Defining Documentation Burden (DocBurden) and Excessive DocBurden for All Health Professionals: A Scoping Review

Deborah R. Levy; Jennifer B. Withall; Rebecca G. Mishuris; Victoria Tiase; Courtney Diamond; Brian Douthit; Monika Grabowska; Rachel Y. Lee; Amanda J. Moy; Patricia Sengstack; Julia Adler-Milstein; Don Eugene Detmer; Kevin B. Johnson; James J. Cimino; Sarah Corley; Judy Murphy; S. Trent Rosenbloom; Kenrick Cato; Sarah C. Rossetti

doi:10.1055/a-2385-1654

Applied Clinical Informatics, Inhaltsverzeichnis

CC BY-NC-ND 4.0 · Appl Clin Inform 2024; 15(05): 898-913
DOI: 10.1055/a-2385-1654

Review Article

Defining Documentation Burden (DocBurden) and Excessive DocBurden for All Health Professionals: A Scoping Review

Deborah R. Levy^*

¹Department of Veterans Affairs, Pain Research Informatics Multimorbidities and Education Center, VA-CT, West Haven, Connecticut, United States

²Department of Biomedical Informatics and Data Science, Yale University School of Medicine, New Haven, Connecticut, United States

,

Jennifer B. Withall^*

³Department of Biomedical Informatics, Columbia University, New York, New York, United States

,

Rebecca G. Mishuris

⁴Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States

,

Victoria Tiase

⁵Department of Biomedical Informatics, University of Utah School of Medicine, Salt Lake City, Utah, United States

,

Courtney Diamond

³Department of Biomedical Informatics, Columbia University, New York, New York, United States

,

Brian Douthit

⁶Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States

⁷Department of Veterans Affairs, Tennessee Valley Health System, Nashville, Tennessee, United States

,

Monika Grabowska

⁶Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States

,

Rachel Y. Lee

³Department of Biomedical Informatics, Columbia University, New York, New York, United States

,

Amanda J. Moy

³Department of Biomedical Informatics, Columbia University, New York, New York, United States

,

Patricia Sengstack

⁶Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States

⁸Vanderbilt University Medical Center, School of Nursing, Nashville, Tennessee, United States

,

Julia Adler-Milstein

⁹Division of Clinical Informatics and Digital Transformation, Department of Medicine, University of California, San Francisco, San Francisco, California, United States

,

Don Eugene Detmer

¹⁰Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, United States

,

Kevin B. Johnson

¹¹Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine; University of Pennsylvania, United States

¹²Applied Informatics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, United States

,

James J. Cimino

¹³Department of Biomedical Informatics and Data Science, University of Alabama at Birmingham, Birmingham, Alabama, United States

,

Sarah Corley

¹⁴MITRE Corporation, Center for Government Effectiveness and Modernization, McLean, Virginia, United States

,

Judy Murphy

¹⁵Indepdendent, Minneapolis, Minnesota, United States

,

S. Trent Rosenbloom

⁶Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States

,

Kenrick Cato

¹⁶Children's Hospital of Philadelphia and University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States

,

Sarah C. Rossetti

³Department of Biomedical Informatics, Columbia University, New York, New York, United States

¹⁷Columbia University School of Nursing, New York, New York, United States

› Institutsangaben

Abstract

Objectives Efforts to reduce documentation burden (DocBurden) for all health professionals (HP) are aligned with national initiatives to improve clinician wellness and patient safety. Yet DocBurden has not been precisely defined, limiting national conversations and rigorous, reproducible, and meaningful measures. Increasing attention to DocBurden motivated this work to establish a standard definition of DocBurden, with the emergence of excessive DocBurden as a term.

Methods We conducted a scoping review of DocBurden definitions and descriptions, searching six databases for scholarly, peer-reviewed, and gray literature sources, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extensions for Scoping Review guidance. For the concept clarification phase of work, we used the American Nursing Informatics Association's Six Domains of Burden Framework.

Results A total of 153 articles were included based on a priori criteria. Most articles described a focus on DocBurden, but only 18% (n = 28) provided a definition. We define excessive DocBurden as the stress and unnecessarily heavy work an HP or health care team experiences when usability of documentation systems and documentation activities (i.e., generation, review, analysis, and synthesis of patient data) are not aligned in support of care delivery. A negative connotation was attached to burden without a neutral state in included sources, which does not align with dictionary definitions of burden.

Conclusion Existing literature does not distinguish between a baseline or required task load to conduct patient care resulting from usability issues (DocBurden), and the unnecessarily heavy tasks and requirements that contribute to excessive DocBurden. Our definition of excessive DocBurden explicitly acknowledges this distinction, to support development of meaningful measures for understanding and intervening on excessive DocBurden locally, nationally, and internationally.

Keywords

electronic health records and systems - documentation burden - excessive documentation burden - clinician documentation - burden - usability - informatics - health informatics - health care

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Referenzen

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