs with clinical workflow, including improved decision making and documentation tools;
- Optimized user interface design to improve efficiency, experience, and end-user satisfaction;
- Harmonized clinical content to reduce burden; and
- Promotion of implementation decisions for clinician efficiency, satisfaction, and lower burden.
Where We Go From Here
To keep advancing health IT, all of us across the health care system need to continue emphasizing user-centered design and human factors and ergonomics. As ONC and CMS’ recent rules are implemented, health IT developers should be designing systems with clinical, cognitive, and workflow needs in mind. Institutions should be making configuration decisions based on frontline clinical users’ needs identified using established human factors and ergonomics methods.
In the coming years, ONC will continue to collaborate with our colleagues in the public and private sectors to address previously identified usability challenges. We will also continue to work with CMS and other federal partners to look for ways to reduce health IT-related documentation requirements that add to clinician burden.
To learn more about the steps ONC has taken and continues to take to reduce the clinician burden, please refer to our latest Journal of the American Medical Informatics Association article, HITECH to 21st Century Cures: Clinician Burden and Evolving Health IT Policy.