Flipping the Script: Leveraging EHR Data to Inform Clinical Burden Reduction Approaches

Chelsea Richwine | February 6, 2023

In 2020, the U.S. Department of Health and Human Services (HHS) released a strategy to reduce regulatory and administrative burden relating to the use of health IT, including electronic health record (EHR) systems. Key burden reduction goals addressed in the report include reducing the amount of time and effort required to record information in EHRs to meet regulatory requirements and improving the usability of EHRs.

Transitioning the strategy into actionable steps requires continuous monitoring of the burdens associated with EHR use and identification of specific methods that can optimize EHR use and reduce burden associated with use.

Increased Value in Quantifying Documentation Time

One such method includes using audit log data to assess EHR burden. Audit logs and other sources of data from EHRs can track the time clinicians spend documenting and carrying out certain tasks (e.g., note-taking, chart review, messaging). Audit logs are a uniquely rich data source that can be efficiently leveraged to measure EHR burden on a national scale. EHRs certified by ONC must be capable of generating audit log data based on a set of specific events, which makes it possible to create comprehensive reports of clinicians’ EHR use and increases the utility of data for additional purposes.

These data and associated measures can inform opportunities to improve clinical workflows, monitor performance and efficiency, and reduce documentation burden. As a part of HHS’ broader efforts to monitor and assess burden, a recent ONC study published in the special health IT issue of the American Journal of Managed Care examined trends in hospitals’ access and use of data from EHR developers that quantify the amount of time clinicians spend documenting clinical care in EHRs between 2017 and 2021.

In 2021, more than two-thirds of hospitals had access to measures from their EHR developer that quantified the amount of time clinicians spent documenting in the EHR. Over time, a higher proportion of hospitals with access to these measures used them for more purposes, suggesting their increased value.

While our findings indicate increased access and use of these data in inpatient settings, progress was slower among lower-resourced hospitals and those with smaller, non-market leading EHR developers. Encouragingly, the share of hospitals with smaller, non-market leading developers who provided the ability to track EHR use time increased over the 5-year period examined in this study. However, gaps remain between hospitals using smaller vs. market leading developers.

Making these data more accessible could significantly improve hospital organizations’ and physician practices’ ability to monitor the amount of time their clinicians spend in the EHR. Moreover, improving data accessibility and aiding interpretation via tools and dashboards can increase the utility of these data by making them more actionable for organizational decision-makers. This has important implications for the ability of organizations to reduce burden, improve job satisfaction for clinicians, and mitigate burnout and staff turnover – issues that have been exacerbated by the pandemic.